Ask the Experts: What to do when baby cries

It breaks my heart to hear my baby cry, but sometimes I’m not sure what it is she wants. Is there a protocol I should run through to make sure her needs are met?

A: There are few things that inspire a more hardwired sense of alarm in parents than when their baby cries. Infant crying peaks from 3 to 4 weeks until 4 months old and can be incredibly stressful. While crying can reflect a serious problem, it is also an important aspect of normal development. Knowing the difference can be challenging, but asking three key questions can reduce anxiety and promote baby’s health:

  • Is this something that I can help?
  • Do I need to ask my doctor for help?
  • Is this something that only time will help?

Infant crying comes in as many varieties as there are temperaments. Fortunately, there are a small number of red flags that warrant medical attention. Fever, defined as rectal (yes, that’s the best way to check) temperature of 100.4 degrees Fahrenheit, is by far the most important. Any fever in the first two months should be evaluated to rule out serious infection. For older babies with fever, the decision to seek medical attention depends on parental comfort and the presence of worrisome signs of illness, such as not drinking well or shortness of breath.

If these are absent, parents can proceed to a three-system checklist:

1. Gastrointestinal(GI). Is baby’s diaper clean? If not, change it. Is baby hungry? If so, feed her, but never force. Because a baby’s life largely revolves around eating, it’s tempting to attribute crying to a GI problem: gassiness, food allergy, etc. Weight loss, blood in stool or pain with spitting up are (rare) red flags. Barring these, we often want to do something, such as switch formulas, use gas drops or probiotics, or restrict a nursing mother’s diet. There is little evidence any of these help, though, largely providing an illusion of control until crying decreases on its own.

2. Cardiac. All babies need to feel safe and loved. Walks outdoors, rhythmic rocking, talking, gentle touch or massage, swaddling, and singing all convey these, and they foster a wonderful bond. It’s important for caregivers to breathe and stay calm. If babies sense frustration or anger, crying will likely intensify, fueling a cycle that can tragically result in abuse. If negative emotions fueled by exhaustion arise, enlist help from a partner, family member or friend. If no one is available, place baby safely in her crib and walk away for 10 to 15 restorative minutes.

3. Nervous. A baby’s nervous system develops rapidly during infancy, processing amazing new sights, sounds, smells and feelings. Because they can’t yet talk, babies communicate by crying, often “venting” at the end of the day.

This can be an intense stage—called “colic” in extreme cases—and one that does not need to be “fixed” as much as recognized. Self-soothing, including falling asleep independently, is a critical developmental milestone. Once their basic needs and safety are ensured, letting babies cry for a reasonable span of time to encourage this is not harmful. Babies who are better self-soothers will likely adapt better to stress and adversity as toddlers and beyond. Resist the urge to use videos, apps or other electronic means of soothing, which are habit-forming and interfere with healthy development.

Take solace that there is only so much that even the most loving parent can control—crying gets better with time.

—John Hutton, MD, pediatrician at Cincinnati Children’s Hospital Medical Center and author of Calm Baby Gently and the Love Baby Healthy children’s book series



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