You hear a piercing shriek reverberate across your emergency department. The tracking board shows a chief complaint of “crying.”
What Is Normal?
Medical professionals and laypeople understand that infants cry as a primary means of communication. However, the first challenge when assessing a crying infant is determining what crying is defined as normal. The definition of normal crying originates from a 1962 article by T. Berry Brazelton, who determined that the median hours an infant spends crying is 1.75 hours a day at two weeks of age, peaks at 2.75 hours a day at six weeks of age, and decreases to less than one hour of crying a day by 12 weeks.1 As a medical provider, it is important to seriously consider the concerns of any caregiver who has noticed an acute change in the crying patterns of a child.
The physician should determine the onset, duration, frequency, and aggravating and alleviating factors of the crying and any of its associated factors. Distinctive aspects of the infant’s past medical history should be recorded, including birth history and the maternal history of prescription drug use, illicit drug use, alcohol use, and smoking. The infant’s stool frequency and consistency should be determined. Caregivers should also be screened for their response to the crying, their social support, and fatigue.2 Such factors may be associated with abuse.