Crying and unsettled babies

Colic is the word used to describe when babies cry a lot or fail to settle for a lengthy period of time. It is now understood that 'colic' refers to the normal range of unsettled behaviour in many babies, which can be very demanding and exhausting for parents.

This crying and fussing can happen at any time, but often occurs in the late afternoon and evening, especially in babies between two weeks and four months of age. It is very common for young infants to have crying and unsettled times.

This type of normal crying happens in babies all over the world, in all cultures, and resists the usual soothing techniques.

Causes

Medical

Sometimes there is a medical reason for the baby's crying and this may need to be checked by a doctor or nurse. This can be very helpful because it is hard for parents to provide reassurance to their baby if they are worried there may be a medical problem. But in most babies no medical cause is found. Crying is a communication from the baby to their care giver that they are not comfortable or are distressed. This is a normal part of their growth and development.

New experiences

Newborns have to adapt to a range of new experiences and differ in how sensitive they are to physical and emotional events inside and outside their bodies.

Sometimes the causes of the discomfort may be a wet nappy, being too hot or cold, wind (gas in their tummy), hunger, tiredness, feeling anxious or unhappy or needing company. Over time, newborns learn to anticipate what will help them feel better. For example, a good feed makes hunger go away, tiredness is fixed by a sleep, a wish for comfort met by holding and talking and playing. This process seems to take longer for some infants who are crying persistently. 

Differences

Some babies are easily frightened by and struggle to cope with normal physical sensations such as digestion or normal reflux. Others take a long time to adapt to the world and cope with changes. Many babies are very tuned in to the emotional world of their family and can be affected by family distress. 

Some babies seem to cry more than others or to need more soothing than others. This does not mean there is anything wrong, rather that all babies respond differently.

Effect on parents

Parents may also worry that crying is caused by something they have done and this can sometimes affect their confidence in handling and looking after their baby. Maternal depression, family stresses or losses or a difficult time in their own childhood can reduce parents' confidence in interacting with their baby and make it hard to feel responsive or playful with their baby.

Parents should be reassured that a number of things can help them with a difficult to soothe baby. The most important is to get support from the family and talk to a health professional, such as a maternal and child health nurse or doctor.

Care at home

• Try to stay calm (easier said than done). Although you may not be able to stop the crying, you can help your baby to cope with their distress. It is hard to think clearly or provide reassurance to your baby if you are feeling panicky.
• Let your baby suck at the breast or bottle. It may help them to settle for a short period. Your nurse or doctor can advise you on feeding and the amount of milk your baby needs.
• Offer a dummy. Sucking may provide comfort and help your baby to settle.
• Try and adopt a ‘baby-centred’ approach and think from the baby’s point of view.
• Remember, you cannot spoil your baby by too much cuddling or feeding.  
• Try to select some soothing strategies that are suited to your infant and use these regularly so that the baby learns to anticipate what happens when they are upset.  
• Gently rock or hold your baby in your arms or in a baby carrier or sling.
• Continue to speak softly to your baby. Your voice and presence may help soothe them.
• You can try playing some soft music.
• Try giving a warm bath.
• Try a nut- free baby massage oil. This may calm the baby and also help you to relax.

The demanding evening time may be easier if you plan around it. For example, plan to eat dinner earlier if your baby is unsettled around then or plan to carry your baby in a sling at this time.

Some babies seem to need to be with their mother all the time. Try not to battle this. As the baby develops their confidence, they will learn to self soothe. Keep separations to a minimum, try to remain in the baby's view, carry the baby in a sling or move the baby from room to room in the pram.

Introduce a doll or teddy, outside the bassinet or cot, that the baby can look at when they wake from a sleep so that they do not feel so alone. Have a photo of you and the baby on the wall at the height that the baby can see.

Try not to get caught up in a campaign to get your baby to sleep or to adjust to a rigid routine. As babies get older they become more alert and awake for longer periods and their interest in you and the world can help them to be distracted from what is going on inside their bodies.

If your baby is in a playful mood make the most of this time for some enjoyable interaction for you both.

• If possible try and get support from family and friends. Some mothers find it helpful to have a short break from the baby so that they can relax. For others, help with family chores is most helpful as then they can concentrate on comforting their baby. If help is not available, safely place your baby in the cot and have a few minutes to relax.
• If your baby is crying for most of the day, it is important to get support and talk to a health professional (MCHN, GP, paediatrician, infant mental health specialist, counsellor) during this difficult time.
• Talk with other parents about things that have helped them.

Medication

Medication is not recommended. It may mask illness, interfere with feeding or make your baby too sleepy.

Medication should only be used on the advice of a doctor and only for a short period of time.

Follow-up

See a doctor if:

• You would like the doctor to check there is no medical cause for the crying.
• Your baby is refusing feeds or is having less than half their normal feeds.
• Your baby does not seem to settle with any of the things you are trying.
• Your baby continues to cry for long periods.
• You feel you are not coping.
• You feel the crying is impacting on your relationship with your baby.
• You are finding it hard to enjoy your baby or to feel positive about them.
• You feel your mental health or your relationship with your partner is being affected.
• OR you are worried for any other reason.

Key points to remember

• Being unsettled and crying is very common in young babies up to 4 months old.
• Comfort your baby if they seem distressed.
• All babies are different. Some cry for longer periods and are more unsettled than others. This is normal.
• Try and have breaks from your child or have an afternoon nap before the early evening.
• Seek help from family and friends whenever possible.
• Sometimes there is a medical reason for the baby's crying. Most times this is normal infant behaviour and settles as the baby gets older.
• NEVER shake a baby. Shaking babies even gently can cause brain damage and life-long disability.