Crying Baby - Before 3 Months Old

• A baby less than 3 months old is crying and you don't know why
• Crying is the only symptom
• The type of frequent crying called colic is included
• For crying with an illness or other symptom, go to that care guide

Causes of Unexplained Crying

• Hungry Baby. The most common reason babies cry is because they are hungry. They stop crying at the onset of feeding. By the end of the feeding, they are happy.
• Sleepy Baby. The second reason babies cry is they need sleep. They need their parent to put them in a comfortable position. It may be swaddled and on their back. Then they fuss a little and fall asleep.
• Fed Too Much. Some babies cry because of a bloated stomach from overfeeding. Unlike gas, too much milk can cause discomfort that lasts a short time.
• Caffeine. Caffeine is a stimulant that can cause increased crying and trouble falling asleep. Breastfeeding mothers need to limit their caffeine intake.
• Clothing. Being too hot or too cold can make a baby cry. So can clothing that is too tight.
• Dirty Diaper. Stool is very irritating to the skin. If not cleaned off, it can cause pain and burning.
• Colic. Colic is the main cause of recurrent crying during the early months. All babies have some normal fussy crying every day. When this occurs over 3 hours per day, it's called colic. When they are not crying, they are happy.
• Pain (Serious). Painful causes include an earache, mouth ulcers, or a raw diaper rash. An ulcer on tip of penis may also cause pain and crying. These babies cry a lot and are not happy when they are not crying. They need to see a doctor to make a diagnosis. Fever in this age group is serious until proven otherwise. Shaken baby syndrome is a concern.

Myths About Causes of Crying

• Not Due to Gas. Gas passing through normal intestines does not cause pain or crying. All crying babies pass lots of gas. Their stomachs also make lots of gassy noises. The gas comes from swallowed air. The gas is normal. It does not become trapped nor cause any pains. That's why burping a baby doesn't help the crying. Blaming gas is a myth.
• Not Due to Spitting Up. Spitting up occurs in half of babies and is normal. It does not cause crying or colic. Heartburn meds do not help crying babies. They also have side effects.

Definition of Colic

• A lot of crying once or twice per day
• Usually consolable when held and comforted
• Acts normal (happy, contented) between bouts of crying
• The baby is getting enough to eat and is not hungry
• The baby is not sick
• Onset most often before 2 weeks of age
• Usually goes away by 3 months of age (sometimes up to 4 months)

Call 911 Now

• Not moving or very weak
• You think your child has a life-threatening emergency

Go to ER Now

• Not alert when awake ("out of it")

Call Doctor or Seek Care Now

• Age less than 1 month old and looks or acts abnormal in any way
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Bulging or swollen soft spot
• Swollen scrotum or groin
• Vomiting
• Cries when you touch, move or hold your baby
• Could be an injury
• Nonstop crying lasts more than 2 hours. Your baby can't be consoled using this Care Advice.
• Will not drink or drinks very little for more than 8 hours
• You are afraid someone might hurt or shake your baby
• High-risk child (such as with heart or brain disease)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Not gaining weight or seems hungry
• New crying, but your baby can be consoled. Your baby will stop crying, but cause of crying not clear.
• You are worn out from all the crying
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Your baby has never been checked for excessive crying
• Crying started after 1 month of age
• Crying occurs 3 or more times per day
• You have other questions or concerns

Self Care at Home

• Normal crying in all babies
• Colic (Excessive crying in a well baby who can be consoled)

Care Advice for Normal Crying or Colic

1. What You Should Know About Crying:
   • Normal Crying: all babies cry when they are hungry. Also, the normal baby has 1 to 2 hours of unexplained crying each day. It is scattered throughout the day. As long as they are happy and content when they are not crying, this is normal.
   • Colic: some babies are very hard to comfort. Some babies also cry a lot (over 3 hours per day). If growing normally and have a normal medical exam, the crying is called colic. Remind yourself that colic is due to your baby's temperament. It has nothing to do with your parenting or any medical disease.
   • Here is some care advice that should help both types of crying.
2. Feedings:
   • For formula-fed babies, feed if more than 2 hours since the last feeding. For breast-fed babies, feed if more than 1½ hours since the last feeding.
   • Be careful not to feed your baby every time she cries. Some babies cry because of a bloated stomach from overfeeding. Let your baby decide when she's had enough milk. (For example, she turns her head away.) Don't encourage your baby to finish what's in the bottle.
   • Caffeine. If breastfeeding, decrease your caffeine intake. Limit your coffee, tea and energy drinks to 2 servings per day. That's 2 cups or 16 ounces (480 mL).
     
