Every newborn and infant cries at some point. Though we would all agree it is normal for all little ones, it pulls on most of our heartstrings. I hear infants cry all day, every day—be it at home, in my practice, or in the emergency room. I never get used to it. Hearing my own kids cry, this is a whole other story for another time.
The most common concern I hear from parents at the 1 or 2 month visit is about their baby’s crying and fussiness. Hearing your baby cry is utterly exhausting and painful for new parents. One of the biggest challenges we have as new parents is to learn what the baby’s cry means so we can best soothe.
Technically, colic occurs when your baby cries more than three hours a day, more than three days a week, for more than three weeks. The definition is pretty arbitrary. We don’t usually know why these babies cry so much. This fussiness peaks around 4-8 weeks and fades with time. With no treatment your baby will stop crying as much. But these weeks can pass so slowly! The crying is unpredictable, but does usually occur within the same few hours each day, usually in the evening. Babies often seem to be in pain, though we usually can’t figure out the source.
Parents often look to me to provide suggestions of how to soothe their fussy baby. I wish there was a one-size-fits-all solution for all fussy babies. If this were the case, someone out there would have a Nobel Peace Prize. In fact, a systematic review published in the prestigious journal, Pediatrics, demonstrated that no individual complementary medicine treatment was consistently helpful at treating symptoms of colic. The reality is, there is nothing that works for everyone, but some tricks work for some children and other tricks work for others.
Here are my suggestions for how to calm a crying baby that worked for my kids. Remember, this is trial and error and not all tricks will help all babies. I liken 4-8 weeks of age to the fourth trimester where babies want to reproduce what it was like in the womb. This means being held/cradled/saddled tightly, with gentle movement and sound, like it was in mom’s tummy.
1. Ensure your baby is well fed—hunger is a common cause of crying.
2. Try to burp your baby—gas pains can be painful and irritate your baby.
3. Ensure your baby has a clean diaper.
4. Make sure your baby is dressed appropriately—is she too hot or too cold?
These suggestions you have likely considered. They are just a reminder.
Though there is some recent debate about the safety of white noise, thus far I do not see any compelling evidence that white noise (such as the sound of running water or ocean waves) at a low sound level and for only a few minutes or hours a day is harmful. See more on sound machines.
When you were pregnant, your baby was shaking all the time. When you were walking, exercising, and even just lying around, as the blood flow was pumping from your heart it was shaking the baby. Many babies like this type of movement outside the womb, too. Baby wearing or using a vibrating chair or swing (my kids’ favourite) can help the baby relax.
Another hotly debated topic. I personally like swaddling babies to prevent the startle reflex (Moro response), which often wakes them up from sleep. The caveat is that babies should only be sleeping on their backs and there should be no material (blanket, fabric, or pillows) near the baby’s face. I swaddle from the shoulders down to minimize suffocation.
Many babies like to suck and do so to sooth themselves. For babies that are gaining weight well and have no breast feeding difficulty (if mom is breastfeeding), using a pacifier can help settle your baby. Read more on pacifier use.
Some parents swear by Ovol (Simethicone) or Gripe Water. There is no consistent evidence that shows these are effective, but they don’t seem to cause ill effect either. Try each one out and hope for some colic relief.
Respite is the most important thing. Take some moments or hours to yourself, if you are lucky enough to have a friend or family member who can watch your baby. Sleep deprivation and missing socializing and exercising can lead you to feel even more drained and out of control. Take some "me" time if you can.
If you are concerned that something more significant is wrong with your baby, please see your doctor. Bladder infections, reflux (heart burn), food intolerance, and other medical problems can cause significant crying, and it’s best to ensure no medical reason for crying if your strategies aren’t working.
Colic is difficult to treat and needs a trial-and-error approach. The good news—it invariably resolves with time, you just need some patience. Please speak to your doc with any concerns or questions you have around your baby’s crying to ensure you aren’t missing a medical cause. Read more on how much sleep your baby needs.
How To Interpret Your Baby's Cries: Learn how to understand your baby's language during your first months together.
Are you a sleep deprived mom of a newborn? Here are 6 Ways To Get Your Newborn To Sleep At Night.
Lately the news is filled with stories about a scary new virus that is making many kids across the United States and Canada unwell. It is called Enterovirus-68 or EV-68. I am finding mass alarm at the Hospital for Sick Children and in my office, with many parents not knowing if their child is affected, what to do about infection and how to prevent the spread.
EV68 is one of hundreds of enteroviruses, including such viruses as coxsackieviruses (that cause hand-foot-and-mouth disease) and polioviruses. They generally cause symptoms of a common cold, with runny nose, congestion, cough, fever and diarrhea.
For the last 50 years, EV-68 has causes sporadic outbreaks in the United States, the Philippines, Netherlands, and Japan. We generally see these outbreaks in entero-viruses season, typically August-September. This outbreak is hitting hard, with many children and adults affected, with some becoming quite ill. Children less than 5 years of age, those with a history of asthma and immunocompromised people are most at risk of illness.
By mid-September we have seen thousands of confirmed cases across the US and Canada, with many more not confirmed with testing.
