A crying baby is a force to be reckoned with. A tiny infant can throw a family into turmoil. A new study has found that a baby that engages in inconsolable crying can give mom a bad case of postpartum depression. The results were published online on May 6 in the journal Pediatrics by researchers affiliate with Boston Medical Center and Boston University (Boston, Massachusetts), University of Washington (Seattle, Washington), eNational Center on Shaken Baby Syndrome (Farmington, Utah), and University of British Columbia (Vancouver, British Columbia, Canada).
The researchers compared the relationship of inconsolable infant crying rather than colic to postpartum depression. Inconsolable infant crying was defined by Wessel’s criteria of daily duration of fussing and crying more than three hours each day. The study group comprised 587 mothers who were recruited shortly before or after delivery and followed over time. At five to six weeks after giving birth, the mothers recorded the duration and mode (fussing, crying, or inconsolable crying) of their infant’s distress by using the Baby’s Day Diary. The Edinburgh Postnatal Depression Scale (EPDS) was administered at enrollment and at eight weeks postpartum. Using statistical analysis techniques, the researchers examined associations of colic and inconsolable crying with later maternal EPDS scores at eight weeks postpartum.
The investigators found that 60 mothers (10%) met the EPDS threshold for “possible depression” (score 9 or higher) at eight weeks postpartum. For mothers reporting more than 20 minutes of inconsolable crying per day, the adjusted odds ratio for an EPDS score of 9 or higher was 4.0, meaning that the mothers were four times more likely to suffer from postpartum depression. In contrast, the adjusted odds ratio for possible depression in mothers whose infants had colic was 2.0; meaning that these mothers had half the risk of developing postpartum depression than the mothers with infants whose crying was inconsolable. These associations persisted after adjusting for baseline depression symptoms, meaning that the results were adjusted for women who had depression not related to postpartum.
The authors concluded that a maternal report of inconsolable infant crying may have a stronger association with postpartum depressive symptoms than infant colic. They recommended that healthcare professionals should ask a mother about her ability to soothe her infant because this may be more relevant for potential intervention than questions about crying and fussing duration alone.
Almost all babies go through a fussy period. When crying lasts for longer than three hours a day and is not caused by a medical problem (such as a hernia or infection), it is called colic. This phenomenon occurs in almost all babies. The only thing that differs is the degree. The first step for evaluating an infant that cries excessively is to rule out a medical condition that may be causing it. After a thorough medical exam, some otherwise healthy infants will cry excessively.
Helping a child who cries excessively is primarily a matter of experimentation and observation. If you can identify and eliminate a trigger for the colic, that is best. Even if you cannot, learn which measures most comfort your baby.
- Foods: If you are breast-feeding, avoid stimulants such as caffeine and chocolate. Try eliminating dairy products and nuts for a few weeks, as these may be causing allergic reactions in the baby. Other foods may also irritate the baby.
- Formula: Switching formulas is NOT helpful for most babies, but is very important for some.
- Medicine: Some medicines mom may be taking can also lead to crying.
- Feeding: If a bottle feeding takes less than 20 minutes, the hole in the nipple may be too large. Avoid overfeeding the infant or feeding too quickly.
- People often hear that breastfeeding moms should avoid broccoli, cabbage, beans, and other gas-producing foods. However, there is not much evidence that these foods are a factor.
Tips for comforting the baby:
- Different children are comforted by different measures. Some prefer to be swaddled in a warm blanket; others prefer to be free. Try many different things, and pay attention to what seems to help, even just a little bit.
- Holding your child is one of the most effective measures. The more hours held, even early in the day when they are not fussy, the less time they will be fussy in the evening. This will not spoil your child. Body carriers can be a great way to do this.
- As babies cry, they swallow more air, creating more gas and perhaps more abdominal pain, which causes more crying. This vicious cycle can be difficult to break. Gentle rocking can be very calming. This is directly comforting and seems to help them pass gas. When you get tired, an infant swing is a good alternative for babies at least three weeks old with good head control.
- Singing lullabies to your baby can be powerfully soothing. It is no accident that lullabies have developed in almost every culture.
- Holding your child in an upright position may help. This aids gas movement and reduces heartburn. A warm towel or warm water bottle on the abdomen can help. Some babies prefer to lie on their tummies, while awake, while someone gives them a back rub. The gentle pressure on the abdomen may help. (To avoid sudden infant death syndrome (SIDS), DO NOT put babies on their tummies to sleep.)
- Some babies are only happy when they are sucking on something. A pacifier can seem like a miracle in these cases.
- The concentration of breast milk changes during a feeding. The “foremilk” at the beginning is plentiful but low in calories and fat. The “hindmilk” at the end of emptying each breast is far richer. Sometimes you can reduce colic by allowing the baby to finish the first breast before offering the second. If the baby still seems uncomfortable or eating too much, then offering only one breast (as often as desired) over a two-to-three hour period might give the baby more hindmilk, which is richer and sometimes more soothing.
- Some children seem to do best when they are riding in a car. If your child is one of these, you might try a device developed by a pediatrician to imitate car motion and sound. Alternatively, some kids do better with cheaper forms of white noise, such as a vacuum cleaner motor or the sound of a washing machine or dishwasher.
- Simethicone drops, a defoaming agent that reduces intestinal gas, may help. It is not absorbed into the body and is therefore quite safe. Sometimes doctors will prescribe stronger medicines for severe colic (but this should only be done after a physical exam).
- Take breaks. Each of you can take charge and relieve the other. Time for oneself is an important part of the new family dynamic. You will be able to pay more loving attention to your baby when you’ve had a chance to get refreshed.