8 Baby Steps to Rating Infant Crying

New “Rule of 3s.”

For the most widely used definition of colic, the Wessel criteria-the infant fusses or cries for > 3 hours > 3 days per week for > 3 weeks-parents have found assessing and documenting fuss/cry duration for so long to be impractical. So, now there are “modified Wessel criteria“: the infant fussed/cried for > 3 hours a day on at least 3 days in any 1 week.

A Far Cry.

Babies cry ≈ 2 hours a day in the first 2 weeks and then increase to 2 hours 15 minutes at 6 weeks. The duration of fussing/crying drops significantly after 8-9 weeks, to 1 hour 10 minutes by week 12. No 2 babies are exactly alike: some cry as little as 30 minutes in a day, others > 5 hours.

Who Says Brits Don’t Cry?

The highest levels of colic were found in the United Kingdom (28% of infants at 1-2 weeks of age). In second place: Canada (34.1% at 3-4 weeks). And the bronze medal goes to Italy (20.9% at 8-9 weeks).

Where Babies Cry the Least.

The lowest colic rates were reported in Denmark (5.5% at 3-4 weeks of age), followed by Germany (6.7% at 3-4 weeks). The second runner up: Japan.

Why Country Makes a Difference.

Possible reasons why differences in mean fuss/cry durations between studies were moderated by country: economic conditions (eg, less social inequality), caretaking patterns (eg, responsiveness and carrying behavior), population genetic differences, and the gene-environment correlation. Further analysis may provide clues for effective preventative strategies.

Feeding Type and Placebo Effect.

Bottle or mixed feeding was associated with reduced crying duration from age 3-4 weeks onward. Parents dealing with a crying baby frequently adopt a switch in feeding, which has reduced crying regardless of what the formula change is, suggesting a placebo effect. Breast feeding has been linked to more night waking in infants.

“Average” or “Excessive”?

The new chart provides clinicians with an approximation of whether an infant is fussing or crying excessively according to age or within the normal range. Giving this feedback to parents is a first step of education on fussing or crying and whether their infant’s fuss/cry is within the normal range.

Implications for Treatment.

Colic is the extreme of normal fuss/cry behavior and self-limiting. In the first 3 months, adequate management of fussing and crying may be required rather than treatment. If excessive fuss/cry persists beyond 3 months, there may be regulatory problems with adverse consequences for future development that may require treatment.