tag:theconversation.com,2011:/us/topics/crying-baby-29787/articlescrying baby – The Conversation2023-08-18T02:08:23Ztag:theconversation.com,2011:article/2054772023-08-18T02:08:23Z2023-08-18T02:08:23ZCurious Kids: why do babies cry when they come out of their mum?<figure><img src="https://images.theconversation.com/files/543119/original/file-20230816-21-5r1861.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-78559918">Shutterstock</a></span></figcaption></figure><blockquote>
<p>Why do babies always cry when they come out of their mum? – Nam, 12, Hanoi, Vietnam</p>
</blockquote>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>When babies are born, they all seem to cry. We see this a lot <a href="https://www.goldderby.com/gallery/best-tv-births-ranked-worst-to-best/tvs-most-memorable-births-little-house-ont-the-prarie/">on TV</a>.</p>
<p>But not all newborn babies cry straight away. Here’s what’s going on.</p>
<h2>What happens at birth?</h2>
<p>When a baby is born, they move from their mum’s warm body, and out of their dark, watery world into a much cooler, drier and brighter one.</p>
<p>It’s a bit of a squeeze. As the baby comes out from their mum, the cooler air hits their wet skin. </p>
<p>The cooler air makes them gasp. They also gasp when the midwife or doctor touches their body to help them come into the world.</p>
<p>That gasp is their first breath, which usually comes with a cry. And when this happens the gasp or cry triggers an amazing <a href="https://www.youtube.com/watch?v=zTXmaVgobNw">change</a> in how the baby gets oxygen and moves it around their body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-cry-119814">Curious Kids: why do we cry?</a>
</strong>
</em>
</p>
<hr>
<h2>What changes?</h2>
<p>In the womb, babies depend on their mum for oxygen – via the <a href="https://theconversation.com/explainer-what-is-placenta-28851">placenta</a> and <a href="https://theconversation.com/ive-always-wondered-whats-behind-the-belly-button-84598">umbilical cord</a>.</p>
<p>The placenta looks a bit like a pancake and filters oxygen-rich blood from the mum. The umbilical cord then pumps that to the unborn baby.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Unborn baby with umbilical cord and placenta" src="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The placenta, on the left, and the umbilical cord work together to send oxygen from the mum’s blood to the unborn baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-fetus-727111807">Shutterstock</a></span>
</figcaption>
</figure>
<p>But once babies are born, their first breath or cry triggers a whole range of changes to the way their heart moves blood around their body. So, rather than breathing fluid from the womb, they can now breathe air and get oxygen into their lungs just like we do. </p>
<p>The process of being born also squeezes water out of the baby’s lungs, allowing them to work properly.</p>
<p>A newborn baby crying is a sound parents and health workers are very <a href="https://www.romper.com/p/why-do-babies-cry-at-birth-the-answer-will-probably-surprise-you-18746386">happy</a> to hear. That’s because it usually means the baby is well and won’t need any extra help to breathe.</p>
<p>But not all newborn babies cry. And it’s not always something to be worried about.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-is-it-true-that-male-seahorses-give-birth-92843">Curious Kids: Is it true that male seahorses give birth?</a>
</strong>
</em>
</p>
<hr>
<h2>Why don’t all babies cry?</h2>
<p>Sometimes this switch to moving oxygen around the body just like us <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/persistent-pulmonary-hypertension#:%7E:text=In%20persistent%20pulmonary%20hypertension%2C%20also,difficult%20birth%2C%20or%20birth%20asphyxia.">does not happen smoothly</a>.</p>
<p>There might be problems with the baby’s heart, or there may have been a difficult birth. For instance, the baby might have been very short of oxygen in the womb and need some help to start breathing when they are born. </p>
<p>Sometimes there’s a delay in babies crying. </p>
<p>Babies born by caesarean section – when doctors operate on the mum to lift the baby out of her womb – might be <a href="https://link.springer.com/article/10.1007/s00404-019-05208-7">slower</a> to breathe and cry. That’s because they don’t have the fluid squeezed from the lungs like they do when born through the vagina. </p>
<p>Sometimes newborn babies don’t cry at all.</p>
<p>Babies born in water (known as a <a href="https://www.bellybelly.com.au/birth/doulas/preparing-for-a-water-birth/">waterbirth</a>) may have lots of warm water around them and not even realise they are born. That’s because they don’t feel cold air as they come into the world; they are often in their mother’s arms in the water. So they tend to just <a href="https://www.sarawickham.com/questions-and-answers/whats-an-aqua-apgar/">breathe quietly</a>, and turn pink (showing they are getting enough oxygen), without crying.</p>
<hr>
<p><em>Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/205477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from NHMRC and ARC. She is affiliated with The Australian College of Midwives</span></em></p>Crying triggers changes in how a newborn baby gets their oxygen. But not all new babies cry, and it’s not always a problem.Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1270442019-11-18T11:41:04Z2019-11-18T11:41:04ZSleep-training and babies: why ‘crying it out’ is best avoided<figure><img src="https://images.theconversation.com/files/301782/original/file-20191114-26273-4r0nva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-crying-baby-boy-new-born-340818158?src=998c412c-af4e-4e9e-b681-b72a72b071c0-1-2">Shutterstock/FamVeld</a></span></figcaption></figure><p>A full night’s sleep will be near the top of many parents’ wish lists. Sleep deprivation <a href="https://psycnet.apa.org/record/2009-09621-004">is no fun</a> and many parents find themselves turning to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/mcn.12858">baby care books</a> that promise to train their child to sleep through the night. </p>
<p>These books promote a range of ideas. At the more extreme end, extinction – often known as “<a href="https://www.babysleepsite.com/sleep-training/sleep-training-from-no-cry-to-cry-series-part-5/">cry it out</a>” – involves putting the baby to bed and ignoring their cries (sometimes checking periodically to make sure they are not unwell or in danger). A <a href="https://www.happiestbaby.com/blogs/baby/avoid-crying-it-out-sleep-training">modified version</a> of this, often known as “controlled crying”, suggests parents should ignore cries for a set amount of time, before responding briefly to reassure their baby, gradually increasing the amount of time between checks. The idea is that babies will eventually realise no one is going to come – and sleep instead. </p>
