Why do babies cry?  That’s not an easy question.  Crying can lead to a desired result, like having your needs met.  Or it can lead to a truly undesired result, like abuse.

 

Human infants are the only infants in which crying can persist once the cause of the crying is fixed.  For example, only human infants will cry while in the arms of a caregiver.  And then that crying can continue independently of the original cause.  It’s this crying that gets us worried: no matter what we do it doesn’t seem to stop.

 

Some have theorized that crying is a way to relieve tension and excess energy.  I remember hearing that somewhere in my education:  “let them cry, it’s good for their lungs…sometimes they need to blow off steam.” You could see how it may be linked to how we feel as adults when we cry.  But studies have been done to look at newborns raised in non-Western cultures, and those newborns are healthy and psychologically sound without crying, suggesting that babies don’t need to cry to relieve tension.

 

Research (and practical experience) suggests that crying happens because of pain, hunger, and a need for attention.  Crying and infant well-being are very much linked.

 

But the most important cause of crying in an otherwise healthy newborn appears to be being alone. Crying is a survival tactic when our kids are alone, yet we are encouraged as part of our culture to ignore it.  When we ignore it, that crying can escalate and gets very hard to stop.  Therefore, our parenting culture is an important contributor to crying in our infants.  We carry our babies much less than our non-Western counterparts.  In fact, in randomized controlled trials, even a little bit of extra holding has shown a huge difference in the amount of crying a new born will do.  We also know from research, that crying is likely lessened because the physiologic state that goes with by being held increases opioid release and increases serotonin.

 

Crying is means of communication from the newborn that says “I need something.” However, crying likely developed as a means of occasional communication.  Vocalizing displeasure and need may get mom’s attention but it’s also a good way to get the attention of predators. Using it as a consistent means of communication wouldn’t make a lot of sense.  Probably, smell and vision were meant to be the main ways of communication, with vocalizations being last resort.  In our culture, instead of addressing crying early to prevent the newborn from being attacked by predators, we may actually just ignore it, or worse, go to extreme ways of getting it to stop. Ignoring crying, unless you just need to walk away, is not going to make anything better.  In non-Western cultures, the response to crying is immediate and rates of infant crying are much lower.

 

So, my approach to a crying breastfed baby. 

I used to work in an ICU, so my first approach, even after all these years as a generalist, I still go to “Is the baby sick or not sick?”   Then we look for indicators of infant well-being: is the baby gaining weight, maintaining a normal temperature, respiratory and heart rate.  Is the child eating normally?  Showing signs if illness, like lethargy?  Does the crying have a pattern (as it would with colic) or is it consistent (which could mean pathology). Is the baby consolable?  Inconsolable babies should be evaluated. So should one who isn’t gaining weight, is demonstrating signs of illness, isn’t eating well…you get the point.  Call your provider.

 

Things to think about if we’re in the “not sick” category:

 

The child is hungry:  We have some need to schedule feedings in our culture, but we have the ready-made answer right at our breasts.  If the baby is crying and the breast soothes that crying, well then, breastfeed!  Schedules. Yuck.

 

The baby loves you:  You are not a failure because your child doesn’t want to be separated from you.  You are a rock star.  Just because our culture says they should be able to be away from us doesn’t make it true.

 

Taste is developed long before delivery and breastmilk provides an array of flavors:  Keep that in mind before we blame what you are eating.  I’m not saying what you are eating isn’t the cause, but it’s not as likely as we seem to make it.  What do you think mothers in Mexico, Greece, Thailand or Italy eat while nursing?  They certainly aren’t staying away from spices, or garlic.  We think what you eat during lactation helps babies adapt to their native cuisine.  There are people who know their children have a specific sensitivity to something- I'm not saying this can't be true.  But it's over-blamed.

 

True gastroesophageal reflux disease is rare: Reflux is not a common cause of unexplained crying or distressed behavior in otherwise healthy infants. Reflux is a normal physiological process occurring several times per day in healthy infants, children, and adults.  It’s diagnosed a lot, but the research does not support it as a cause of crying.

 

What else it may be:

 

• Oversupply or the coughing, choking, unhappy, breastfed child:  http://www.drjen4kids.com/breastfeeding/oversupply.htm 

• Nicotine: In several studies the prevalence of unexplained crying was higher among infants of smoking mothers, but less among breastfed infants. 

• Withdrawal:  Remember the part about opioid and serotonin involvement in calming crying?  Well, the opposite can be true.  Babies withdrawing from opioid are cranky. And there are reports of “colic” symptoms in children of mothers who were on the drug class of SSRIs (Prozac, Zoloft, Paxil) during pregnancy. 

• Cow’s milk protein in the diet.  That’s a rare thing with studies showing that about 4% of children actual have a cow’s milk protein allergy.  But it is a recognized cause of crying. 

• Colic: An infant “who, otherwise healthy and well-fed, has paroxysms  of irritability, fussing or crying lasting for a total of three hours  a day and occurring on more than three days in any one week for a period of three weeks.” (Wessel et al. Pediatrics, 1954)  This is what we call a “diagnosis of exclusion”, meaning we’ve looked at everything else and can’t find an answer.    Crying for no good reason.  I don’t like this diagnosis.  Dr. Karp, of “Happiest Baby on the Block” Fame, explains it well.  http://www.defranca.com/PDFs/Colic%20and%20%204th%20trimester.pdf 

 

What we do to fix it?

 

Well, all answers point to holding the baby, and being responsive to crying.

Some great resources for baby-wearing can be found here:

http://www.milkface.com/images/carriers.pdf

http://www.thebabywearer.com/

And if you don’t want to baby wear, just holding them more helps tremendously.

 

But if the crying is too much, please walk away and find someone to care for the baby until you are better.  If you don’t get better, please find help.

http://www.postpartum.net/

 

Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM

www.drjen4kids.com