The Fussy Baby

Fussy babies are frustrating, both for parents and their Pediatricians.
Is the baby sick? Is something really wrong?

The first step in figuring out why a baby is fussy is knowing whether this is a new problem or one that has been going on for awhile. A baby that has been fussy for several weeks or months might have colic, a formula intolerance, reflux, or because they have a difficult temperament.

It is more difficult when a baby that has usually been happy all of a sudden becomes fussy, crying, and inconsolable. Although these babies usually need to be seen by their Pediatrician, there are some things you can look for first.

Is he off his usual routine, with a late night or a missed nap? This often happens when you are traveling or you have visitors in your home.

Is he teething?

Does your baby have a fever? Has he had a runny nose or cough? If so, then he might have a simple ear infection.

Does he have sores or blisters in his mouth or on his hands and feet? These sores and blisters could be a sign of a viral infection, like Hand Foot and Mouth disease.

If he has some vomiting and diarrhea, then he might have a stomach virus, especially if other people around him have been sick. Persistent vomiting and a distended and tender abdomen might indicate a more severe infection or a blockage, so seek immediate medical attention if your baby has any of these other symptoms.

Does he have a rash? Insect bites, eczema, or skin irritation can cause an itchy rash that might make a baby fussy as they can't usually get relief from scratching the rash.

In an older, mobile infant, you might also look for signs that he may have fallen and injured himself. Is he moving all of his arms and legs normally? Are any areas of his arms or legs painful when touched or moved? Remember that some injuries in young children, like a Toddler's fracture, might not be red or swollen.

The child without other symptoms is even more confusing.

In this case, a careful examination of your undressed baby can help to find common things that can make a baby fussy.

The first thing to look at is your baby's fingers and toes (check your baby boy's penis too). Are any of them red or swollen? If so, then he may have a hair tourniquet, in which a hair or thread twists and wraps around the extremity and cuts off circulation. This is usually a medical emergency, so if your child's fingers or toes are red, tender and swollen, you should seek immediate medical attention.

An incarcerated hernia can be another cause of inconsolable crying. Check your baby's groin area. Is there an area that is swollen? If so, is it painful when touched? A swollen and painful and swollen bulge in your child's groin could be caused by a hernia that has become trapped. This is also a medical emergency and you should seek medical attention as soon as possible. A hernia that is not painful is not usually a medical emergency, but you should still see your doctor about it.

Another cause of crying in an otherwise healthy baby is a scratched eye. Is his eye red and watery? Does he have other scratches on his face? Although this will usually heal on its own in a few days, your doctor may prescribe antibiotic eye drops or an ointment to prevent the scratch from getting infected, so call your doctor if you suspect this. Fussiness and eye problems can also be caused by infantile glaucoma.

Food intolerances might also cause your child to become fussy. Have you introduced anything new into your baby's diet? If breastfeeding, have you changed your own diet recently?

Management of the Fussy Baby
So what do you do when your baby is fussy?

The first thing you should likely do is check your baby for a fever. Next, get him undressed and give him a good once over. Do you notice any of the problems described above?

If he appears normal, doesn't have a fever, is eating well, and you don't suspect any of the symptoms described above, you might just give him a pain reliever. If that relieves the fussiness, a visit with your Pediatrician the next day might be a good idea.

If he does have a fever and is inconsolable, or you do suspect an injury, hernia, hair tourniquet or any of the other problems described above, then you should call your Pediatrician or seek medical attention.

It can be frustrating taking care of a crying baby, so get help if you are having trouble coping with your infant's crying. Remember that you should never shake your baby, which can cause shaken baby syndrome. Get help if you think you might harm your baby.

Shaken Baby Syndrome

Never shake a baby!
It seems like common sense and something everyone should know, but rates of child abuse and shaken baby syndrome continue to increase.

Each year, 1,000,000 children in the United States are victims of child abuse and 3 children a day die from abuse or neglect.

According to reports, 'homicide is the leading cause of injury-related deaths in children younger than 5 yrs' and 'shaken baby syndrome may account for up to 25%' of these homicides.

Also, although likely under-reported, 3,000 children a year in the United States are thought to be victims of shaken baby syndrome.

Can these deaths be prevented?

Many people think that they can't, and that is likely why we don't hear more about shaken baby syndrome. After all, what kind of person would shake their baby? Can someone who would shake a baby be educated to not do it?

