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THE BABY WHO CRIES EXCESSIVELY - a parent's guide
Dr Logan Mclennan - Family Doctor
Overview
All babies cry to communicate.
Excessive crying does not have a firm definition and it
is really defined by the parents and caregivers. If the
crying is unusual and distressing to the caregiver then
it is "excessive".
"Sudden-onset" excessive crying means that the child is
distressed. Distress can be pain or feeling ill.
Excessive crying with fever means that an infection is
present.
Excessive crying with vomiting may mean infection, or an
obstruction in the bowel or pain in the abdomen. It almost
always requires medical assessment.
Possible causes of excessive crying:
The doctor will look for causes for the pain such as an
ear infection, throat, and lung or kidney infection; and
in particular will look for meningitis and septicaemia (blood
borne infection). Other common causes for the infant's distress
include a nappy rash and the generalised aching that occurs
with flu.
Infants who cry excessively week after week present a
huge problem for parents and also for the doctors and nurses
involved. Often a cause for the crying cannot be found.
If an infant with this problem also spills food after
a meal (spills or possets) then that child may have gastro-oesophageal
reflux. This is a situation where the valve at the bottom
end of the swallowing tube (the oesophagus or gullet) is
not closing properly after swallowing food. This valve holds
the food in the stomach and prevents the stomach acid washing
back. If it does wash back then it can cause a burning pain
at the bottom of the oesophagus. This is called "reflux
oesophageitis". It is a difficult diagnosis to confirm in
a small infant and usually anti-reflux medicine is given
to try to improve the situation on a trial basis. In most
cases the valve will begin to work better with growth.
Some infants cry excessively week after week without "spilling"
and without any obvious cause. In the past this has often
been blamed on "infant colic" but there are no real tests
that can be done to definitely diagnose this condition.
A small percentage of these infants may have an allergy
or reaction to certain foods.
The bowel is a long tube and food is propelled along it
by a process of "peristalsis". A wave of circular constriction
passes along the tubing of the bowel pushing food material
along with it. The circular constriction will cause a cramping
pain if it passes a certain threshold and this applies to
adults as much as infants. If an adult gets a bowel infection,
the irritation of the inflamed lining of the tubing causes
the circular constriction to exceed the threshold, and pain
and usually diarrhoea result.
For infants the theory is that the immature bowel muscle
passes the threshold and causes intermittent cramping pain
without any bowel infection being present and that this
will resolve with growth. Various anti-spasmodic medicines
have been used in the past but these can have side-effects
and are mostly avoided these days.
Conclusion:
It is tough work being a parent with a baby who cries excessively
week after week without a treatable cause. The parents need
to have "time out" and your doctor or nurse may recruit
other family members or friends to take over and give the
parents this time out. Eventually most of these infants
will grow out of this tendency and develop as perfectly
normal children.
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