What can be given to a crying 2-month-old infant?

Management of a Crying 2-Month-Old Infant

For a crying 2-month-old infant, start with gentle motion, rhythmic movement, and white noise while avoiding overstimulation—this is the peak age for normal crying (6 weeks to 2-4 months) and also the highest risk period for abusive head trauma, making parental support and safety counseling absolutely critical. 1

Understanding Normal Crying at This Age

• Crying peaks between 6 weeks and 2-4 months of age, which is exactly when this infant presents 1, 2
• This is developmentally normal, with crying duration progressively increasing until peaking at this age 1
• Up to 20% of parents report problems with infant crying or irritability during the first 3 months 2
• Importantly, organic causes account for less than 5% of cases 3, 4

First-Line Interventions

Behavioral soothing techniques should be implemented immediately:

• Gentle motion and rhythmic movement to calm the overstimulated infant 1
• White noise to provide consistent auditory input without overstimulation 1
• Avoid overstimulation from excessive tactile, visual, auditory, and kinesthetic stimuli 1
• Swaddling combined with positioning or facilitated tucking (holding infant in flexed position with arms close to trunk) 5
• Nonnutritive sucking with a pacifier 5, 6
• Skin-to-skin contact or kangaroo care, which is highly efficient for preventing, minimizing, and halting crying 5, 6

When to Investigate for Organic Causes

Red flags requiring immediate evaluation include: 1

• Bilious vomiting
• Gastrointestinal bleeding
• Consistently forceful vomiting (≥5 times daily suggests gastroesophageal reflux) 2
• Fever
• Lethargy
• Hepatosplenomegaly
• Abdominal tenderness or distension
• Consider fractures or trauma if crying is truly intractable 1

If no red flags are present, organic investigation is not warranted initially since less than 5% have an underlying medical cause 3, 4.

Dietary Interventions (If First-Line Fails)

For breastfed infants:

• Consider maternal dietary allergen elimination (2-4 week trial eliminating milk and eggs) if cow's milk protein intolerance is suspected 1
• Lactobacillus reuteri (DSM 17938) may reduce crying by approximately 65 minutes per day, though evidence is insufficient for routine use 1

For formula-fed infants:

• Switch to extensively hydrolyzed formula if cow's milk protein intolerance is suspected 1

Critical Safety Counseling

This age represents the highest risk for abusive head trauma:

• Crying is the most common trigger of abusive head trauma, with incidence paralleling the normal crying curve that peaks at 2-4 months 1
• Almost 6% of parents of 6-month-old infants admit to smothering, slapping, or shaking their infant at least once because of crying 1
• Explicitly counsel parents that it is safe to put the baby down in a safe place and take a break if overwhelmed 1
• Crying causes documented physiologic stress including increased heart rate and blood pressure, reduced oxygen levels, and elevated cerebral blood pressure 6

Parental Support Strategies

Provide concrete coping mechanisms:

• Remain calm and serve as an "emotional container" for the infant's strong emotions 1
• Use distraction techniques such as games, music, or deep breathing 1
• Implement "time-in" or special time (10-30 minutes of child-directed play) to strengthen parent-child connection 1
• Establish protective routines using visual and verbal cues for mealtimes and sleep times 1
• Encourage accepting help from friends and family, and simplifying household tasks 2

What NOT to Do

Avoid ineffective or harmful interventions:

• Do not prescribe proton pump inhibitors—they are ineffective for colic and carry risks including pneumonia and gastroenteritis 1
• Do not perform extensive organic workup in the absence of red flags, as this increases parental anxiety without benefit 3, 4
• Caregivers should answer infant cries swiftly, consistently, and comprehensively rather than ignoring them 6

When to Escalate Care

Consider admission to a parenting center or hospital if: 2

• Parents are unable to manage the baby's crying despite interventions
• Maternal exhaustion, anxiety, or depression is severe
• Safety concerns exist regarding potential harm to the infant