Lightning Learning: Crying Babies in ED

Lightning Learning: Crying Babies in ED


Babies cry (on average) 2-3 hours per day. Excess crying is defined as >3 hours/day for >3 days/week. Regardless of definitions, at least 1/5th of all parents say their otherwise healthy baby cries excessively. Many struggle to find help. A cycle of anxiety can ensue. Advice often varies. As such a considered and compassionate approach is required to…

  1. Exclude serious pathology

  2. Safety net the baby’s welfare

  3. Provide accurate advice

Whilst most scenarios are benign (95%) needing no tests, parent fears must be heard. Balancing reassurance against not missing serious illness or early psychosocial stress.


10 Step Assessment of the Crying Baby

  1. Perform a thorough history & exam. e.g. perinatal history, sepsis risk factors.

  2. Establish no serious underlying cause (<5%), e.g. serious bacterial infection, hair tourniquet, hernia, torted testicle, urinary infection (consider urine testing). 

  3. Assess/refer for feeding problems. Check technique, position, latch, teat, milk preparation, tongue tie, cleft palate, inappropriate supplementation with water etc.

  4. Assess/refer for perinatal mental health. Check psychosocial risk factors, screen for postnatal depression, consider safeguarding issues, are they coping?

  5. Provide sensitive reassurance and advice. Relaxed cue-based care, safe sleep practice, physical contact (skin to skin), soothing techniques, massage etc.

  6. If signs of cow’s milk allergy. A two-week trial of extensively hydrolysed formula or the elimination of dairy from breastfeeding mothers’ diet may help.

  7. Avoid unnecessary medications. Poor evidence colic or reflux medication helps.

  8. If caregivers ever feel like harming baby. Advise them to put baby safely down, walk away, take a minute and if needed get help.

  9. Encourage seeking help/other caregivers, e.g. family, friends if at all available.

  10. Refer and or follow the case up closely. Know your local health services, breastfeeding drop in, lactation consultant, parent groups, charities & websites.

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