<p>But there are two main issues with both variations of this sleep training. Babies can become distressed during longer periods of crying, with <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/dev.20248?casa_token=JWzdwg3VudMAAAAA:H02ezajDvlB2bk-QY5wp6dWJRzPCiUU0XJ6rO_nGn9FuZgOdBKTuForZsNiHxmwUPRAnG-t61LUP">raised levels of stress hormones</a>. In addition, not responding to a baby’s cries goes against everything we know about building <a href="https://www.simplypsychology.org/bowlby.html">positive attachment relationships</a>. Babies who learn that someone will respond to their needs, in a loving and appropriate way, typically go on to have better <a href="https://apps.who.int/iris/bitstream/handle/10665/42878/924159134X.pdf">social, emotional and educational</a> outcomes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/301785/original/file-20191114-26262-vhl2ir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301785/original/file-20191114-26262-vhl2ir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301785/original/file-20191114-26262-vhl2ir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301785/original/file-20191114-26262-vhl2ir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301785/original/file-20191114-26262-vhl2ir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301785/original/file-20191114-26262-vhl2ir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301785/original/file-20191114-26262-vhl2ir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">To cuddle or not to cuddle, that is the question.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-comforting-newborn-baby-son-nursery-624521201?src=f5e5ea33-5839-4a7d-aa08-340fd6e44d47-1-5">Shutterstock/MonkeyBusinessImages</a></span>
</figcaption>
</figure>
<h2>The research explained</h2>
<p>Research into these methods has shown <a href="https://www.sciencedirect.com/science/article/pii/S1087079210001322">mixed results</a>, mainly because many parents find leaving their baby to cry <a href="https://academic.oup.com/sleep/article/29/10/1263/2709180">too distressing</a>. This is unsurprising. <a href="https://theconversation.com/are-we-hardwired-to-pick-up-crying-babies-86162">Parents are hardwired</a> to want to respond to their baby’s cries. Other research suggests that such techniques may <a href="https://cdn.journals.lww.com/jrnldbp/Abstract/2013/09000/Behavioral_Sleep_Interventions_in_the_First_Six.7.aspx">only work temporarily</a> or only work for some babies. </p>
<p>In one study that examined whether <a href="https://www.tandfonline.com/doi/abs/10.1080/03004430.2017.1378650">mothers implemented sleep training</a> advice in books, the advice only worked for around 20% of babies. Most struggled to follow the guidance or it had no impact, leaving them feeling frustrated and even like a failure. </p>
<p>One reason why sleep training might not work is because waking at night is <a href="https://www.bmj.com/content/346/bmj.f2344.full">developmentally normal</a> for most babies throughout their first year. Even adults sometimes have difficulties sleeping through the night and <a href="http://sleepeducation.org/news/2014/03/10/insomnia-awareness-day-facts-and-stats">insomnia is a common complaint</a>. But, unlike babies, adults are able to meet their own needs. If we do wake, we can get ourselves a drink, pull the covers back or rationalise our thoughts. </p>
<p>In addition, some parents may be getting confusing advice, as research headlines don’t always give the full picture. One trial randomised mothers who felt their baby had a sleep problem to either <a href="https://pediatrics.aappublications.org/content/133/2/e346">behavioural sleep training techniques</a> or “usual care”. Those in the sleep training group reported better mental health and fewer sleep problems at one year. But those mothers were also taught about normal infant sleep and given an opportunity to chat to a nurse about their worries and ideas for self-care.</p>
<p>At the end of the trial, mothers rated “having someone to talk to” as the most useful thing. Is this evidence that rather than trying to teach babies to sleep, there should be more <a href="https://www.holisticsleepcoaching.com/post/drowning-not-waving-why-holistic-sleep-coaching-is-necessary-in-a-crisis">support for new families</a> instead? </p>
<h2>So what does work?</h2>
<p>If you are reading this as a sleep-deprived parent, do not despair. There are <a href="https://www.holisticsleepcoaching.com/blog">gentler ways to help your baby sleep better</a> that do not involve listening to your baby cry. And the good news is that responsive sleep support can be just as effective and less stressful for everyone. </p>
<p>First, understanding the sleep needs and circadian rhythms of the baby can go a long way towards optimising sleep. There are two sleep regulating mechanisms in the human body. The first is <a href="https://www.sleep.theclinics.com/article/S1556-407X(12)00067-7/abstract">the Circadian rhythm, or body clock</a>. This is regulated by exposure to light, noise, activity and social cues at the right time of day. Getting outside in the daytime and having a predictable darkening of the room one to two hours before bedtime can really help. Some parents find a predictable routine that signals bedtime helps (having a bath, getting changed and maybe a soothing story or song). </p>
<p>The second regulating mechanism is something known as “<a href="https://psycnet.apa.org/record/2014-12063-001">homeostatic sleep pressure</a>”. The drive to sleep (when your eyes start drooping) builds during wakeful hours. The younger we are, the less time we can manage awake. So, understanding how to support babies to take regular naps to prevent them from becoming overtired makes a big difference.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/301988/original/file-20191115-66925-1chthv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301988/original/file-20191115-66925-1chthv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301988/original/file-20191115-66925-1chthv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301988/original/file-20191115-66925-1chthv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301988/original/file-20191115-66925-1chthv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301988/original/file-20191115-66925-1chthv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301988/original/file-20191115-66925-1chthv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Napping is crucial to developing good sleep at night.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-baby-girl-sleeping-nursery-cot-627695969?src=b01f9b2f-6405-4755-a08d-c5d584859849-1-15">Shutterstock/MonkeyBusinessImages</a></span>
</figcaption>
</figure>
