Crying in children
All infants and young children cry as a form of
communication. It is the only way they have to express a need. Thus, most
crying is in response to hunger, discomfort (such as that due to a wet diaper),
fear, or separation from parents. Such crying is normal and typically stops
when the needs are met—for example, when infants are fed, burped, changed, or
cuddled. This crying tends to occur less often and for shorter times after
children are 3 months old.
Excessive crying refers to crying that continues after
caregivers have attempted to meet routine needs or crying that continues for
longer than usual for a given child.
Causes of Crying
More than 95% of the time, there is no specific medical
disorder responsible for excessive crying. Although such crying is stressful
for parents, children eventually settle down and stop crying on their own.
Fatigue is a common cause of crying in infants. Between 6 months and 3 years of
age, crying at night is often due to difficulty falling back to sleep after
normal night awakenings. Falling back to sleep on their own is especially
difficult for children who are used to falling asleep under certain conditions
such as while being rocked or with a pacifier. Nighttime fears are common after
age 3 years. The particular fears usually depend on the child's age and stage
of emotional and physical development. Sometimes children aged 3 to 8 years cry
fearfully in the middle of the night and do not seem to be awake or able to be
comforted. They also have no memory of a dream or of the crying when they wake
in the morning. These episodes of crying are called night terrors.
Did You Know...
More than 95% of the time, there is no specific medical
disorder responsible for excessive crying.
Medical disorders
Less than 5% of the time, excessive crying is caused by a
medical disorder. Some disorders are uncomfortable but not immediately
dangerous. Such less serious causes of crying include gastroesophageal reflux,
hair wrapped around a finger, toe, or penis (hair tourniquet), a scratch on the
surface of the eye (corneal abrasion), an anal fissure, and a middle ear
infection.
Less commonly, a serious disorder is the cause. Such
disorders include a blocked intestine caused by intussusception (sliding of one
segment of intestine into another) and volvulus (twisting of the intestine), as
well as heart failure, meningitis, and head injuries that cause bleeding within
the skull. Infants with such severe disorders often have other symptoms (such as
vomiting or fever), which alert parents to the presence of a more serious
problem. However, sometimes excessive crying is the first sign.
Colic refers to excessive crying that has no identifiable
cause and that occurs at least 3 hours a day for more than 3 days a week for
more than 3 weeks. Colic typically occurs in infants about 6 weeks to 3 or 4
months old.
Evaluation of Crying
Doctors try to identify any medical disorder that may be
causing an infant’s persistent crying.
Warning signs
Certain symptoms are cause for concern and suggest that a
medical disorder is causing the crying:
Difficulty breathing
Bruises or swelling over the head or other parts of the body
Abnormal movements or twitching of any body part
Extreme irritability (normal handling or movement causes
crying or distress)
Continuous crying, especially if it is accompanied by a
fever
Fever in an infant under 8 weeks old
When to see a doctor
Children should be evaluated by a doctor right away if they
have any warning signs, if they are vomiting, if they have stopped eating, or
if parents notice swelling of the abdomen, a red and/or swollen scrotum, or any
unusual behavior (in addition to the crying).
If children without such signs appear well otherwise,
parents can try typical measures such as feeding, burping, changing, and
cuddling. If crying continues after such measures, parents should call the
doctor. The doctor can help parents determine how quickly the child needs to be
evaluated.
What the doctor does
Doctors first ask questions about the child's symptoms and
medical history. Doctors then do a physical examination. What they find during
the history and physical examination often suggests a cause of the crying and
the tests that may need to be done ( see Table: Some Medical Disorders That
Cause Excessive Crying in Infants and Young Children). Infants with fever often
have an infection, those with difficulty breathing may have a heart or lung disorder,
and those with vomiting, diarrhea, or constipation may have a digestive
disorder.
Doctors ask about the crying:
When it started
How long it lasts
How often it happens
Whether it is related to feeding or bowel movements
How infants respond to efforts to soothe them
Parents are asked about recent events that may explain the
crying (such as recent immunizations, injuries, and illnesses), and about drugs
given to the infant. Doctors also ask questions to learn how well the parents
are bonding with the infant and managing the infant’s needs.
A physical examination is done to check for symptoms of
disorders that can cause discomfort or pain. Doctors look particularly at the
child's eyes for a corneal abrasion and at fingers, toes, and the penis for a
hair tourniquet.
Testing
Tests may or may not be needed depending on the infant's
symptoms and the causes that doctors suspect. If the doctor's examination does
not suggest a serious disorder, tests are not usually done, but doctors may
schedule a follow-up visit to reevaluate the infant.
Treatment of Crying
Any specific disorder is treated. For example, a hair
tourniquet is removed, or a corneal abrasion may be treated with antibiotic
ointment.
For infants who have no specific disorder, parents or
caregivers should continue to look for obvious causes of crying, such as a wet
diaper or clothing that is too hot, and meet those needs. They can try various
other strategies. For example, an infant may be soothed by
Being held, gently rocked, or patted
Listening to white noise, such as the sound of rain or the
electronically produced sounds made by a fan, washing machine, vacuum, or hair
dryer
Riding in a car
Sucking on a pacifier
Using nipples with a smaller hole if infants are feeding too
quickly
Being snugly wrapped (swaddled)
Being burped
Being fed (but parents should avoid overfeeding in an
attempt to stop the crying)
When the cause of the crying is fatigue, many of the above
interventions only briefly console infants and the crying returns as soon as
the stimulation or activity stops, leaving infants even more fatigued.
Sometimes it is more effective to encourage self-soothing and sleep by
routinely laying infants in their crib awake so they do not depend on their
parents or certain motions, objects, or sounds to fall asleep.
Mothers who are breastfeeding may notice that after they eat
certain foods, their infant cries after nursing. They should then avoid eating
those foods.
Teething eventually passes, and the crying it causes usually
lessens with time. Mild pain relievers, such as acetaminophen or ibuprofen, and
teething rings can help in the meantime. Teething products containing the pain
reliever benzocaine should not be used because of the risk of a serious side
effect called methemoglobinemia. The Food and Drug Administration (FDA) has
asked companies to stop selling these products for teething.
Support for parents
When an infant cries excessively for no apparent reason,
parents may feel exhausted and stressed. Sometimes they become so frustrated
that child abuse occurs. Emotional support from friends, family members,
neighbors, and doctors can help parents cope. Parents should ask for whatever
help they need (with siblings, errands, or child care) and share their feelings
and fears with each other and with other support people. If parents are feeling
frustrated, they should take a break from the crying infant or child and put
the infant or child in a safe environment for a few minutes. Such a strategy
can help parents cope and help prevent abuse.
Doctors can provide information about support services to
parents who feel overwhelmed.
Key Points about Crying
Crying is a way to communicate and is part of normal
development.
Often, identifying and meeting the infant’s need stops the
crying.
Crying typically decreases after infants are 3 months old.
Less than 5% of crying is caused by a medical disorder.
If parents are concerned about an infant’s crying, they can
call a doctor, who can advise them about bringing the infant in for evaluation.
Parents may need support when infants cry excessively for no
apparent reason and cannot by soothed.
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