Family doctor

Overview:

• All babies cry to communicate.
• Excessive crying does not have a firm definition and it is really defined by the parents and caregivers. If the crying is unusual and distressing to the caregiver then it is "excessive".
• "Sudden-onset" excessive crying means that the child is distressed. Distress can be pain or feeling ill.
• Excessive crying with fever means that an infection is present.
• Excessive crying with vomiting may mean infection, or an obstruction in the bowel or pain in the abdomen. It almost always requires medical assessment.

Possible causes of excessive crying:

The doctor will look for causes for the pain such as an ear infection, throat, and lung or kidney infection; and in particular will look for meningitis and septicaemia (blood borne infection). Other common causes for the infant's distress include a nappy rash and the generalised aching that occurs with flu.

Infants who cry excessively week after week present a huge problem for parents and also for the doctors and nurses involved. Often a cause for the crying cannot be found.

If an infant with this problem also spills food after a meal (spills or possets) then that child may have gastro-oesophageal reflux. This is a situation where the valve at the bottom end of the swallowing tube (the oesophagus or gullet) is not closing properly after swallowing food. This valve holds the food in the stomach and prevents the stomach acid washing back. If it does wash back then it can cause a burning pain at the bottom of the oesophagus. This is called "reflux oesophageitis". It is a difficult diagnosis to confirm in a small infant and usually anti-reflux medicine is given to try to improve the situation on a trial basis. In most cases the valve will begin to work better with growth.

Some infants cry excessively week after week without "spilling" and without any obvious cause. In the past this has often been blamed on "infant colic" but there are no real tests that can be done to definitely diagnose this condition. A small percentage of these infants may have an allergy or reaction to certain foods.

The bowel is a long tube and food is propelled along it by a process of "peristalsis". A wave of circular constriction passes along the tubing of the bowel pushing food material along with it. The circular constriction will cause a cramping pain if it passes a certain threshold and this applies to adults as much as infants. If an adult gets a bowel infection, the irritation of the inflamed lining of the tubing causes the circular constriction to exceed the threshold, and pain and usually diarrhoea result.

For infants the theory is that the immature bowel muscle passes the threshold and causes intermittent cramping pain without any bowel infection being present and that this will resolve with growth. Various anti-spasmodic medicines have been used in the past but these can have side-effects and are mostly avoided these days.

Conclusion:

It is tough work being a parent with a baby who cries excessively week after week without a treatable cause. The parents need to have "time out" and your doctor or nurse may recruit other family members or friends to take over and give the parents this time out. Eventually most of these infants will grow out of this tendency and develop as perfectly normal children.