It’s quite common for parents to experience difficulties with a baby that is unsettled. This unsettled behaviour can vary from mild issues at certain times of the day, to a baby that cries constantly throughout the whole day and night. Whilst not all these problems have long term consequences, there is much research to suggest that unsettled behaviour in infants is not benign, and these issues can have consequences for both the baby and the parents (1).
There are many reasons a baby can cry (2). Simply labelling the issue as “colic” or “reflux” often misses the true cause (or multiple causes), which can all contribute to a baby that is feeling and functioning at less than their best. When seeking solutions to these problems it is essential to find a trained practitioner, who has skills in identifying all the causes based on a good knowledge in this area.
These conditions can be categorised into 6 main areas – which we call ISSNUT.
- Subluxation (body dysfunction, pain)
In this blog we look at the first two areas – Illness and Subluxation.
The incidence of a serious illness causing a baby to be unwell is actually quite low – under 5-10% of babies with constant crying will have a serious illness (3/4). However, illness should be considered, and ruled out with every unsettled baby, especially if there is no obvious cause identified.
The role of extra investigations (tests etc) in identifying the cause of crying in infants is limited. According to a few cohort studies, it may help in only 3-5% cases where history and examination findings are inconclusive (3). To rule out this area, seek advice from a qualified health practitioner.
Subluxation, body pain, musculoskeletal issues
The key question here to consider is could my baby be in physical pain or discomfort?
Pain pathways develop in the second trimester (in utero), and even the smallest neonates (babies in first 4 week) can respond to pain stimulation. Also, younger babies are more hypersensitive to milder stimuli, have more prolonged discharges in spinal neurons, larger overlap of sensory fields, less inhibitory pathways (ability to self-inhibit pain) (5).
These reasons make babies more sensitive to pain and are one reason why every effort should be made to reduce painful stimuli, such as through touch, cuddle and responsive caregiving, or other approaches.
Indicators that a baby may be in pain include:
- increased heart rate and sweating.
- “withdrawal” body postures such as sudden neck arching or arm extension. (sustained postures are abnormal as should prompt medical assessment)
- facial expressions such as grimacing.
- crying responses (different cry to hunger or fear cry)
- sucking – strongly and quickly when in pain.
- frequent feeding – pain relief for 90-120 minutes
- unsettled behaviour, especially that relieved by holding (touch), or movement (rocking/car).
- altered sleep patterns and difficult settling
Again, to rule out this area, seek the advice of a qualified practitioner.
Dr Adam Stewart
- Multiple references available on request.
- J Miller, D Newell. JCCA 2012; 56(1):40–48
- Arumugam J et al , The evaluation and management of an incessantly crying infant. Sri Lanka Journal of Child Health 2012; 41(4): 192-198
- Rautava P, Helenius H, Lehtonen L.Psychosocial predisposing factors for infantilecolic. British Medical Journal 1993; 307 :600 http://dx.doi.org/10.1136/bmj.307.6904.600
- Hatfield LA. Neonatal pain: What’s age got to do with it? Surgical Neurology International. 2014;5(Suppl 13):S479-S489