<p>This is easier to achieve when you learn to recognise your baby’s <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/imhj.21455">sleep, feeding and other cues</a>. Understanding these cues helps parents to spot when their baby is ready for sleep, before they become overly tired and frustrated. It also helps deepen the bond between parent and child. Being able to accurately interpret a baby’s need for more action, quiet time, food, cuddles or sleep will mean that parents are more in tune with them. No book can tell a parent what their baby needs right now. This can only be learned through observation and trial and error.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/babies-dont-need-sleep-coaches-but-sometimes-their-parents-do-70464">Babies don’t need sleep coaches – but sometimes their parents do</a>
</strong>
</em>
</p>
<hr>
<p>Finally, <a href="https://academic.oup.com/sleep/article/37/8/1295/2416809">decreasing parental stress</a> can make a huge difference to sleep. The more we worry about sleep, the worse it gets. Little things like accepting what’s normal, taking time for self-care and accepting offers of help, not only make it easier to feel more rested and able to cope, but can also rub off on the baby. Babies are masters at <a href="https://journals.sagepub.com/doi/abs/10.1177/0956797613518352">responding to emotional states</a>, so parents will probably find that their baby is easier to settle and sleeps better when they take care of their own emotional well-being.</p>
<p>And if you are one such sleep-deprived parent, please remember: your baby will not be like this forever – they <em>will</em> sleep one day.</p><img src="https://counter.theconversation.com/content/127044/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received research funding from the ESRC, NIHR, Public Health Wales, the Breastfeeding Network and First Steps Nutrition Trust. She is author of four books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' , 'The Positive Breastfeeding Book' and "Informed is best'</span></em></p><p class="fine-print"><em><span>Lyndsey Hookway is the co-founder and clinical director of the Holistic Sleep Coaching Program and the author of Holistic Sleep Coaching, published by Praeclarus Press. She is affiliated with the Lactation Consultants of Great Britain for whom she works on a voluntary ad hoc basis.</span></em></p>Many baby books promote sleep-training methods that involve leaving babies to cry at night. But there are gentler ways to get a good night’s sleep.Amy Brown, Professor of Child Public Health, Swansea UniversityLyndsey Hookway, PhD in Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779432017-09-11T19:41:21Z2017-09-11T19:41:21ZEssays on health: Australia is failing new parents with conflicting advice – it’s urgent we get it right<figure><img src="https://images.theconversation.com/files/181928/original/file-20170814-28487-1h0x1q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Much of the baby's distress, as well as that of the parents, can be prevented.</span> <span class="attribution"><a class="source" href="https://unsplash.com/search/photos/baby?photo=EpbIXGCrtK0">Janko Ferlič/Unsplash</a></span></figcaption></figure><p>Every year, hundreds of thousands of Australians embark on a disorienting, life changing journey. They have a baby.</p>
<p>What happens after a woman gives birth should be a matter of serious public interest. Screaming babies, breast pain, baby weight-gain worries, breastfeeding issues, wind, colic, reflux, allergies, tongue tie, sleep deprivation, and parental anxiety and depression. These are common concerns at the beginning of the life of every Australian citizen. </p>
<p>In reflecting on these, we’re actually considering the developmental origins of disease. This is so for many reasons, including that the infant gut microbiome <a href="https://www.ncbi.nlm.nih.gov/pubmed/26663826">affects</a> metabolism and immunity even as an adult, and that postnatal depression has <a href="https://www.ncbi.nlm.nih.gov/pubmed/25455250">long-term effects</a> on a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412485/">child’s cognitive potential and mental health.</a></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gut-instinct-how-the-way-youre-born-and-fed-affect-your-immune-system-65104">Gut instinct: how the way you're born and fed affect your immune system</a>
</strong>
</em>
</p>
<hr>
<p>Throughout the developed world, <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/AFF3C1C460BA5300CA257BF0001A8D86/$File/NFUCFHS.PDF">non-communicable diseases</a> are now the <a href="http://adc.bmj.com/content/early/2016/08/29/archdischild-2016-310991">major cause of illness</a> and death in children, mirroring trends in adults. Among these, immune, gut, developmental disorders and mental illness feature prominently. All are shaped by environmental factors in very early life.</p>
<p>Yet, our health professionals often recommend approaches to behaviour problems in infants - such as with <a href="https://www.ncbi.nlm.nih.gov/pubmed/27286289">breastfeeding</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24372749">crying</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26257315">fussing</a>, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/26555938">sleep</a> - that have been demonstrated to be ineffective. Some <a href="https://www.ncbi.nlm.nih.gov/pubmed/23905907">recommendations</a> actually <a href="https://www.ncbi.nlm.nih.gov/pubmed/26895966">risk worse health outcomes</a> for both the mother and baby.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What happens after a woman gives birth is a matter of serious public interest.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>From the moment their baby is born, Australian parents receive vastly conflicting advice from <a href="https://www.ncbi.nlm.nih.gov/pubmed/22951297">different health disciplines</a>, or even from different health professionals in the one discipline. Confusion during an already challenging life transition drives parents to seek <a href="https://www.ncbi.nlm.nih.gov/pubmed/21679331">opinions from multiple providers</a>: the GP, paediatrician, midwife, child health nurse, pharmacy nurse, lactation consultant, dentist (yes dentist), and the emergency department. Many visit complementary and alternative medicine practitioners.</p>
<p>Yet <a href="https://www.mja.com.au/journal/2016/205/2/prioritising-general-practice-research">less than 2%</a> of the National Health and Medical Research Council funding goes to research into primary care, the first port of call for new parents. Research performed in hospitals or specialised settings, including concerning issues of early life care, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221610/">often isn’t relevant in the community</a>. We must take primary care research seriously if we want to ensure parents are provided with consistent, evidence-based advice that is beneficial to the baby, themselves and society at large.</p>
<h2>Breastfeeding confusion</h2>