3. Hold and Comfort for Crying:
   • Hold and try to calm your baby whenever he cries without a reason. Hold your baby flat to help them relax and go to sleep.
   • Rock your child in a rocking chair, in a cradle or while standing. Many babies calm best with rapid tiny movements like vibrations.
   • Place in a swing or vibrating chair.
   • Take for a stroller ride, outdoors or indoors.
   • Do anything else you think may be comforting. Examples are using a pacifier, massage, or warm bath.
4. Swaddle your Baby in a Blanket for Crying:
   • Swaddling is the most helpful technique for calming crying babies. It also keeps your baby from waking up with a startle reflex.
   • Use a big square blanket and the "burrito-wrap" technique:
   • Step 1: have the arms inside and straight at the sides.
   • Step 2: pull the left side of the blanket over the upper body and tuck.
   • Step 3: fold the bottom up with the knees a little flexed. Safe swaddling keeps the legs in a straddle position.
   • Step 4: pull the right side over the upper body and tuck.
   • Caution: don't cover your baby's head or overheat your baby.
   • Caution: stop swaddling when your baby shows signs of rolling over. Age limit: 2 months. The startle reflex will most often be gone by this age. At 2 months, transfer to a sleep sack with the arms out.
   • Read the book (or view the DVD),"The Happiest Baby on the Block". Both products are authored by Dr. Harvey Karp. It is a good resource on how to calm fussy babies.
5. White Noise for Crying:
   • Swaddling works even better when paired with a low-pitched white noise. Examples are a CD, vacuum cleaner, fan or other constant sound.
   • Caution: avoid making white noise too loud. Reason: risk of hearing damage.
   • Keep the white noise on any time your baby is crying.
   • When your baby is awake and not crying, keep your baby unwrapped. Turn off the white noise. Reason: so she can get used to the normal sounds of your home. For details, view Dr. Karp's DVD.
6. Falling Asleep on their Own:
   • Often babies cry because they need to sleep. If over 2 hours have passed since the last nap, this probably is the reason.
   • You have tried different ways to comfort your baby. You fed him recently. Nothing you do seems to help your baby relax. So, now, it's time to get out of the way.
   • Swaddle your baby. Place him on his back in his crib. Turn on some white noise or soothing music. Then, leave the room.
   • Let your baby fuss until he falls asleep.
   • For some overtired babies, this is the only answer.
   • Try to prevent an overtired baby. If your baby has been awake for 2 hours they often need sleep. Help them fall asleep before they become fussy.
7. Encourage Nighttime Sleep (Rather Than Daytime Sleep):
   • Try to keep your child from sleeping too much during the daytime.
   • If your baby has napped 2 hours or longer, gently wake him up. Play with or feed your baby, depending on his needs. This will lessen the amount of time your baby is awake at night.
8. Warning: Never Shake a Baby
   • It can cause bleeding on the brain. Severe brain damage can happen in a few seconds.
   • Never leave your baby with someone who is immature or has a bad temper.
   • If you are frustrated, put your baby down in a safe place.
   • Call or ask a friend or relative for help.
   • Take a break until you calm down.
9. What to Expect:
   • The right technique should start to reduce the crying. You may have to try several things before finding the best method.
   • The crying should start to decrease to about 1 hour per day.
   • Colic peaks at 4 to 6 weeks. Colic gets better after 2 months of age. Most often, it is gone by 3 months.
10. Call Your Doctor If:
    • Your baby starts to look or act abnormal
    • Cries nonstop for more than 2 hours
    • Your child can't be consoled using this advice
    • You think your child needs to be seen
    • Your child becomes worse