Why do babies cry?
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7222.1381 (Published 27 November 1999) Cite this as: BMJ 1999;319:1381
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Just like to add to Oliver C Colt's comment "When I worked in Africa
it was usually believed that African babies cried little because, in rural
areas, they were in constant contact with the mother, being strapped onto
her back during the day, even when she was at work. I can't see this
practice taking on here"
well it is catching on here and it works! I have a variety of slings in
which to carry my son (who is now 20 months and rides on my back). I live
in Essex, people think I'm odd, but when they see how happy he is they
like the idea.
Competing interests:
None declared
Competing interests: No competing interests
Having read the interesting article by Dr.Choonara and the responses
that accompanied the article,I would like to make a point that has not
been addressed in this debate.
This is to with the fact that the junior doctor in the neonatal unit
who has the onerous responsibility of drawing blood (sometimes upto 4-5
mls) either from a heel prick or venous puncture also feels a degree of
pain and feels sorry for the baby.
Sometimes the drawing of blood is done on a so-called "routine" basis
and the clinical condition of the baby not considered as adequate proof of
the baby's health.
I really feel pained when I take blood from a baby without knowing
why I am taking the sample.I try to find out from the child's clinical
notes as to the likely reasons for the procedure.
There have been occasions when careful examination of the child's
notes reveal that the same sample has been taken by another person but not
recorded in the notes!
This is a problem of the shift systems we work in most hospitals,
poor note keeping and communication.
I would request that all SHOs and Registrars should think twice before
subjecting babies to "routine blood tests".
I also appeal to parents to ask their doctors exactly what the blood
test will show and whether the result will make a substantial difference
in the management.
Competing interests: No competing interests
While I share Dr Guthrie's concerns about the lack of attention paid
to parental views about their child's pain, I would hope that publishing
editorials such as this one serves precisely to challenge that state of
affairs, rather than shore up professional power.
My own experience as a
parent included being told my baby son would need to have a urine sample
taken by a needle direct into his bladder, because repeat samples
collected by urine bags suggested E Coli. When I asked the (female) junior
doctor if that would not be very painful, she said brightly 'oh, no more
than a blood test'. Having seen the pain inflicted on him a few weeks
earlier by repeated heel pricks for hyopglycaemia and a blood test on the
back of his hand - which required quite hard squeezing of his tiny fist to
get enough blood out - I declined the needle into the bladder until we had
at least tried a 'clean catch'. We did, and it came back negative for E
Coli.
It is the routine acceptance of painful procedures in neonates which
needs confronting.
Competing interests: No competing interests
Babies cry because they are in pain.
Distress is the pain of nervous system.
When adults, we learn to deal with everythings. They are our
extension. We suffer when lost anything.
Babies are isolated of our universe. The songs are responsible for
these distresses.
An adult know when anything break, by the song, or a noisy music. He
can to be a fugitive of them. But babies don't know what is this, and they
feel the fear.
Fear is a instinct that make we feel the pain or distressed. So the
babies, with fear, contract your muscles, as well as we contract our
muscles or we lower when we listen a noise of an explosion, for example.
Contractions liberate us of the songs that our nervous system can
feel.
When the babies receive a non-nutritive sucking, they contracting
various muscles, avoiding noises undesirable.
When we use solutions of glucose or sucurose, these solutions make
with its energy a bigger centrifuga force in the atoms of the cells,
reducing the friction internal of them, liberating the babies of the pain,
across a work made by the chromosomes. Pain come of of the friction of the
elements. More energy, minus pain.
William.
Competing interests: No competing interests
Dear Editor
Crabajal et al [1] address the issue of neonatal pain relief and in
the accompanying editorial [2] health professionals are encouraged to
study the 'painfulness' of clinical procedures and institute pain
prevention measures.
Neonatalogists agree on the importance of pain relief for newborn
babies undergoing undergoing invasive procedures [3], such as chest drain
placement. Further, alalgesia decreases the incidence of accidental
extubation and provides pain relief for ventilated newborn babies [4,5].
Yet, for the most painful procedure, intubation, neonatologists in the
United Kingdom have been cautious.
American and Austrlian Neonatal Intensivists have been using
intravenous assistance to intubation for some time[6,7]. Evidence suggests
that awake intubations are associated with higher spikes in intracranial
pressure compared to when a general anaesthetic is given[8]. Even ‘awake’
but paralysed neonates have shown significant increases in mean arterial
blood pressure and intracranial pressure[9] indicating the effect of pain.
Adequate anaesthesia prevents swings in blood pressure and thus
potentially the subsequent development of intracranial haemorrhage.
Although one study showed there was no hypertensive response to awake
intubation in neonates, however no measure of changes in intra-cranial
pressure were made[10].
To accept or decline the practice from abroad a trial on medication
for neonatal intubation is long overdue.
[1]Carbajal R, Chauvet X, Couderc S, Olivier-Martin M. Randomised
trial of analgesic effects of sucrose, glucose and pacifiers in term
neonates. BMJ 1999;319: 1393-7.
[2] Choonara I. Why do babies cry? BMJ 1999;319:1381.
[3] Anand KJ, Hansen DD, Hickey PR. Hormonal-metabolic stress
responses in neonates undergoing cardiac surgery. Anesthesiology.
1990;73(4):661-70.
[4]Levene MI, Quinn MW. Use of sedatives and muscle relaxants in
newborn babies receiving mechanical ventilation. Archives of Disease in
Childhood 1992;67:870-873.