<p>Up to <a href="http://www.health.gov.au/breastfeeding">96% of Australian women</a> want to breastfeed at the time of the birth. Women want to breastfeed so much that not being able to do so <a href="https://www.ncbi.nlm.nih.gov/pubmed/25305429">affects their mental health</a>. Yet multiple studies demonstrate <a href="https://www.ncbi.nlm.nih.gov/pubmed/25864129">serious gaps</a> in health professional training in the two most common post-birth problems: <a href="https://www.ncbi.nlm.nih.gov/pubmed/28167998">breastfeeding difficulty</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/22951297">unsettled</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26257315">infant</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/24372749">behaviour</a>. Both <a href="https://www.ncbi.nlm.nih.gov/pubmed/25305429">increase</a> a woman’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/19432839">risk of postnatal depression</a> and are <a href="http://www.bmj.com/content/343/bmj.d7772">linked with</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26869575">poorer infant outcomes</a>.</p>
<p>Undiagnosed problems with the baby latching on to the breast and finding a stable position during breastfeeding (which I call “fit and hold”) can lead to a range of distressing infant behaviours. These include back arching, refusing or fussing at the breast, crying, poor weight gain and excessive night waking. These signs of positional instability are often thought to be signs of reflux and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23495859">treated with acid medications</a>. But evidence shows these medications <a href="https://www.ncbi.nlm.nih.gov/pubmed/25556017">don’t help</a> the problem.</p>
<p>Existing approaches used to support fit and hold, including letting the baby find their own way to the breast, don’t <a href="https://www.ncbi.nlm.nih.gov/pubmed/27286289">improve outcomes</a> for many. Common advice, such as using one hand on the back of the baby’s neck while the other creates a particular shape of the breast, has been shown to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26895966">increase nipple pain</a>. </p>
<p>I commonly see women who have been told by multiple professionals their fit and hold is good, even though the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24075595">baby’s behaviour communicates</a> inability to fit stably into the mother’s body. That is, the baby is showing their <a href="https://www.ncbi.nlm.nih.gov/pubmed/18243594">position is uncomfortable</a> or there is a drag of breast tissue pulling in another direction in the baby’s mouth, in conflict with the inward pull created by the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26928319">vacuum when the jaw drops</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Australian mothers need more support to breastfeed.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Oral tie ‘epidemic’</h2>
<p>Then there’s the issue with tongue tie, upper lip tie, and buccal (cheek to gum) tie. This is another way health professionals are dealing with breastfeeding problems and unsettled behaviour – by referring the child for oral surgery. A classic tongue-tie needs a simple scissors snip. But normal <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas%20BFM%202013.pdf">variations of the frenulum</a> - the bits of connective tissue under the tongue and upper lip - are these days <a href="https://www.smartspeechtherapy.com/wp-content/uploads/2017/04/Three-experienced-lactation-consultants-reflect-upon-the-oral-tie-phenomenon.pdf">often labelled abnormal</a> and blamed for problems. </p>
<p>If we put aside the situation of a classic tongue-tie, the belief cutting or lasering the frenula (called a frenotomy) helps breastfeeding is <a href="http://www.cochrane.org/CD011065/NEONATAL_surgical-release-tongue-tie-treatment-tongue-tie-young-babies">not supported by research</a>. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28614671">Our work</a> suggests that diagnoses of normal variants of connective tissue as abnormal are based on an <a href="https://www.ncbi.nlm.nih.gov/pubmed/26928319">outdated and inaccurate</a> model of how infants attach to the breast.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/deep-cuts-under-babies-tongues-are-unlikely-to-solve-breastfeeding-problems-54040">Deep cuts under babies' tongues are unlikely to solve breastfeeding problems</a>
</strong>
</em>
</p>
<hr>
<p>Parents are <a href="http://tonguetie.net/consequences/">sometimes warned</a> if the baby doesn’t have a frenotomy for the diagnoses of posterior tongue-tie or upper lip-tie, their baby is at risk of speech and swallowing problems, expensive orthodontic problems, sleep disorders and other developmental problems in later childhood, though <a href="http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2015-0658">there is no evidence</a> to support these claims. </p>
<p>There are now studies demonstrating that the diagnosis of “oral ties” in breastfeeding babies has reached epidemic proportions in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28168891">United States</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27280112">Canada</a>. Exponential increases in frenotomy rates are also evident in our team’s analysis of early Australian Medicare data (yet to be published). Many, if not most, frenotomies are <a href="https://www.smartspeechtherapy.com/wp-content/uploads/2017/04/Three-experienced-lactation-consultants-reflect-upon-the-oral-tie-phenomenon.pdf">performed by dentists</a> using laser, and are not captured by Medicare. </p>
<p>I regularly see <a href="https://griffithreview.com/articles/tongues-tied-about-tongue-tie/">babies after laser surgery</a> with worsened breastfeeding problems. Sometimes their <a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.12773/abstract">wounds become infected</a>. I often see pale cords of scarred tissue under the tongue. I have also seen the underbelly of a little tongue somewhat separated by a too-deep cut. I have seen suture knots hanging from a newborn’s upper gum after scissors frenotomy. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=612&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=612&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=612&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Breastfeeding problems are often blamed on the baby’s frenulum - the bit of connective tissue under the tongue and upper lip.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>The tongue-tie epidemic hasn’t come from a sudden burst of new congenital abnormalities in the mouths of infants in the English-speaking world in the past ten years, as <a href="http://mthfr.net/the-intersection-of-tongue-tie-mthfr/2014/05/23/">some proponents argue</a>. The epidemic parallels broader <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32585-5/abstract">international trends of medical overtreatment</a> and is, in my mind, a painful sign clinical breastfeeding support is in crisis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-rein-in-the-widening-disease-definitions-that-label-more-healthy-people-as-sick-76804">How to rein in the widening disease definitions that label more healthy people as sick</a>
