Season 6 | Episode 3

 

 

Pediatric Myths

 

Dr. Alicia Pekarsky, MD: Parents don't have to be perfect. They have to be good. They have to be loving and attentive and they have to do their best.

 

Joe McIntyre (Host): Welcome to another episode of the Merck Manuals Medical Myths Podcast. On this show, we set the record straight on today's most talked about medical topics and questions. Today's episode will focus on the question that keeps many parents up at night. Why is my baby crying?

I'm your host, Joe McIntyre, and to help us answer that question is Dr. Alicia Pekarsky, an Associate Professor of Pediatrics at SUNY Upstate Medical University, Upstate Golisano Children's Hospital, and she also serves as program director of Child Abuse Pediatrics Fellowship at Upstate Medical University, Golisano Children's Hospital. Dr. Pekarsky also specializes in general pediatrics, child abuse pediatrics, and neglect. She also has chapters about child neglect and abuse available for free on merckmanuals.com.

Dr. Pekarsky, thanks for joining us on the podcast!

 

Dr. Alicia Pekarsky: Thanks so much for having me.

 

Host: Our first question for this episode is why do babies cry?

 

Dr. Pekarsky: There are so many reasons why babies cry. I think some of the more obvious reasons are things like hunger, baby is in a wet or dirty diaper, baby may be too hot or too cold, or even possibly developing a viral illness. On the other hand, there are other reasons that I think that many parents and caregivers overlook. Sometimes, the baby is overstimulated, just too much is going on in their environment, and sometimes they're bored.

The other possibility, I think babies cry if they have an injury that just hasn't been recognized by the parent yet. And then another theory is that babies cry because they have an immature nervous system, and they're just unable to soothe themselves when they're frustrated.

 

Host: Let's move on to the question about colic. Can you explain what colic is and the symptoms it may present in infants?

 

Dr. Pekarsky: Colic is defined by frequent and long periods of crying that occur in young infants who are otherwise completely healthy and well. The crying typically begins in young infancy. In those first few weeks of life, it peaks between six to eight weeks of life and tends to resolve by three to four months of age. And then another feature of colic crying is that it typically occurs around the same time, in the late afternoon and early evening, but the child is otherwise completely healthy.

 

Host: I'm sure a lot of parents have questions like my child is crying for x number of minutes, maybe x number of hours. How long should a parent try to comfort a crying baby before deciding, hey, maybe this is an actual emergency and not just a baby who is frustrated or one of the other reasons you mentioned in the beginning?

 

Dr. Pekarsky: It’s going to be longer than minutes. I think you're right when you point out hours because babies with colic will cry for hours. I think that the most important thing to do before you chalk it up to colic is to look at your baby, check your baby, and feed your baby. But I think after a couple of hours, it should kind of quiet down. If your baby's crying from 6 pm to 9 pm, for example, most nights of the week, and then is otherwise well during the rest of the day, acting well, feeding well, and is engaged with their environment. It's not anything to worry about in terms of a medical emergency. Of course, it can cause a lot of frustration and anxiety in parents.

Host: I'm sure it can. I have a question here, which may be a little bit silly. When a baby is crying, that doesn't mean that the child is angry with the parent or does not like a parent or does not like someone else? It could mean a whole host of things, but probably not anger is my guess.

Dr. Pekarsky: That's right because infants with colic are those young infants. They're not angry with the person who's caring for them. They just don't have that level of intentionality yet. And it's important; this is such a great question because the level of frustration that the parents feel towards themselves, their family, and the child just increases exponentially. I think it's important to remember that children cry for so many different reasons, as we mentioned before, and it really has to do with the child.

Host: Is there a strategy or advice you give to parents to handle maybe the guilt, for lack of a better word, of not being able to stop your child from crying?

Dr. Pekarsky: It really depends on the level of concern that the parents are having. If they're just having some mild feelings of guilt, one of the recommendations I will make, which may seem very simplistic, but it is effective, is just to put the baby down in a safe place and walk away, whether it's leaving the room, or it's taking a walk around your house or around the block. Interrupting that cycle and walking away may just brighten your mood. Other simple things that most people can access are turning on music or free apps that help with deep breathing, which are important.

However, there are some parents who are really being pushed beyond guilt into postpartum depression or feeling angry towards the baby. I would recommend speaking with a pediatric medical professional. In addition to if you have a trusted friend or family member, it's important to engage our community resources when parenting because it's one of the most challenging things that people will ever do.

