Baby Fussiness: When It’s Normal and When It’s Not - Baby Chick
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Baby Fussiness: When It’s Normal and When It’s Not

newbornsPublished August 9, 2022

by Kirsten White, BSN, RN

Pediatric Nurse

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Unfortunately, it is a fact of life: babies cry. Because they cannot yet speak, crying is their primary form of communication with their caregivers, and we need to figure out what is normal baby fussiness and what is not. Without words, when infants are cold, hungry, tired, or need a diaper change, their only way to tell you what they need is to fuss. As a new parent, it can be challenging to differentiate between types of cries and decipher what the baby needs based on their crying. It’s frustrating when they are still fussing and you feel like you have tried everything.

It can be overwhelming to hear your baby crying throughout the day. You want to console and solve their discomfort, but you may also need a break from the noise. The constant crying can be overstimulating for a new parent, especially when running on little sleep. In addition to learning your baby’s specific cries and needs, you may be wondering if your baby’s fussiness is within the realm of normal. While there is a wide range of typical infant fussiness, here is a guide to knowing the difference between what is normal baby fussiness and what is not.

Normal Baby Fussiness

Babies cry—a lot! Even happy, healthy babies cry. Healthy infants typically follow a crying curve, in which crying gradually increases from birth until five to six weeks old. Fussiness may peak or plateau at this point until crying typically begins to decline around three months of age.

It may seem like an infant should only cry for a specific reason, and if you could find that reason, you could stop the crying. Some reasons include being tired, hungry, hot, cold, overfull, bored, lonely, or having a wet diaper. Remember, though, that babies cry for other reasons we cannot guess. It can be expected for babies to cry without apparent cause. Sometimes, there is a cause, but you may be unable to identify or rectify it quickly. One less obvious source of fussing is overstimulation. Just as we can get overstimulated by their crying, they can get overstimulated by our typical environments. And sometimes, maybe all they need is the opportunity for a reset in a low-stimulation setting. I sometimes had success rocking my swaddled newborn daughter in a dark room with quiet white noise to settle her during a crying episode.

Unexplained Crying Can Be Normal

Crying for a predictable reason is almost always normal baby fussiness. Again, this is their primary way to communicate. If they stop crying after you remedy the source of their discomfort, this crying is very likely to be normal. However, it can be normal to have unexplained crying. One to two hours of unexplained crying throughout the day can be considered normal. When considering whether unexplained crying is normal, it is important to note if the baby is otherwise happy when they are not crying. If your baby is consolable and content between periods of crying, their fussing is likely within the normal range.

Abnormal Baby Fussiness

Sleep-deprived new parents may have shorter fuses. In this state, it can be easy to assume that a normal level of infant fussiness is abnormal. We have identified some ways to know if your baby’s fussiness is normal, but when is it not?

Some professionals define excessive crying as “colic,” which is “frequent, prolonged and intense crying or fussiness in a healthy infant.”

Excessive crying affects between 5% and 40% of infants globally and accounts for 10-20% of pediatrician visits in early infancy. Colic usually starts to present itself by week three. Just as normal infant crying increases in the early weeks and peaks around week six, excessive crying or colic also often peaks around week six. The condition usually resolves on its own between three and four months. So how do you know if your baby’s fussiness lies above the normal crying curve? Below are some characteristics of fussiness to consider:

Wessel’s Rule of Threes

The original criteria for a colic diagnosis fell under what’s known as Wessel’s Rule of Threes and were: crying for greater than three hours per day, on at least three days per week, for three weeks or more. While this can be a good starting point for helping to identify whether your baby’s fussiness is excessive, the medical field has started to account for not only the amount of crying but also the character of that crying.

Unsoothable

Even in typical fussiness, it may take some time to figure out why your baby is crying and how to make them feel better; however, most often, you will be able to soothe them eventually (or they may soothe themselves!). If you would classify your infant’s fussiness as often unsoothable and prolonged, this may be outside the normal range.

Mysterious distress

While sometimes not being able to identify the cause of your baby’s crying can be expected, if the reason for their crying is often or always a mystery, this may be abnormal. If you would describe excessive crying as a part of your baby’s character, their level of fussiness may be abnormal.