</strong>
</em>
</p>
<hr>
<h2>The importance of sleep</h2>
<p>Parents are also being advised their child’s healthy development and their own wellbeing depends on implementing sleep training. This includes strategies such as: don’t breastfeed your baby to sleep; don’t let the baby get overtired or overstimulated; put the baby down in the cot at the first tired sign; teach the baby to self-settle in the cot; make sure the baby is getting big blocks of sleep instead of catnapping during the day; and use feed-play-sleep cycles. </p>
<p>Technically known as <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Whittingham2014_Optimising%20parent-infant%20sleep%20from%20birth%20to%206%20months%20a%20new%20paradigm.pdf">first wave behaviourism</a>, these approaches arose in the 1950s and 1960s. Girls like me were taught them in the 1970s in compulsory mothercraft classes at high school – a long time before the emergence of evidence-based medicine. </p>
<p>But now, <a href="https://www.nhmrc.gov.au/book/promoting-social-and-emotional-development-and-wellbeing-infants-nhmrc-report-evidence-5">high-level evidence</a> demonstrates these approaches do not <a href="http://www.smrv-journal.com/article/S1087-0792(15)00100-8/abstract">decrease night waking</a> or reliably improve women’s mental wellbeing in the first year of life, and especially not in the <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas_Hill%20JDBP%20%2023_9_13.pdf">first six months</a>. </p>
<p>A <a href="http://onlinelibrary.wiley.com/doi/10.1111/bjep.12109/abstract">small subgroup of babies</a> with sleep problems go on to have sleep problems in later childhood. The evidence <a href="https://www.ncbi.nlm.nih.gov/pubmed/22748447">does not support</a> the idea that applying sleep training in the first year will prevent this, yet I hear parents are often told if the baby doesn’t get enough sleep, or if they let “bad habits” grow, their baby’s development and capacity to learn in later childhood will suffer. The threat they are doing the wrong thing if they don’t sleep train <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934563/">heightens parental anxiety</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents are advised their baby’s healthy development depends on implementing conventional sleep strategies.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/sleeping-baby?photo=WCbCRXk7nmU">Carlo Navarro/Unsplash</a></span>
</figcaption>
</figure>
<p>In my experience in general practice, where I’ve had the privilege of following many families over months and years, first wave behavioural approaches cause parent-baby communication confusion, and also unnecessarily disrupted nights for many, due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312214/">disruption of the baby’s circadian clock</a>. </p>
<p>In Australia, many sleep-deprived mothers seek help from <a href="https://www.stayathomemum.co.uk/my-kids/behaviour/sleep-schools-in-australia">residential sleep schools</a>. Some are even referred there by health professionals if the baby just <a href="http://www.saveoursleep.com.au/free-reading/triggers-sleep-problems/">catnaps during the day</a> and doesn’t go to sleep alone in the cot, due to fear of developmental implications. Yet only families with the most severe problems should require this hospital-based solution, which is extremely expensive to the health system. </p>
<h2>So, what are the solutions?</h2>
<p>We have enough evidence to show what works. For instance, <a href="http://www.cppah.com/article/S1538-5442(11)00049-6/pdf">latest research</a> tells us it is important to respond to our baby’s cues for the baby to develop secure psychological attachment. Babies should not be left to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113571">grizzle or cry</a> as a pattern over time, and breastfeeding to sleep is one sensible tool for making the days and nights manageable. </p>
<p>It’s also important to know about the young human’s biological need for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223372/">rich sensory nourishment</a>. This means encouraging parents to enjoy a social life outside the house, trusting that the baby’s biological sleep regulators will take whatever sleep he or she needs with minimal effort on the parent’s part.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents should trust the child’s natural sleep sensors will kick in when he or she is tired.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We’ve developed an <a href="https://education.possumsonline.com/sleep-film">alternative parent-baby sleep program</a>. This repairs <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Whittingham2014_Optimising%20parent-infant%20sleep%20from%20birth%20to%206%20months%20a%20new%20paradigm.pdf">unnecessary disruption to night-time sleep</a> either by identifying underlying breastfeeding problems in younger babies, or by helping to reset the circadian clock, which is commonly disrupted by the first wave behavioural focus on long blocks of sleep during the day. </p>
<p>And breastfeeding problems can resolve when women are <a href="https://www.ncbi.nlm.nih.gov/pubmed/28614671">helped to stabilise</a> the way their and their baby’s <a href="https://education.possumsonline.com/programs/gestalt-breastfeeding-online-program">unique anatomies fit together</a>. This is when the baby’s breastfeeding reflexes are turned on, his or her face is symmetrically buried into the breast, and as much breast tissue as possible is drawn deep into the baby’s mouth without a drag in another direction. </p>
<p>Our programs have a well-developed and published evidence base, and <a href="http://www.publish.csiro.au/PY/PY13011">promising preliminary evaluations</a>. Obviously, these require bigger trials. But there is too little funding available for clinical primary care research. The UK’s <a href="https://www.nuffieldtrust.org.uk/">Nuffield Trust</a> recently issued <a href="http://adc.bmj.com/content/101/12/1084">a report</a> advising that if we are to care for our children’s health needs in a sustainable health system, models need to shift the focus from hospital-based care to integrated child health care in community settings.</p>
<p>Investing in primary health care <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12348/abstract">has been demonstrated</a> to be more effective, at a fraction of the price of treating problems in hospitals. Just a single visit to an Australian hospital’s emergency department costs the tax-payer <a href="https://theconversation.com/medicare-spending-on-general-practice-is-value-for-money-33948">ten times</a> the cost of a visit to a GP. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/medicare-spending-on-general-practice-is-value-for-money-33948">Medicare spending on general practice is value for money</a>