Some of these people are likely just abusive and won't be stopped until their abuse is recognized and they are caught, but others are just angry and frustrated that their baby won't stop crying and don't realize that they are harming their child. The harm to these children can likely be prevented with more education.

In fact, one program, the Upstate New York Shaken Baby Syndrome Education Program, reports a 'sustained and consistent 50% reduction in incidence' of shaken baby syndrome in the counties in which the program has been started. You can view the video, Portrait of Promise: Preventing Shaken Baby Syndrome, that is used in the program online.

According to George Lithco, who lost his eleven month old son after he was shaken by a day care provider, 'educating new parents about the danger of shaking, the need to cope with the inevitable moments of frustration, and ways that they can help protect their child from injury is the single most important way to protect babies - and children as old as 5 years of age - from shaking injuries.'

In addition to a crying baby, other stressors that might put a child at risk for shaken baby syndrome include financial problems and a recent separation.

Also, many children who are victims of shaken baby syndrome have had previous abuse. Recognizing and reporting this abuse can help to prevent it from escalating to the point where the child is seriously injured or dies.

What is Shaken Baby Syndrome?
According to the National Institute of Neurological Disorders and Stroke, 'shaken baby syndrome is a severe form of head injury that occurs when a baby is shaken forcibly enough to cause the baby's brain to rebound (bounce) against his or her skull. This rebounding may cause bruising, swelling, and bleeding (intracerebral hemorrhage) of the brain, which may lead to permanent, severe brain damage or death. The condition is usually the result of non-accidental trauma or child abuse. Symptoms may include changes in behavior, irritability, lethargy, loss of consciousness, pale or bluish skin, vomiting, and convulsions. Although there usually are no outward physical signs of trauma, there may be broken, injured, or dislocated bones and injuries to the neck and spine.'

Preventing Shaken Baby Syndrome
Of course, the most important tip to prevent shaken baby syndrome is to never shake your baby or young child.

Having a baby that is continually crying for hours and hours can be very frustrating, especially for new moms and dads. If you feel that your baby is crying too much and you are not able to cope with it, get help immediately. Your pediatrician can be a good resource for you, but if you fell like you are going to harm your baby, call 911 and seek immediate help.

If you have a difficult or fussy baby, be sure to make all caregivers aware of this and make sure that they understand the dangers of shaking a baby and that they also know to never shake a baby or young child. In addition to the story of George Lithco mentioned above, there are many personal stories on the internet about parents who lost a child after they were shaken by a day care provider.

New fathers or a mother's boyfriend are also commonly responsible for shaking a baby. In one study in Canada, 50% of identified perpetrators of shaken baby syndrome were the child's biological father. Another 20% of episodes of shaken baby syndrome were caused by a stepfather or boyfriend and only 12% by the biological mother. Be sure that, just like you are raising awareness of shaken baby syndrome in your other caregivers, make sure to discuss the dangers of shaking a baby with dad or a boyfriend or any other friends or family members that are going to help care for your child.

In addition to warning caregivers not to shake a child, you might also ask about how the caregiver:

copes with stress
deals with a crying baby
disciplines a child
Another important way to stop shaken baby syndrome is to report suspected abuse before it can escalate to shaken baby syndrome. If you think a child is being abused, don't hesitate to report it.

Even if you don't think a child is being abused, if a parent or caregiver seems to be under a lot of stress and can't seem to cope with caring for their infant or child, try to get them help.

And don't hesitate to seek care for your child if you think that he or she may have been the victim of shaking baby syndrome. Remember that symptoms might include trouble breathing, seizures, vomiting, loss of consciousness, irritability, bruises, poor feeding and lethargy (sleeping more than usual).

The following national organizations and programs have local chapters in States and communities across the country and can be helpful for parents who need extra help:

AVANCE Family Support and Education Program
Alliance for Children and Families

Child Welfare League of America (CWLA)

Circle of Parents

Family Support America (FSA)

Healthy Families America (HFA)

Meld: Programs to Strengthen Families

National Alliance of Children's Trust and Prevention Funds (ACT)

National Exchange Club Foundation for the Prevention of Child Abuse

National Resource Center for Community-Based Family Resource and Support Programs (FRIENDS)

Parents Anonymous, Inc.