Host: I'm sure plenty of parents have also held their baby trying to get them to fall asleep, finally, get them to fall asleep only for them to start crying again once they put their baby down. Can you tell us why that may be? And if there are any strategies or ways to kind of resolve that?

 

Dr. Pekarsky: Yeah, sure. Babies love to be in physical contact with their caregivers. I think, when we think about babies, not as little people, we really discourage that in pediatrics, but just as human beings, it makes sense that they want to be close to the people that they love and who love them. So, they don't have the same level of awareness as older children and adults do, but they recognize when they're being placed down, they're no longer next to their warm caregiver. And I think they respond to that because they're frustrated with crying, that's their way of communicating, they don't have a lot of other ways, especially in the first six months of life, to respond to their environment. They signal their distaste for being placed in their safe sleep space, while crying. And I know some parents there's a lot of different approaches to this. One approach is to put the baby down, walk away, close the door, and either listen to the crying because you have a monitor, or don't listen to the crying, and it will extinguish eventually, and you have several rough days when you're doing that. So that's one method of sleep training, and some people are able to tolerate that, I will say that it is really challenging for new parents, whether it's their first baby, second, third, or fourth, to listen to the baby cry a lot, and some people live in smaller homes that they really can't get away. I never recommend that if the parents are not ready to do that.

Another technique is to put the baby to sleep, and then go back and reassure the baby that the parent is still there. And I think that has its pros and cons for the baby and the parents. It's sometimes sad if it satisfies the parents more than the baby, though, because the baby may be, like, partially asleep, and then the parent comes in to pat them or even comes into the room, and the baby wakes up again. It's based on parental preference and support and resources. I wouldn't recommend this for a parent who's parenting alone, necessarily, who has three other kids in the house and who's already really frustrated. I would, for that family, recommend lots of soothing, as much as possible, with walking with the baby, white noise, other things that may help the situation.

 

Host: Yeah, so there's no right or wrong way to handle situations like this. Which I'm sure in some ways is probably good for parents to hear and in some ways, it may be frustrating, because there is no one way. It's basically whatever feels right for the parent in some ways?

 

Dr. Pekarsky: I think in medicine, and especially in pediatric medicine, which I practice. It's shared decision-making. In shared decision-making, even about parenting practices, the parents have the final say in everything. And if a parent comes to me and says, “What would you do?”, then I tell them what I would do and what I did do with my children when they were young. And sometimes, families just want to hear that, and I'm happy to talk to them through my professional and personal experience.

 

Host: It feels like parents can be understandably very judgmental of themselves and want to be the best parent that they possibly can be. But as you said, asking a doctor like yourself, asking a friend or someone, a family member you're close with how they handled it can be reassuring to know that hey, whatever you do, whatever you decide to do, is probably going to be right for you and your child.

Dr. Pekarsky: I think as long as they're being safe, the things to avoid are in my opinion, endorsed by the American Academy of Pediatrics, not sharing the sleep surface. If you're getting to a point where the only way you can get your child or your baby to sleep is by sleeping in the same bed with them, then we have to revisit that approach. And then the other issue that will come up, of course, no one would condone this as someone who's become so frustrated that they pick up and hurt the baby. So in those scenarios, the latter, the advice is always put the baby down in the crib, walk away. Doesn't matter if the baby's crying, the crying is not going to hurt them. It's more piercing to our ears and our hearts as parents.

I think parents need to know that because you're right, there's so much judgment of parents, especially these days with social media, and all the resources that are online. And I think you said it best: parents don't have to be perfect, or you were kind of going there; parents don't have to be perfect; they've got to be good. They've got to be loving and attentive, and they have to do their best.

Host: Yeah, just to maybe reiterate, it is true that if you leave your baby in the crib or in their bassinet, whatever it is, and then check on them periodically, they will eventually go to sleep, the crying will eventually stop to tell parents that hey, this won't last forever.

 

Dr. Pekarsky: It won't last forever, but for anyone who's parented or has provided care to a young infant, it feels like it's going to last forever. But I can guarantee you it won't. Particularly if you look at the length of time that this occurs during the baby's life, it is a period of time when most babies are starting to soothe a little bit better by three months of age. But it is an incredibly long period of time when you listen for hours on end to the baby’s cry. I should also mention that sometimes colic just presents as a baby who must be soothed the entire time, so that's also a baby who has colic. It's just that you can soothe them, but you must hold them the entire time, or you have to rock them the entire time, which is exhausting as well.

 

Host: What are some tips or best practices you have? You mentioned rocking, consoling kind of constantly. But some best practices for parents to console their baby who may be crying a lot.