</strong>
</em>
</p>
<hr>
<p>We can’t expect hospital-based parenting support centres to improve outcomes when mothers and babies are seen there by health professionals who continue to offer conflicting advice. It would be much cheaper and more cost effective to invest in freely accessible, evidence-based, perinatal services in a family’s own community, co-ordinated by their own GP.</p>
<p>In view of the health system costs and tsunami of mental health problems and chronic disease, this is a matter for urgent political and health system attention.</p><img src="https://counter.theconversation.com/content/77943/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Pamela Douglas is Medical Director of a charitable organisation, the Possums Clinic <a href="http://www.possumsonline.com">www.possumsonline.com</a> (Possums for Mothers and Babies Ltd). Possums Education sells two educational products online, the Gestalt Breastfeeding Online Program and the Possums Sleep Film (also available as a DVD). All proceeds are invested into the development of further educational materials.</span></em></p>From the moment their baby is born, Australian parents receive conflicting advice on how to cope with newborn issues. What we are doing wastes our resources, but we’re not investing in alternatives.Pamela S Douglas, General Practitioner, Researcher, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/632452016-08-30T07:35:17Z2016-08-30T07:35:17ZWhy it’s so hard to ignore a baby’s cry, according to science<figure><img src="https://images.theconversation.com/files/135475/original/image-20160825-6595-981zwe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">That noise is far more sophisticated than it sounds.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-330367088/stock-photo-crying-baby-girl.html?src=7IxJ0dyhYy-BiDVgEKrUyA-1-16">Shutterstock</a></span></figcaption></figure><p>Have you ever been sat on a flight with a crying baby in your vicinity, wondering more and more with each successive wail how much longer you can stand the sound? Or maybe you’ve been a parent, barely able to resist for a second before running to soothe your precious infant’s ear-piercing distress? Most of us have been there at some point in our lives. But what exactly is it about a baby’s cry that makes it so hard to ignore?</p>
<p>First, it is important to draw a distinction between crying and tears. Many species produce cries, but we appear to be the only animals that send emotional droplets streaming down from our tear ducts. While tears often accompany cry vocalisations in older age, they are by no means a prerequisite of crying – newborns cry from birth but don’t produce tears until they are two to three months in age. It also turns out that these early cries have evolutionary roots separate from the more cultural, learned “emotional crying” that we develop in later life.</p>
<p>Crying is a primitive behaviour shared across mammals, whose governing mechanisms are rooted in the evolutionarily ancient brain stem – infant rats, cats, and humans have all been shown to be able to cry even when the forebrain, which evolved much later, is absent. Indeed, the cries of many <a href="http://cz.oxfordjournals.org/content/58/5/698.abstract">human and non-human mammal infants</a> are highly similar in both acoustic structure and in the contexts in which they occur – across the mammal kingdom, infants cry primarily when they’re hungry, when they’re in pain, and when they’re alone.</p>
<h2>Crying chemicals</h2>
<p>But why cry? As is the case with any primal vocalisation, crying evolved to have a specific impact on listeners. Plentiful research has shown these calls to <a href="http://www.sciencedirect.com/science/article/pii/S0006322311001399">specifically activate adults’ brain regions</a> important for attention and empathy. This makes them highly effective at grabbing the attention of caregivers and orienting them to provide company, safety, food, or comfort.</p>
<p>While research is in its early stages, oxytocin – popularly termed the “<a href="http://pss.sagepub.com/content/18/11/965.short">love hormone</a>” and central to the fostering of social bonds – seems to be at the neurochemical heart of this attention-grabbing behaviour. Infant distress results in reduced oxytocin and opioid levels, and <a href="http://journal.frontiersin.org/article/10.3389/fnhum.2012.00031/full#B100">evidence suggests</a> that this then triggers and escalates crying. When a mother hears these cries, this in turn causes an increase in her oxytocin levels and encourages care-giving behaviour.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/135479/original/image-20160825-6609-2p309l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/135479/original/image-20160825-6609-2p309l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=455&fit=crop&dpr=1 600w, https://images.theconversation.com/files/135479/original/image-20160825-6609-2p309l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=455&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/135479/original/image-20160825-6609-2p309l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=455&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/135479/original/image-20160825-6609-2p309l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=572&fit=crop&dpr=1 754w, https://images.theconversation.com/files/135479/original/image-20160825-6609-2p309l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=572&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/135479/original/image-20160825-6609-2p309l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=572&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Oxytocin time.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-98870129/stock-photo-happy-mother-with-baby.html?src=2DDbQfhiGJLvnCdfy_LWyA-1-0">Shutterstock</a></span>
</figcaption>
</figure>
<p>What little we know about father-infant bonding suggests a <a href="http://www.livescience.com/25391-oxytocin-boosts-father-baby-bonding.html">similar role</a> for oxytocin. Additionally, cries cause a <a href="https://theconversation.com/low-testosterone-may-make-you-a-better-father-61184">dip in testosterone</a> in empathetic men, facilitating nurturing behaviour. In fact, oxytocin may even <a href="http://www.nature.com/articles/nature14402.epdf?referrer_access_token=HwKYKJg2RickHd3kx57K4tRgN0jAjWel9jnR3ZoTv0M2Hd6p0I6p5-RIA8-UyCI4xY6nvuqWbT2NnKDnBaX8V6x0uIRhiZpenoNQpdw6I1TGfEWu0UQfPm82aTdK1L4QKXqi3WlU6PopVGDxXF_aQhROeQQ5OqfxLACOk9VX9OZ_j0KdR59OLcPapYOVNs2S6dRRlQukzZbkExDtStHaoINvSo4-7w6V4MckPxcUHzliUEMhwt8CCWnoe92gBudjKZMBlGI0I3tMZnUBhj4QzmiXPDDfprbulrWDjY-KDig%3D&tracking_referrer=www.theguardian.com">amplify the brain’s response</a> to cries, making us more likely to hear them and respond appropriately. Finally, when social contact is established, this stimulates oxytocin release in the infant, and crying behaviour ceases. Sometimes.</p>
