Is it acceptable to allow a 4-month-old infant to continue crying?

From the Guidelines

No, it is not acceptable to allow a 4-month-old infant to continue crying, as crying is a common trigger for child abuse and is the most common trigger of abusive head trauma 1.

Reasons to Respond to Crying

• Crying is a normal developmental phase that may cause difficulty for some parents, and pediatricians should anticipate and provide guidance to families about how to best manage potentially difficult situations 1.
• The severity and frequency of caregivers’ adverse responses to crying have largely been underappreciated, with almost 6% of parents of 6-month-old infants admitting that they had smothered, slapped, or shaken their infant at least once because of his or her crying 1.
• Factors that place a child at risk for child maltreatment include child characteristics that could predispose a child to maltreatment, such as a demanding infant or a child with special health care needs, which may test the parent’s patience 1.

Interventions to Prevent Child Maltreatment

• Programs have been developed to help parents better cope with a child’s crying, such as the Period of PURPLE Crying, which uses a brief video and written material to educate new parents about normal crying and how to cope with an infant’s crying 1.
• Office-based prevention models, such as the Safe Environment for Every Child (SEEK) model, have been shown to improve mothers’ knowledge about crying and to improve their behavioral response to it, as well as reduce reports of child maltreatment made to child protective services 1.

Key Takeaways

• Pediatricians should play a role in preventing child maltreatment by understanding the situations that commonly trigger maltreatment and identifying and addressing factors that may make a child more vulnerable to maltreatment 1.
• Responding to an infant’s crying is crucial to prevent child maltreatment, and interventions such as education and support programs can help parents better cope with a child’s crying 1.

From the Research

Acceptability of Allowing a 4-Month-Old Infant to Continue Crying

• The decision to allow a 4-month-old infant to continue crying is a complex issue, with various studies suggesting different approaches 2, 3, 4, 5, 6.
• Research indicates that around 20% of 1- to 4-month-old infants cry for long periods without an apparent reason, and in most cases, the crying is attributable to normal developmental processes rather than organic disturbances 2, 3.
• Studies suggest that parental vulnerabilities influence how parents evaluate and respond to the crying, and that supporting parents is crucial in addressing the issue of excessive crying in infants 2, 3, 4.
• Some research proposes that excessive crying may be a signal of vigor that evolved to reduce the risk of a reduction or withdrawal of parental care, although the evidence is not conclusive 5.
• Management of persistent crying in infants includes exclusion of medical causes, ensuring the baby is adequately rested and fed, and using techniques such as carrying, bathing, or playing white noise to distract the baby from crying 4, 6.
• It is essential to note that postnatal depression is common in mothers of crying babies, and screening for and addressing this issue is crucial 6.
• Overall, the evidence suggests that allowing a 4-month-old infant to continue crying without intervention may not be the most effective approach, and that supporting parents and addressing the underlying causes of the crying is essential 2, 3, 4, 5, 6.