EV68 starts as a common cold, with runny nose, sore throat, cough and fever. If the disease progresses, difficulty breathing, decreased urine production, lethargy and dehydration can occur. Some kids develop skin rashes, diarrhea and abdominal pain. A few children have developed paralysis.
As EV68 is a virus, antibiotics do not help. There is no specific treatment for the illness. We are left to treat symptomatically, and wait for the virus to run its course. The vast majority of patients will recover fully and will not require hospital care. This is what you need to know about treating viral infections and colds.
EV68 has indeed made some kids sick. This is rare and most infected kids will develop common cold symptoms only. If your child becomes unwell, please see your doctor to rule out serious illness like pneumonia. If your child has asthma or recurrent chest infections, please be extra diligent about asthma care. Cover your mouth and nose if you are ill and wash your hands often – this is good practice all year, but especially during cold season. And, don’t panic!
“Grab some clean towels and boil the water, my water broke.”
This is hardly the reality for moms-to-be nowadays, at least not in major cities. There is a plethora of options—some people choose to have a midwife birth their baby, others a doula, and many more a physician. The choices don’t end there, as you can use a family physician, the standard in most Canadian cities, or an obstetrician. There are many further options, including hospital versus home delivery and medication options. We’ll leave those for another time.
When I was pregnant with my first child, I was in the midst of a Pediatric Emergency Medicine Fellowship in Toronto. I was working at the Hospital for Sick Children, conveniently located across the stress from Mount Sinai Hospital. Many of my friends and colleagues had positive experiences using obstetricians there. It seemed a no-brainer to see one of them for my pregnancy and delivery care. My family doc was a drive away, and Mount Sinai a brief walk.
Now, I had a very strange, unpredictable delivery. I was dilated for weeks before I delivered Dylan, my first. My obstetrician, a no-nonsense, tell-it-like-it-is woman (which I truly value), thought it best to break my water in hospital. She wanted to deliver Dylan and worried that my labour would be fast. She was right, but still didn’t deliver him.
My water was broken and she left to do a Caesarean Section. She didn’t think it possible that I would go into active labour before she returned in an hour. This was my first pregnancy, after all. She was wrong. I went into immediate, intense labour and with no doctor in the room, Dylan came out within two hours. No time for an epidural. No doctor was in the room, leaving my husband to catch him. If you don’t believe me, I have the video to prove it. My husband had the video camera in one hand and caught Dylan with the other—how’s that for a visual?
As it turns out, I didn’t actually need anyone in the room to help us, let alone an obstetric specialist! For many women, a midwife and/or doula could actually be superior and provide more holistic care.
What is a midwife?
A midwife is a registered health care profession who provides primary care to low-risk pregnant women throughout the pregnancy and for 6 weeks after delivery. Registered midwives in Ontario complete a four-year university degree through the Ontario Midwifery Education Program, and they complete a mentorship year before they practice on their own. They are available to clients 24 hours a day and seven days a week. If you see a midwife in Ontario, you will not see a physician unless there are complications during pregnancy.
Midwives are involved in all aspects of pregnancy and help with both non-medical and medical issues. Many midwives are former nurses and in Canada they train through the Canadian Association of Midwives (CAM). Midwife care is covered in Ontario, and there is no need to pay out of pocket.
What is a doula?
Doulas are assistants who provide emotional and some physical support during childbirth. They only provide non-medical help to moms. They are certified through various institutions, such as DONA and CAPPA. Doulas, like midwives, are involved in both pre- and post-partum care. Doula support is not covered in Ontario, and parents must pay out of pocket for their services. Depending on what support parents need, these prices are variable. Doulas work alongside physicians and midwives, so if you have a doula you need a midwife or doc, too.
What do physicians do?
Physicians follow patients every 2-4 weeks during the pregnancy, usually from 12 weeks onwards. The care provided by a family physician and obstetrician tend to be the same, unless the pregnancy is deemed high-risk, in which case more investigations and more frequent appointments may be required. Though some physicians provide tremendous emotional support, most follow the pregnancy with a medical focus with minimal to no holistic support.
Though women usually describe being followed by a physician, nurses perform most hospital-based care. Some women are even followed by Nurse Practitioners who act independently to provide care throughout pregnancy. Nurses are usually the health care providers who are present with mom during labour and provide most postnatal care. They assist the physician during active labour and delivery.
I initially chose a physician and have developed a relationship with her and seen her for each of my pregnancies. I relate to her very well and am comfortable with her style and no-nonsense attitude. Despite missing delivering Dylan, when she came into the room for Ryan’s delivery, she looked at me and said, “Why haven’t you started pushing?” That labour was also short and sweet.
I do always consider using a midwife or doula as well in pregnancy, though I don’t think I require as much emotional support now as I did with my first. Perhaps I am more of my own 'expert’ now and know what I want and need. Depending on what you plan and expect from your caregiver during pregnancy and delivery, you can best chose the provider.
What kind of provider did you use? Would you use the same person or service next time?
Before you make any decisions, read this: Home Birth vs Hospital Birth.