<h2>The boy who cried deer</h2>
<p>Pitch is certainly important in drawing a response from caregivers – species of deer only come running to isolation cries possessing a pitch within a species-specific frequency range. But this frequency range is actually surprisingly wide – deer will <a href="http://www.jstor.org/stable/10.1086/677677?seq=1#page_scan_tab_contents">respond to the cries of infant seals, cats, and humans</a>, and even bats and marmots if the pitch of the call is manipulated to fall within that frequency range.</p>
<p>The response of deer to other species from which their evolutionary lineage diverged as much as 90m years ago isn’t as amazing as you might first think though – it really just illuminates our shared ancient history.</p>
<p>Mammals all descended from the same common ancestor, so the mammalian larynx (which produces pitch) is remarkably similar across species until puberty, when species-specific environmental pressures lead to major differentiation along sex and species lines in voice characteristics and vocal repertoires. Before that point, there is no evolutionary reason for any mammal to differentiate their voices from any other.</p>
<p>This similarity in calls affects the approach of caregivers. Many distress calls occur before mothers have had time to learn the specific vocal signature of their offspring through contact calls. With the succession of your genes possibly at stake, it therefore makes sense to respond to any cry that vaguely resembles your child. This and the <a href="https://www.researchgate.net/publication/301290738_Sex_stereotypes_influence_adults'_perception_of_babies'_cries">substantial variation</a> within members of the same species in cry pitch have oriented cries towards casting as wide a net of influence as possible.</p>
<h2>Chaos theory</h2>
<p>While we can distinguish cries from other vocalisations, we’re pretty bad at identifying the <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124317">specific motivation</a> behind a cry without accompanying contextual information – perhaps because there don’t appear to be reliable <a href="http://journals.lww.com/nursingresearchonline/Abstract/1991/05000/Acoustic_Discrimination_of_Three_Types_of_Infant.7.aspx">acoustic differences</a> between pained howls, hungry whines, and lonely wails.</p>
<p>What is represented, however, is the level of distress. As urgency increases, so do the maximum pitch and loudness, while the pause length between cries decreases. In addition, more of the sound wave’s energy becomes concentrated in higher frequencies, towards the range where both adult hearing is most sensitive, and where sound diminishes least rapidly in the environment. <a href="http://www.sciencedirect.com/science/article/pii/S0891422212000157">Across cultures</a>, we use these same acoustic attributes to accurately track distress, and this influences the urgency of our responses.</p>
<p>What really puts paid to ignorance, though, is unpredictability. Studies show that when babies are really distressed, their cries start to deviate from their predictable, tonal quality. Be it in the form of <a href="http://www.sciencedirect.com/science/article/pii/S0375960105003270">chaos</a>, otherwise known as turbulence or “roughness”, where the voice contains energy at random frequencies and has a scratchy quality (think <a href="https://www.youtube.com/watch?v=2hOwKmPzoj0">white noise</a>); <a href="http://pms.sagepub.com/content/86/3_suppl/1123.full.pdf+html">biphonation</a>, where the voice has two pitches; or <a href="http://www.nature.com/pr/journal/v55/n1/full/pr200421a.html">high variation in pitch</a> during a call, these vocal attributes are representative of a voice pushed to the limit.</p>
<p>This vocal regime is segregated from other signals, enabling faster and more accurate localisation of the sound source and <a href="http://www.sciencedirect.com/science/article/pii/S096098221500737X">engaging brain structures</a> critical to rapidly appraise danger. It has been suggested too that this unpredictability makes cries <a href="http://www.sciencedirect.com/science/article/pii/S0003347201919128">harder to habituate to and ignore</a> – which can you imagine falling asleep to more easily, a tonal cry or a chaotic one? When an infant is in serious pain or grave danger, it will do everything in its power to make its voice heard.</p>
<p>So now the next time you hear one of those delightful cries for help, you’ll understand a little better how it’s piercing its way into your brain, and just how deeply your discomfort is hardwired into you by evolution. Will that make it any easier to bear? Somehow, I doubt it.</p><img src="https://counter.theconversation.com/content/63245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jordan Raine does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>That deafening din was millions of years in the making.Jordan Raine, PhD Researcher, Nature and Function of Human Nonverbal Vocalisations, University of SussexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/629522016-08-17T20:28:36Z2016-08-17T20:28:36ZMy baby is crying. Is it colic? How can I help?<figure><img src="https://images.theconversation.com/files/132321/original/image-20160728-21569-i0ud5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are lots of theories about why babies cry excessively, but many of the over-the-counter remedies are ineffective. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Colic is a term used to describe a baby who is well, but who cries an excessive amount of the time. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">Formal definitions</a> describe it as a well-fed and otherwise well infant less than three months old who cries for more than three hours per day, for more than three days per week, for at least three weeks. Babies are affected from around three weeks of age, and usually improve by around three months. </p>
<p>Colic is often worse in the early evening and can affect up to <a href="http://www.ncbi.nlm.nih.gov/pubmed/27017027">20%</a> of babies. </p>
<p>Caring for babies with excessive crying or colic is very difficult, worrying, tiring and frustrating for parents. </p>
<p>Working out what is causing the crying and how to make a difference is not easy. Multiple factors are likely at play. As a result, treatment options are not very well understood - what works for one baby may not work for another. </p>
<h2>Is it the gut?</h2>
