Discerning your baby’s cry

John Muturi

Many new parents get distressed when they suspect their baby is in pain. The good news is that once you are familiar with your baby, it becomes easier to distinguish between normal and pain cries, by her pitch and movements.

A pain cry is different from an everyday cry in several ways. Research carried out at Liverpool John Moores University suggests that there are tiny, subtle movements in babies’ bodies, fingers, toes and faces that may indicate extreme pain.

For instance, a pain cry is normally high-pitched, continuous and sounds urgent as the baby is calling out for help. The accompanying body language will tell you the baby is in pain — the baby could squeeze her eyes together, make a bulge of flesh between the eyebrows and squeeze her eyes shut. She or he may also pull their mouth very taut, horizontally and vertically, making a boxy shape, with deep creases running down from the edges of his nostril to his mouth.

The baby’s body will be tensed and the limbs thrashing. She or he will be sleepless, refuse to feed or suck, won’t respond to being consoled and looks ‘different’ — it is not the baby you are familiar with.

Newborns on the other hand make quick, sharp movements. Their arms and legs are usually stiff, legs pulled up towards the stomach, toes and fingers curled and the thumb may be held inside the fist and are generally jittery.

Older babies will hint by touching the sore area or will withdraw if you touch it, while at the same time grimacing.

Comforting your baby

The way you soothe you baby is pegged on the type of pain he or she is experiencing. But these three tactics could be applied in any case.

Cuddle. Once the baby starts thrashing his arms or legs, he or she finds it hard to stop because they cannot control their movements easily. When you hold the baby gently, cradling its arms and legs, he or she will feel less panicky. According to research findings, it helps if you hold the baby with his or her hands together on his or her chest, with the fingers near their mouth.

Rocking. A rocking motion is believed to stimulate special cells in your baby’s inner ear, which can have a soothing and calming effect.

Sucking. It is thought that when your baby moves the mouth muscles while sucking on your breast or a bottle, he or she releases endorphins in the brain, which help him or her relax and block the pain. Sucking also offers a distraction from the pain.

But, if your baby is in severe pain, holding, rocking and sucking may only make him or her more agitated.

Research findings have also shown that something sweet given in small measure helps a baby to cope with pain. Sucrose especially is widely used for pain relief in young babies. Turning down lights, speaking very quietly and leaving the baby alone also help.

What could be causing pain?

Common causes of pain in children include infections, for instance of the middle ear, throat and mouth as well as injuries such as sprains, strains, broken bones or burns.

The symptoms will vary from baby to baby but some of the common ones include:

Colic, in which case the baby will have high-pitched cry, and be arching his back, shooting his legs out, drawing his knees into his chest, particularly in the evening usually between 6pm and midnight. Colic usually occurs from a few weeks after birth to around three months. You will need to lie your baby face down across your knees or along your upturned forearm, while gently patting his back. The doctor will recommend some colic remedies as well. If your baby’s evening cries are the same pitch as those during the day, this could indicate she is not suffering from colic.

Constipation. The child will have discomfort when passing a motion and dry, hard stools. If your baby passes a motion only every three days, but the stool is not dry and hard, she is not constipated. Constipation is rare in breastfed babies. You can help by increasing the baby’s fluid intake. It is important to contact a doctor if your baby is newly born, or if she passes blood in her motions or appears unwell in other ways.

Earache. The most common type of earache, or otitis media as it is called, tends to develop in children up to the age of eight. The baby reacts through a high pitch cry, pointing, clutches at or pulling at an ear, discharge from the ear, irritability, pain, and possibly having a fever, loose stools, and vomiting. The doctor will advise on the correct dosage of infant paracetamol, which is helpful especially to babies over three months. Antibiotics are also very effective for ear infections. If your child has a stiff neck, youa should seek medical advise immediately.

Nappy Rash. You will notice this if there is mild reddening of the skin around the nappy area to severe inflammation with sores and shiny broken skin. The best cause of action is changing nappies often, applying a barrier cream sparingly to allow skin to breathe and making sure the skin is dry, and leaving your baby nappy-free whenever possible. If it does not go away or your baby has blisters or sores or the irritation spreads, then consult a doctor.

Teething. There will be redness on the gum where the tooth is coming through, inflamed cheeks, keeps his fingers in his mouth and is irritable. Offer your baby something hard and cool to chew like a teething ring. Teething gel or infant paracetamol can help.

Wind. If wind is the problem, he will cry and wriggle during and after feeding. You will need to hold your baby upright against your shoulder or on your lap, gently patting or rubbing his back until he burps.

For more information visit www.nhsdirect.nhs.uk