Otherwise healthy

To classify infant fussiness as abnormal, there cannot be an obvious or apparent cause for the crying in a child who is less than five months old when the symptoms start and stop. For instance, the baby must not have a fever or other known or obvious illness. They must also be eating and growing appropriately and demonstrating no evidence of failure to thrive.

If you have identified that your baby’s fussiness is not normal, you may be wondering what you can do about it. Below are some steps you may be able to pursue to address your baby’s fussiness.

Solutions to Baby Fussiness

Unacknowledged colic is associated with higher rates of maternal postpartum depression and shaken baby syndrome, so addressing it can help protect you and your baby. Your medical provider or your baby’s pediatrician may be able to counsel and educate you on treatments, interventions, and coping strategies. Below are some resources and interventions to consider if you think your baby may be suffering from excessive crying.

Talk to Your Pediatrician

There isn’t always a medical reason or cause for abnormal amounts of crying. If you feel your baby is crying above the average amount, reach out to their pediatrician for a visit. They will take a medical history and do a physical examination to ensure there is no underlying cause for the fussiness. Without alarming symptoms, your pediatrician may review some of the therapies below for excessive crying.

Behavioral Intervention

Some parents report success with different behavioral interventions. Some things that may or may not help include infant swings, car rides, pacifiers, white noise, low-stimulation environments, and increased holding and snuggling. Although none are guaranteed to improve crying, most cannot hurt to try. Be sure to discuss any behavioral interventions with your pediatrician to ensure safety.

Dietary Changes

Diet or feeding changes are not typically recommended as a treatment for extreme fussiness, particularly for formula-fed infants. If there is a family history of allergy, some doctors may recommend a brief trial of a hypoallergenic formula as a treatment for excessive infantile crying. A review of studies showed a possible positive effect on breastfed infants’ crying by eliminating allergens from the mother’s diet. However, this can be difficult for the mother. Your doctor should encourage continued breastfeeding over maternal dietary changes in the absence of bloody stools or other explicit symptoms of food allergy or intolerance in the infant.

Pharmacological Options

Several studies have looked at colic treatment with a specific probiotic strain, and some show promising results. Research is still underway, and the efficacy of this intervention is far from guaranteed, but the option could be worth exploring with your pediatrician.

Alternative Therapies

Some have reported success with decreasing infant crying by using herbal teas and other herbal remedies. However, experts need to do more research to examine side effects, standardize dosages, and ensure that consumption would not interfere with a hunger for milk.

Although chiropractic care has not demonstrated a benefit over placebo in studies, many parents report success with this treatment for their fussy infants. Out of desperation, a friend of mine sought chiropractic care three times per week for her fussy and inconsolable six-week-old. She noticed more regular and frequent bowel movements and a happier and calmer demeanor in her little one. Now at nearly four months of age, she has cut back on their visits but continues to visit the chiropractor weekly to keep her baby out of “fight-or-flight” mode.

Good News About Abnormal Fussiness

Self-limiting and Self-resolving

Even without any intervention or treatment, excessive fussiness will go away on its own. No matter what, there is an end in sight. However, this does not mean that you should suffer in silence, wait it out, or accept your fate as the parent of a colicky baby. After all, making it through four months of excessive crying can feel like an eternity while you are living it.

Benign

It may be a relief to know infant fussiness and excessive crying do not always indicate something severe is wrong. In addition, colicky babies showed no difference in temperament by toddlerhood compared to unaffected infants. Parents of babies who cry excessively also show no long-term anxious or depressive symptoms once the fussing has resolved.

You Are Not Alone

Life with any newborn is tough. Your world has just been flipped upside down. While recovering from the physical trauma of birth, you are now responsible for an entirely dependent baby. You are adjusting to your new life and learning each other’s cues. With very little sleep, any amount of crying can set you over the edge.

With a new, fussy baby, it can feel like there is no escape. Remember that you are not alone—another review suggests anywhere from 3% to 28% of infants suffer from colic. It will end, but until it does, be sure to take care of yourself. Get help caring for your baby so you can take breaks when you feel overwhelmed. Remember to reach out to your pediatrician if you are concerned something is not right with your little one.

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