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.
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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
A red and/or swollen scrotum
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.
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
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.
