I am an IBCLC (International Board Certified Lactation Consultant) in private practice in Northern Ireland and a La Leche League Leader with La Leche League of Ireland
No-one wants their baby to cry - but crying doesn't always mean pain
Listening to a baby crying is so distressing. It's supposed to be. It's supposed to stop us doing whatever we are doing, and attend to our baby. If we listen to a baby crying we can see is a very intense response in 2 areas of the brain. One is the area around communication, and the other is an area associated with emotion. We recognise that our baby is communicating something, but we combine it with an emotional component - so we find it distressing. We even know that listening to a cry activates an adult to respond physically - it motivates behaviour. It motivates behaviour in a way that makes us want to do something which will give us a reward. This makes sense biologically. When a baby cries it creates an emotional and physical drive for us to respond. We feel distress. We act, we soothe the baby, that gives us an emotional reward, and it is more likely to guarantee the survival of our baby.
Those responses have likely been in place for as long as humans have been around and have been able to vocalise, but our lives are different now and our expectations of babies are different to thousands of years ago. In the past we lived in large family groups likely with several adults looking after 1 child. It's thought that for most of human history we had 4 adults to one child. The children were carried and tended to by all 4 adults. Now we live in small nuclear family groups, often with one parent at home with one, or often more than one child. How can we meet the needs of a baby in this way? It's likely that we just won't be able to meet all the needs of a baby all the time under those circumstances, and so babies will cry more. That will cause more distress to us. I've written more about biological needs and societal expectations for a baby in a previous blog and if you haven't already read it, I recommend that you read it in combination with this blog.
Why do we cry?
Adults cry for all sorts of reasons. We cry when we see something beautiful, when emotions overwhelm us, when we feel great joy or sadness. Research shows men tend to cry in situations where their sports team wins, so a feeling of togetherness, or pride can make us cry. So can a feeling on loneliness or isolation. We cry when something is in our eye, so that the water will clear it. We cry when we feel hurt - either emotionally or physically. Sometimes we cry simply to relieve stress. When we cry we release cortisol in our tears, so crying is a way to actually reduce stress in the body. That may be why we often feel better after we cry.
We cry for all sorts of reasons. As an adult if we saw a friend crying I'd even suggest perhaps our first thought would be an emotional difficulty rather than a physical one. We may think that someone has said something hurtful, or has betrayed their trust in some way. We may think that they are having relationship problems. If that person has been generally well, we're unlikely to think that the person is struggling with wind/gas or has reflux. Yet this is often the first thought with babies. We relate crying with digestion. Crying equals wind / gas / reflux / wrong milk / food allergy. I think this has come from an unfortunate hangover thought from "parenting experts" in the early 1900s (more in the blog mentioned above). Babies were seen as little more than a digestive system. They didn't have feelings, indeed it wasn't believed that babies even felt pain. The aim was to feed them so they would physically grow and as they became more adult like they would develop the ability to feel. These beliefs were so widespread that open heart surgery on babies was conducted without anaesthetic as late as the 1980s, as horrific as that sounds.
We now know that babies are complex little humans. They most certainly do feel pain. They have stimulation needs. They have emotional and psychological needs. I think as part of this understanding, we should also understand that crying in babies happens for multiple reasons, not just physical pain. With older babies their reasons are more obvious. They have developed different cries, different ways of communication and quite frankly we have had time to get to know them better. Young babies don't have clearly different cries. They haven't yet developed the ability to vocalise in different ways - they simply cry. A cry for physical pain will sound the same as a cry which means, "you set me down and I miss you. Please pick me up". It can sound exactly the same, and can be just as distressing and can ramp up and become very intense in exactly the same way.
