Unsettled babies and crying babies

Understanding unsettled, colicky and crying babies

There are many reasons a baby might cry: hunger, tiredness, temperature or needing to be changed. If a baby has recurring episodes of inconsolable crying with no apparent cause, they may have colic.

What does an unsettled or crying baby really mean according to the medical system?

Crying is normal behaviour in young infants. Babies aged 6-8 week will often cry 2-3 times over a 24-hour period. Babies that cry for more than three hours a day and more than three days a week have ‘excessive crying’, often known as colic.

Infants with colic are often healthy and thriving with no identifiable medical problems.

What is colic?

Colic is a bout of inconsolable crying and abdominal pain in early infancy. It affects roughly 20 per cent of babies during their first few months of life.

Why is my baby crying?

There are many reasons your baby might be crying, with many factors possibly at play. Crying usually develops during the early weeks of life and is worse in the late afternoon and evening.

Things to consider when babies or small children cry a lot

Lactose, animal milk or soy protein allergy

  • Lactose is found in breast milk (and all mammal milks to some degree)
  • The protein in goat’s milk is as allergenic as the protein in cow’s milk
  • A delayed allergic reaction to food
  • If there is blood or mucus in diarrhoea, vomiting or poor weight gain eliminating dairy products and products that contain lactose may help
  • Trialling formula for two weeks can help

Could my baby’s crying be because of gastroesophageal reflux (GORD)?

  • There is no relationship between infant crying and gastroesophageal reflux
  • It is not likely that reflux without vomiting (silent reflux) is the cause of infant crying
  • If your baby has feeding difficulties or frequent vomiting (four or more times a day) they may have gastroesophageal reflux disease
  • The severity of gastro-oesophageal reflux is unlikely to have any effect on the duration of your baby’s crying
  • Certain medications that reduce stomach acid production have not been effective in reducing crying
  • Anti-reflux medication is not recommended to manage persistent irritability if vomiting is not present
  • A doctor should be consulted before giving your baby any medication
  • Gastroesophageal reflux disease may be a characteristic of an intolerance to milk or soy protein

Lactose intolerance/malabsorption/overload

  • It is extremely rare to have a primary lactose intolerance
  • Can be diagnosed by the presence of certain substances and a response to a lactose-free formula
  • If your baby has frothy, watery diarrhoea with perianal itching (if you can tell) you should consult a doctor
  • Babies who feed frequently or switch breastfeeding sides may have a lactose overload if there is high lactose content in the breastmilk
  • Formula-fed babies may have lactose malabsorption
  • Changing to a lactose-free formula or extensively hydrolysed formula may help
  • For babies who breastfed, it is advisable to space feeds three hours or longer
  • Consulting a lactation consultant for feeding advice or trialling a lactose treated breast milk may help.

Causes of an unsettled or crying baby – when it starts quickly

Some of the possible causes for your baby’s sudden onset of crying are:

  • An ear infection
  • Pressure inside the skull
  • A foreign object or scratch in the eye
  • Urinary tract infection
  • A piece of hair tightly wrapped around fingers or toes
  • An incarcerated inguinal hernia

Red flags

Sudden irritability and crying is not always a sign of and should not always be diagnosed as colic. There is usually specific cause present.

If the dynamic of the family has been thrown out of balance or the mother has post-natal depression, it may be possible that the baby is picking up on this and responding.

The types of tests your baby may require to find out what’s wrong

Some possible tests your baby may require include:

  • A stool examination – testing for pH levels and other specific substances
  • Urinalysis and culture
  • Fluorescein staining of the eye – to test for the presence of foreign objects in the eye

What should happen next

After consulting with a doctor, it can be helpful to keep a sleep and cry diary to track your baby’s crying, eating and sleeping patterns. Learning to recognise signs of tiredness and exhaustion can reduce crying.

By establishing regular feeding and sleeping patterns, and having a routine to settle down your baby before naps, can help reduce crying. Avoiding excessive stimulants such as noise and light, and avoiding excessive quiet can soothe babies. Having a darkened room for daytime naps, rocking and patting, and gentle music can help put a baby to sleep.

Medical treatments that may apply

Medication such as colic mixture and gripe water are rarely used. Anticholinergic medications can result in serious adverse events, so they are not recommended. Unless there is a proven lactose allergy, it may not be helpful to change formula.

We can help you establish the cause of your baby’s crying and provide you with advice going forward.