Help! My Baby Won’t Stop Crying
Dr Ray Power BSc (Clin), MHSc (Osteo)
Crying is a typical and expected physiological behaviour in young infants.
Professor Samuel Menahem, Monash University, reported in 2020 that the incidence of unsettled babies was about 20% of all babies. Colic is an outdated term that was previously used to describe excessive crying in babies.
Traditionally they were managed with sedative and anticholinergic medication, however this has not been supported with empirical evidence and is no longer recommended. Parents are often distressed, exhausted, and confused when their baby is unsettled for prolonged periods. They may have received conflicting advice from friends and health professionals.
So, What is Normal?
All babies cry and typically vary in their distress, with some babies crying for up to 5 to 6 hours per day and intensity increasing at around 6 to 8 weeks of age. Most babies tend to reduce crying intensity by 4 months of age but a smaller number may take 12 months. Babies tend to be more unsettled in the evenings. Crying may be related, amongst other factors, to temperament or neuroadaptive maturity.
How Much Sleep?
Average daily sleep requirements reduce as the baby matures.
At birth the baby generally requires about 16 hours of sleep per day. By 2 to 3 months, it reduces to 15 hours. A 6-week-old baby is usually tired and requiring sleep after a wake period of 1.5 hours. At 3 months of age, this extends to 2 hours. The understanding of tired signs and the importance of having parental expectations in synchrony with neurodevelopmental expectations for age is important for parents to understand.
What Can I Do?
Unexpected crying can come and go and not be attributed to any aetiology. Crying can resist soothing and the infant may look as though they are in pain. It is helpful for parents to have a good understanding of the incidence and transient nature of this crying period.
General care giving measures by parents to help their baby deal with discomfort and distress may be enabled with the following settling techniques/ routines.
- Establish pattern to feeding/settling/sleep. Understanding early and late tired signs.
- Aim to settle the baby for daytime naps and night-time sleep in a predictable way (e.g., quiet play, move to the bedroom, wrap the baby, give the baby a brief cuddle, then settle in the cot while still awake)
- Avoid excessive stimulation – noise, light, handling. Excessive quiet should also be avoided. Most babies find a low level of background noise soothing.
- Avoid excessive change of settling strategies – e.g., parents swapping from rocking to jiggling to patting rapidly. Attempt to stay with one technique for about 5 minutes before changing if not effective. At all times parents are encouraged to settle their baby in their arms if their infant is becoming increasingly distressed.
- Darken the bedroom for daytime sleeps.
- Carry baby in a papoose in front of the chest
- Baby massage.
- Gentle music.
- Respond before baby is too worked up.
- Try to rest once a day. This may mean getting some help!
(Royal Children’s Hospital – The Unsettled Baby August 2019, https://www.rch.org.au/clinicalguide/guideline_index/Crying_Baby_Infant_Distress//0)
Care For Mum
Unsettled babies can be very distressing for Mums (and Dads!). Excessive crying is associated with higher rates of postnatal depression. Parental mental health assessment via the family GP or Child Health Nurse may be required. The Purple Crying website is a helpful source for information and settling techniques. www.purplecrying.com
But Why is My Baby Unsettled?
The Most common reasons for your unsettled baby are listed below
- Hunger — more likely if there is poor weight gain
- Delayed self-soothing/adaptive capacity of baby.
- An alert temperament.
- Primary caregiver stressors and mental health.
- cow’s milk protein (CMP) allergy
- Lactose overload or intolerance
What about Silent Reflux?
A Royal Children’s Hospital study (2010), concluded there was no evidence to support the diagnosis of silent reflux. Crying and distress was not associated with lowering of oesophageal pH levels (acidity).
GORD (Gastro Oesophageal Reflux Disease)
GORD can cause severe symptoms (in contrast to normal reflux) including failure to thrive and oesophagitis. The baby may refuse to feed, exhibit poor weight gain or loss, develop a chronic cough and wheeze associated with feeding. Blood-stained vomitus may occur. A GP examination is indicated and proton pump inhibitor medication may be required.