Babies may cry for multiple reasons. They may be hungry, tired, over-stimulated, under-stimulated, dysregulated, cold, warm, scared, bewildered, they may have drunk too much milk, not enough milk, need to comfort suck, need their nappy changed, not want their nappy changed, be having problems with feeding, gas, pain - all sorts of reasons. There may well be a combination of all the reasons. A baby may cry because they want to comfort suck to sleep. You may latch that baby on and they start to comfort suck but then get a letdown. They may then cry because they didn't actually want milk. Or a baby may be hungry and may latch and feed and then fall asleep. You may lay them down and they start to dysregulate and so you pick them back up and latch on again. They will latch and feed again and are now overfull and start to drift off to sleep. They may vomit. The act of vomiting might have unsettled them and now they are awake again. The vomiting may have been painless but the very act of it woke them up when they wanted to be asleep. They may cry and want to feed again to settle back to sleep. Feeding again may make them overfull and cause them to vomit and cry - a vicious cycle all about regulation simply because the baby was put down.
Sometimes babies are in physical pain when they cry, but sometimes they are not. Sometimes something else is going on, and it's normal for babies to want to communicate that they need help with whatever that is. Some crying is normal. In the West our babies are often not regulated well as they are not carried enough. We know that babies who are carried for 80% of the day cry significantly less, but even then crying is normal and increases over time from birth. A study looking at babies in London and Denmark found that, some episodes of intense inconsolable crying was equally common in all babies - even in those who were held a lot. The research tells us that it is normal for babies to have inconsolable crying sometimes, and that some babies cry more than others. Some authors will call these babies "high needs", or "orchids". Whatever we call them, we know that babies cry more around 3 weeks, it increases in the weeks following birth and that it eases off around 12 weeks (the end of the 4th trimester). Sometimes crying may simply be developmental.
Parenting is confusing
I started this blog by saying that crying is distressing. It is, and when your baby is crying inconsolably it's extremely distressing. You are motivated to do something that will stop it. You have a biological drive to do something - but nothing you are doing seems to work. You've tried all the things you can think of - food, carrying, changing nappy, changing layers of clothes, sleep - but nothing is working. The biological drive becomes increasingly desperate. So we google and we reach out for remedies and medications and courses or dietary changes. We just want our baby to be ok, and we want to stop our own distress. This is all normal. The previous blog talks about this too. Sometimes even though we try everything the crying doesn't stop. It can help to remember that most babies seem to have periods of inconsolable crying. Sometimes books or authors soften this by talking about fussy days, or fussy weeks - but lets be plain. When people talk about fussy babies, they usually mean crying. When there is excess crying there may be a medical issue or an immune issue like allergy but where we have some weeks of excessive crying in the middle of normal levels of crying it may be due to something developmental. It may be due to changes in the nervous system, in the way that the baby perceives the world, in their psychological needs.
We should try to resolve crying. We should check that our baby is feeding ok. We should check that they are being held and regulated appropriately. We should check that they are comfortable physically with regards to clothing and environment. We should check that there are no medical problems. If all of those issues have been ruled out sometimes all we can do is hold our baby. Tell them that we are close. Tell them that we will be there for them.....And wait for it to be over. In many ways that is parenting. When our toddler cries because they lost their favourite toy we can't fix it. All we can do is hold them until they are ok again. When our school child has a fall out with their best friend and they are no longer speaking to each other, we can't fix it. All we can do is hold them, tell them we love them and be there until they are ok. When our teen has their first broken heart we can't fix it. All we can do is hold them, tell them we love them and be there for them until they are ok.
We need to stop seeing our babies as digestive systems and linking all crying to gut pain. We need to prepare parents better for the arrival of their new little complex human. We need to re-educate society on baby behaviour and development. We need to stop telling parents that they need to suppress the digestive system through acid suppressants, and that they need to teach their baby to sleep. Our brain is the most complex animal brain that exists on this planet. We need to appreciate the amazing development that needs to go on in a baby to create an adult human brain and just how much support that baby/child/teenager/young adult needs throughout that process.
The early weeks of parenthood in many ways are a brutal introduction to parenting themes that repeat over and over throughout our children's lives. Parenting is hard, confusing, wonderful, exhausting, joyful and bewildering. All at once. It's life.
1. Parsons et al, 2011. Listening to infant distress vocalizations enhances effortful motor performance. Acta Paediatrica DOI:10.1111/j.1651-2227.2011.02554.x