[5]Quinn MW, J Wild, Dean HG, Hartley R, Rushforth JA, Puntis JWL,
Levene MI. Randomised double-blind contolled trial of effect of morphine
on Catecholamine concentrations in ventilated pre-term babies. Lancet
1993;342:324-7.
[6]Rashid A, Bhuta T, Berry A. A regionalised transport system, time
to change? Arch Dis Child 1999;80:488-92.
[7]Barrington KJ, Byrne PJ. Premedication for neonatal intubation. Am
J Perinatol Apr ;15(4): 213-6.
[8]Friesen RH, Honda AT, Thieme RE. Changes in Anterior Fontanel
Pressure in Preterm Neonates during Tracheal Intubation. Anesth Analg 1987
;66:874-8.
[9]Kelly MA, Finer NN. The Journal of Pediatrics 105:1984 (303-309).
[10]Charlton AJ, Greenhough SG. Anaesthesia 1988;43:744-746.
Competing interests: No competing interests
I agree with Dr.Guthrie, that the real experts are experienced and
competent mothers. It is not difficult to reach the conclusion that babies
cry because they are distressed or in pain. What distresses parents,
however, is the baby who cries for no evident reason. Can one say why one
infant will sleep contentedly throughout the night while another wakes and
cries? Having checked all the common causes of discomfort such as dirty
nappies, most mothers will know that taking the baby into bed beside them
will produce peace and quiet, but is this practice to be encouraged? When
I worked in Africa it was usually believed that African babies cried
little because, in rural areas, they were in constant contact with the
mother, being strapped onto her back during the day, even when she was at
work. I can't see this practice taking on here.
Competing interests: No competing interests
Dear Editor,
Pain is and will be an ever elusive sensation in all fields of medicine .
Devising pain scale to assess the severity is one way of preventing
unnecessary pain to the babies. So far I have worked in about 4
neonatal/special care baby units in UK.
I have heard people talking about and sympathising with babies
undergoing painful procedures,but never came across any body following any
particular PAIN SCORING SYSTEM on neonatal units and taking actions
accordingly.
In one unit , SHOs were told to collect blood by heel prick rather
than venepuncture as far as possible because the former method adopted by
doctors in the past left horrible bruises in the hands and feet of newborn
babies much to the dissatisfaction of the parents and embarassment of the
medical profession,and also apparently to save the ever precious veins for
cannulation if necessary.
Pain is a very subjective sensation especially in newborn babies and
to scale the depth of pain suffered by the babies is even more subjective
and painful procedure.
Papers will be written on different aspects of pain management but in
my experience pain will never have a comprehensive measuring unit.
Competing interests: No competing interests
As a general practitioner and mother of four (16, 14 , 12 and 10 year
olds)(1) I read with increasing anger the editorial "Why do babies cry?"
(2)
As a general practitioner I am responsible for the infliction of pain
on my young patients during their routine vaccinations. For 16 years I've
watched mothers use their knowledge of their babies to comfort after such
distressing procedures, be it with soother, feed or analgesia. I have been
only too aware of my causing discomfort.
To suggest that this is an unstudied area is nonsense. For centuries
mothers have conducted n = 1 studies of their babies and developed ways of
sensitively responding to the distress of their own unique infant. To
highlight Darwin, one man's comments, when mothers have been 'reading'
their babies responses from time immemorial, is strange.
I am surprised that the BMJ published this editorial. I suppose it
serves to highlight the reticence of professionals, particularly male
professionals, to learn from the real experts, the patients (by their
observable responses to noxious stimuli) and their lay carers (
mothers and fathers who seek to comfort their babies).
No matter how well validated a scale it cannot recognise the
individuality of a baby's responses in the way that its own parents can.
It is time we took seriously the need to recognise the skills and
competencies of our patient partners(4) and question why we professionals
seek to develop rating scales for a never ending range of phenomena. Is it
to shore up the erosion of professional power?
Yours sincerely
Dr Eleanor Guthrie.
(1) Douglas Guthrie (10.10.83), Grant Guthrie (17.7.85), Lorna
Guthrie (28.6.87), Stuart Guthrie (4.7.89).
(2) Choonara I. Why do babies cry? BMJ 1999;319:1381.
(3)Carbajal R, Chauvet X, Couderc S, Olivier-Martin M. Randomised trial of
analgesic effects of sucrose, glucose and pacifiers in term neonates. BMJ
1999;319: 1393-7.
(4) Coulter A. Paternalism or parnership? BMJ 1999; 319:719-20.
Competing interests: No competing interests
yes neonates and infants even suffer in pain. it was a good article
to read and understand that even tiny newborn babies can perceive pain. we
have a 15 month old cute baby who was premature and spent his first month
of life in intensive care unit having blood test done three times a day in
addition to all the invasive procedures. he accepted everything. now we
know he is a case of trisomy21. has any research being done on perception
of pain in mentally retarded neonates?
Competing interests: No competing interests
Needing to be held
I am so pleased to see this issue being discussed.
It takes me back to life before Munchausen Syndrome by Proxy, when I
recall being interviewed on Trinidad breakfast TV following a Lifeline
(Samaritans) conference in 1995. We were dicussing how parents could help
their children's development. I was very interested in the power of
touching and holding and said `Babies can't walk because they need to be
held'. One could argue against the accuracy of this tongue in cheek
ethological interpretation, but there can be very little argument that
normal babies love to be held close.
Competing interests:
Seeing society start caring again
Competing interests: No competing interests