Cow’s milk protein (CMP) allergy and lactose intolerance
Unsettled and crying baby with “true” vomiting that can be substantial and potentially blood stained indicate the possibility of CMP or lactose intolerance. There may be poor weight gain, blood in stool and often a family history of allergy. Up to 30 % children with CMP allergy will have allergy to soy protein. Lactose intolerance can be associated with frothy stools and explosive nappies.
Breast feeding mothers can trial eliminating dairy and soy products for 2 weeks. Breast milk substitute (BMS) can be changed to a hydrolysed formula.
A GP investigation and Child Health Nurse follow up is recommended.
Probiotics May Help
Probiotic effects are strain-specific; Lactobacillus reuteri DSM17938 is the only probiotic strain with some evidence of efficacy in exclusively breastfed infants with excessive crying.
The probiotic lactobacillus reuteri changes the unsettled babies’ gut microbiota which is different to the gut microbiome of settled babies.
Medications – Don’t Waste Your Money!
Research is showing that most medication is not indicated and may have detrimental side effects. Retrieved from https://www.rch.org.au/hsru/research/Reducing_medications_in_infants/
- Anti-reflux medications (Proton Pump Inhibitors such as Omeprazole) which have been shown to be ineffective in reducing crying (unless baby diagnosed with GORD) compared with placebo and is associated with side effects such as constipation, diarrhoea and headache.
- Colic mixtures – Simethicone (e.g., Infacol, Wind Drops, Gripe Water, pharmacy mixtures) shown to have no effect on crying compared with placebo.
When Do I Need Medical Help?
If any of the following occur, a GP consultation is required
- Sudden onset irritability & crying
- Parental post-natal depression (PND)
- Blood-stained vomit or stools
- Failure to maintain weight
What About Osteopathy for Babies?
Why do parents bring unsettled babies to osteopaths for treatment? There have been several studies that support the benefits of osteopathy for unsettled infants.
In an updated review in 2016 of the existing literature on paediatric osteopathy the following conclusion was made.
“The available studies in neonatal settings provide evidence that OMT (osteopathic manipulative treatment) is effective in reducing the hospital length of stay of the treated infants…” (Bagagiolo et.al., 2016)
In another trail of preterm babies (Cheritelli et.al., 2015) the following conclusion was made
“Osteopathic treatment reduced significantly the number of days of hospitalization and is cost-effective on a large cohort of preterm infants.”
Osteopathic treatment of unsettled babies focuses on identifying strain patterns that may have originated in utero, during the birthing process or other traumatic events. These strain patterns typically affect the head, neck, thorax and shoulders and can affect the normal functioning of these regions. The treatment involves the reduction of the strain patterns to bring the affected region back to a balanced state, allowing nerves, muscles and joints to function optimally. This is often achieved using gentle unwinding techniques that allow the system to rebalance.
At West Perth Osteopathy we have several cranial osteopaths with over a decade of experience treating infants.
Who Refers to Osteopaths?
Here at West Perth Osteopathy we receive referrals from GP’s, Paediatric Dentists, Midwives, Lactation Consultants and Child Health Nurses. However, most babies come to us via word-of-mouth referrals. Mother’s groups and social media chatrooms are a constant source of referral for us.
- Bagagiolo, D., Didio, A., Sbarbaro, M., Priolo. C.G., Borro, T., & Farina, D. (2016). Osteopathic Manipulative Treatment in Pediatric and Neonatal Patients and Disorders: Clinical Considerations and Updated Review of the Existing Literature. American Journal of Perinatology, 33(11), 1050-4.
- Cerritelli, F., Pizzolorusso, G., Renzetti, C., Cozzolino, V., D’Orazio, M., Lupacchini, M., Marinelli, B., Accorsi, A., Lucci, C., Lancellotti, J., Ballabio, S., Castelli, C., Molteni, D., Besana, R., Tubaldi, L., Perri, F.P., Fusilli, P., D’Incecco, C., & Barlafant, G. (2015) A Multicenter, Randomized, Controlled Trial of Osteopathic Manipulative Treatment on Preterms: PLoS One.
- Reducing medication in Children the Royal Children’s Hospital Melbourne. Retrieved from https://www.rch.org.au/hsru/research/Reducing_medications_in_infants/
~ Dr Ray Power BSc (Clin), MHSc (Osteo)
Principal Osteopath, West Perth Osteopathy