Clinical Review

Managing infants who cry excessively in the first few months of life

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7772 (Published 15 December 2011) Cite this as: BMJ 2011;343:d7772
  1. Pamela Douglas, general practitioner, clinical lead; adjunct senior lecturer12,
  2. Peter Hill, associate professor3
  1. 1Possums, Clinic for Unsettled Babies, UQ Healthcare, Annerley, QLD 4103, Australia
  2. 2Discipline of General Practice, University of Queensland, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
  3. 3School of Population Health, University of Queensland, Herston, QLD, Australia
  1. Correspondence to: P Douglas pameladouglas{at}uq.edu.au
  • Accepted 17 November 2011

Summary points

  • Excessive crying in the first months of life is usually benign and self limiting, although in a minority of families it is linked with more long term and serious problems

  • No routine investigations are needed for an afebrile child with no signs of illness on a thorough history and examination

  • Cry-fuss behaviour is linked to feeding problems; assess babies for feeding difficulties as early as possible and refer to experts

  • Assess mothers for psychosocial factors that may put the baby at risk of adverse outcomes; screen for perinatal anxiety and depression and refer as necessary

  • Gastro-oesophageal reflux disease is not linked to excessive crying in the first months of life and proton pump inhibitors are not indicated

  • Cue based care and even moderate levels of physical contact from birth are associated with reduced crying

Community cohort studies report that a fifth of parents say that their otherwise healthy baby has cry-fuss problems at two months of age.1 2 Excessive crying is usually a transient neurodevelopmental phenomenon, although it may herald problems that are more long term and serious. Various studies have found that it is often difficult for parents to access the help they need when they experience problem crying; that they resort to use of multiple health services, including of emergency departments; and that they receive conflicting advice.3 w1 We review evidence from heterogeneous studies across multiple health disciplines to provide a practical guide to the management of term infants who cry excessively in the first few months of life. Our review is aimed at paediatricians, general practitioners, community child health nurses, and midwives. Although definitions of infant crying vary considerably, for practical purposes we use the terms cry-fuss behaviour, excessive crying, colic, and unsettled infant behaviour interchangeably to refer to any crying behaviour that parents report …

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