Evaluation and intervention in excessive crying in infancy

1
Evaluation and intervention in excessive crying
in infancy

• An infant mental health approach
• M Maldonado MD

2
When is crying excessive?

• Rule of threes ( over three hours, three days,
  three weeks)
• Infant is difficult to soothe once crying starts
• Infant cries very easily or with the slightest
  frustration
• Infant fusses most of the time
• Parents report excessive crying

3
When is crying excessive?

• Pediatrician has diagnosed colic
• If colic persist after the first six months of
  life
• If parent feels unable to cope with the infant
  crying
• If infant is at risk due to crying

4
Evaluation of the crying problem

• Historical information about the baby
• Stress during pregnancy?
• Delivery?
• History of maternal depression?
• History of intrapartum period and early neonatal
  period
• History of crying manifestations

5
Evaluation of crying

• Duration of crying problem
• Severity of crying problem
• When does it happen most? Eg
• day, night, both.
• Circumstances in which crying may occur most.
• Are there ecological factors?

6
Evaluation of the baby with excessive crying

• Observe infants posture, muscular tone, movement
  patterns, tremulousness, overall tone of
  muscular functioning
• Observe infants ability to attend and focus. Can
  baby maintain attention on a stimulus?

7
Evaluation of the baby with excessive crying

• If possible observe infant crying..
• Pitch, intensity, precipitants, behavior during
  cry episode
• Is baby soothable?
• What seems to calm or exacerbate the crying
  problem?

8
Evaluation of the baby with excessive crying

• Are there any medical/physical factors?
• Dysmorphic features?
• Evidence of gastroesophageal reflux?
• Neurological condition? (e.g. migraine, GI
  condition, another painful condition?

9
Evaluation of the baby with excessive crying

• Sensory integration issues
• History of unusual sensitivities (hypersensitive
  or undersensitive)
• Tactile Visual
• Auditory Gustatory
• Olfactory Vestibular
• Proprioceptive

10
Evaluation of the baby with excessive crying

• Are there any other symptomatic areas?
• SLEEPING
• FEEDING, GAINING WEIGHT
• RELATEDNESS AND COMMUNICATION
• EMOTIONAL STATE (sadness, anger)
• History of trauma?

11
Evaluation of the baby with excessive crying
12
Evaluation of transactional factors

• Does parent anticipate stimuli or circumstances
  that tend to exacerbate crying?