<p>One popular <a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">explanation</a> is that there is an increase of gas or other irritation in the gut causing windy pain and discomfort. The type of feeding doesn’t seem to influence whether a baby gets colic, but it does affect treatment suggestions. Adjusting a baby’s diet or gut bacteria to try to reduce any gas build up is often tried. </p>
<p>If a baby is breast-fed, some suggest adjusting mum’s diet to reduce any allergens (in particular dairy food), which may irritate the baby’s gut. There is <a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">no clear evidence</a> these changes make any significant difference. The risk of following these dietary changes is reducing nutrition for mum, and hence baby. Changing from breast feeding to formula feeding to treat colic is not advised.</p>
<p>If a baby is exclusively formula-fed, a trial of an alternative formula may be given. In particular, trying a formula where the milk proteins have been broken down to improve absorption (hydrolysed) <a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">may be helpful</a>. </p>
<p>Different types of <a href="http://www.ncbi.nlm.nih.gov/pubmed/26721871">bacteria</a> are found in the gut of a colicky baby compared to a baby without colic. To try to rectify this, probiotic supplements have been trialled in babies with colic.</p>
<p>Although <a href="http://www.bmj.com/content/348/bmj.g2107">one recent study</a> showed no effect, there is generally a trend toward reduced duration of crying time in babies treated with probiotics, in particular, <em><a href="http://www.ncbi.nlm.nih.gov/pubmed/26655941">L.Reuteri</a></em>. Probiotics are safe for use in babies, and may help reduce the features of colic. </p>
<h2>Is my baby overstimulated?</h2>
<p>Another explanation is that by the end of the day, the baby (used to the peace and quiet of the uterus for so many months) has “had enough”. Supporters of this theory advise parents to reduce stimulation of their baby to improve crying. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/132536/original/image-20160801-25634-8x344q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/132536/original/image-20160801-25634-8x344q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/132536/original/image-20160801-25634-8x344q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132536/original/image-20160801-25634-8x344q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132536/original/image-20160801-25634-8x344q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132536/original/image-20160801-25634-8x344q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132536/original/image-20160801-25634-8x344q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132536/original/image-20160801-25634-8x344q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Over-the-counter and home remedies have no proven effectiveness.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>In practical terms, this means keeping the baby away from bright lights and loud noises (and relatives), and lightly wrapping the baby. </p>
<p>The research on these interventions is split. Some studies show a <a href="http://www.ncbi.nlm.nih.gov/pubmed/10888690">reduction in crying</a>. </p>
<p>Provided a caregiver is still nearby or with the baby, there is little harm in this intervention, and it may be of <a href="http://www.bmj.com/content/316/7144/1563">benefit</a>.</p>
<h2>Is it a migraine?</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/27017027">Migraines</a> are often inherited. Mothers with migraines are more likely to have babies with colic, and colicky babies are more likely to have childhood migraines. It makes sense that some babies with colic may have a form of migraine. </p>
<p>Children with migraines often improve with reducing external stimuli, including turning down noise and lights, avoiding strong smells and going to sleep. Similar management can be applied to babies. This correlates well with the management of the “overstimulated baby” described above. </p>
<p>Medications can be of use in migraines, but in general they are avoided in babies due to safety concerns, and the potential for the medications themselves to <a href="http://www.ncbi.nlm.nih.gov/pubmed/27017027">worsen the migraine</a>. </p>
<h2>What about colic medications?</h2>
<p>The only medication which has <a href="http://www.ncbi.nlm.nih.gov/pubmed/9596593">proven benefit</a> in the treatment of colic (dicyclomine) comes with several serious side-effects including breathing difficulties, seizures and coma. It is unlicensed for use in babies in several countries. </p>
<p>Other over-the-counter medications have <a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">not been proven</a> to reduce crying.</p>
<p>Tea containing fennel may make some improvement, but the associated <a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">side-effects</a> such as vomiting and loss of appetite may have negative effects on a baby’s nutrition. </p>
<p>Some other herbal preparations for colic have been found to have serious side-effects such as <a href="http://www.ncbi.nlm.nih.gov/pubmed/26875753">liver failure</a> and should be avoided.</p>
<h2>Chiropractice?</h2>
<p>Although chiropractic care may be promoted as a treatment for colic, multiple reviews demonstrate any studies showing any benefit are <a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">not well designed</a>. </p>
<p>Well-designed studies show <a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">no benefit</a> of chiropractic treatment over being held by a nurse. </p>
<p>Worrying possible side effects such as rupture of arteries in the neck add to the advice that chiropractic treatment <a href="http://www.ncbi.nlm.nih.gov/pubmed/26581647">is not recommended</a> in the treatment of colic.</p>
<h2>So what can I do?</h2>
<p>Time cures colic. In the meantime, probiotics are a safe treatment, reducing stimulation may help a baby settle, a trial of hydrolysed formula may help (but don’t change to formula if you are breastfeeding) and other medications should be avoided. </p>
<p>Seek support. Caring for a baby with colic is hard. There is a <a href="http://www.ncbi.nlm.nih.gov/pubmed/15474137">higher rate</a> of dangerous actions such as shaking, smothering and slapping in crying colicky babies. Family and community supports differ in each area, but talking to your health-care professional will help you find support in your local area.</p>
<p>Remember, crying can be caused by many things, not just colic. If you are worried about your baby, it is very important to have your baby checked by a doctor or nurse before assuming this is colic.</p><img src="https://counter.theconversation.com/content/62952/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kirsten Thompson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Babies cry. A lot. But when does crying become colic, and what can we do about it?Kirsten Thompson, Senior clinical lecturer, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.