 

Dr. Pekarsky: I’m going to share a personal tidbit because my youngest child had colic. And some of the things that worked best for her were holding her and walking around with her, which we mentioned. Another thing that I eventually figured out when she was a little bit bigger, I think probably around the one-month age, maybe six weeks, was putting her in an infant carrier that was strapped to my chest, because she needed that contact, and she was fine. If I had her against my chest, she would have been fine. That allowed me to move about my home, do chores, do the other work, and take care of her twin brothers, who were toddlers at the time.

Some other things that help babies would be swaddling, and it's not super-duper hard to swaddle an infant, you can get help from a pediatrician or a nurse in a pediatric practice or another pediatric professional. Maybe your parents and extended family may know how to do it as well. It's just important that it's not so tight that the baby can’t obviously breathe. You must make sure that the blanket is below the collarbone of the baby so nothing comes up above their face. But they do like that sensation, it kind of mimics them being in utero when they were growing and kind of being compressed by the uterus.

I'd say another technique is to use white noise and this makes sense again, other people, adults use white noise, kids use white noise to sleep. Sometimes that sound, whether it's a white noise machine or something as simple as putting your phone on with some white noise or the vacuum like people used to do. Those are very effective at soothing babies. It's not going to work every time, but that's a great technique as well.

 

Host: Dr. Pekarsky, there's a myth, or maybe it's not a myth, out there that sometimes crying for an infant child is their form of exercise. It's their way of moving their body, moving their muscles a little bit. Is that the truth? What's the reality there?

 

Dr. Pekarsky: That's an interesting question. I don't think I've been asked that, or anyone's shared that myth with me, but I can see it. And it kind of makes sense because if we think about crying as a way of expending energy, I think babies who are overstimulated do cry. And that's their way of getting off some of that steam that they have built up. Older children and adults could use, hopefully, their words to express themselves and other modalities, but infants have nothing else besides the sounds that they make.

 

Host: It's very interesting. We all have our own ways, I'm sure, of expending energy, whatever it is that we're looking to get out of our bodies and babies are limited, so that's interesting. Dr. Pekarsky, you're also an expert in child abuse pediatrics. Can you talk to us about Shaken Baby Syndrome or shaken baby? How does that come to be? What are some of the effects of that? And obviously, why is it so important for parents to avoid that?

 

Dr. Pekarsky: As a child abuse pediatrician, I see many victims of abusive head trauma. And while it is gratifying to make that diagnosis, to help the child and family moving forward, I think prevention is the key in terms of avoiding this because it does often lead to lifelong permanent disabilities for children. So many times, babies start crying between three and four weeks, and they peak at about two months of age. And that is the time when we start to see more cases of abusive head trauma. The peak in crying coincides with the peak in the diagnosis of abusive head trauma.

The message I'd like to share is to normalize that for parents and caregivers, that baby is crying, it's normal, it's probably healthy for the baby, even though it doesn't feel like it to us as parents and caregivers. And the baby is fine. And you're doing a fine job as a parent. As a medical professional and as a general pediatrician, I always share with families at their child's two- and four-week visit, as part of my anticipatory guidance, that your baby is likely to start crying a lot more over the next couple of weeks.

If we can share that with families in advance, normalize it, and say it more than just once, during a time period when they're exhausted and tired and taking care of lots of other things. Hopefully, they will internalize that and be less frustrated when their baby does start to cry more. We want to avoid parents and caregivers shaking because most times when parents and caregivers do that, they're not doing it with the intention to hurt their child or they're not waking up in the morning and thinking I want to shake my child because I want them hurt. They're doing it because they're frustrated. And their threshold for frustration and acting out on that has been crossed. Because babies are frustrated when they cry. We need to normalize crying and we need to tell parents and caregivers that they're doing a great job and be supportive of them. And hopefully, we're going to decrease the incidence of abusive head trauma over time with that and other measures.

 

Host: Finally, Dr. Pekarsky, if our listeners are looking for more information about general pediatrics, colic, crying children or just have questions about parenting, where should they go for that?

 

Dr. Pekarsky: I would reference the chapter on colic at merckmanuals.com and another great resource is healthychildren.org which is produced by the American Academy of Pediatrics. There are several pages on colic, crying and what to do for your baby there.

 

Host: Dr. Pekarsky, thank you so much for joining us on this episode of the Merck Manuals Medical Myths Podcast. As we close it out, I'll let you leave our listeners with a final word.

 

Dr. Pekarsky: I want to thank you for having me. It's been a pleasure. Medical knowledge is power. Pass it on.

 

Host: Thank you so much.