Pain

• Is my baby in pain?
• Distress does not automatically mean pain!
• How can I be sure it's not pain?
• If it's not pain then why does my baby behave like this?
• What you can do to help
• How we can help!

Is my baby in pain?

One of the most puzzling jobs for parents is trying to figure out why their baby becomes so distressed.  When the reason is not obvious, pain is often the first thing parents suspect and/or the first thing suggested by well meaning friends, family and health professionals.  (Most often without having asked you a single question to rule out other reasons for distress).

No doubt, others have made comment about your baby's distress... "It's probably tummy cramps", "It might be gas', "She could be constipated", "I think its colic", "It's possibly reflux", "Perhaps she's teething" and the list goes on and on.  These could all be valid reasons for a baby to become distressed, but in reality these problems occur far less often then they are suspected.  There are many more common reasons for a baby's distress than pain... that are not always obvious.

Distress does not automatically mean pain!

Just like adults, babies can become stressed at times.  Each baby may display their distress in slightly different ways.  Distressed behavior commonly seen in healthy, thriving infants, include the following...

• persistent crying
• screaming
• straining
• pulling up legs
• back arching
• clenched fists
• flailing/jerking arm and leg movements
• feeding difficulties, i.e. refusing to feed or "fighting" feeds
• extreme wakefulness

Obviously, if a baby is experiencing pain she's likely to become distressed.  However, it's not always a simple matter to tell whether a baby's distress is due to pain or not, because babies will also display the same distressed behaviors for many reasons that have nothing to do with pain or physical discomfort.

How can I be sure it's not pain?

Caring for a distressed baby for hours on end, sometimes day after day, is one of the most emotionally heart wrenching and exhausting experiences a parent will face, and it can be difficult to 'see the forest for the trees' when it comes to figuring out what the actual problem is. It may only be through a process of elimination that you can confidently rule out pain as the reason for your baby's distress.

1. Is your baby FAILING to gain enough weight OR loosing weight?
NO	YES    SEE A DOCTOR
	Your baby's distress may be an indication of hunger. Any child who is failing to thrive needs to be reviewed by a doctor for a thorough medical assessment.
2. Does your baby have any physical signs or symptoms (besides behavior)?
NO	YES    SEE A DOCTOR
	If symptoms are related to the digestive tract, i.e. gas, loose watery bowel movements or spitting–up, also consider over-feeding as a possible cause or contributor to your baby’s distress. (See hungry baby for more on over-feeding).
3. Has your baby's behavior SUDDENLY changed? In other words, is the behavior new for your baby?
NO	YES    SEE A DOCTOR
	A sudden change in behavior can be a sign of illness.
4. Can your baby be comforted during these episodes?
YES	NO    SEE A DOCTOR
	If a “NO” answer coincides with a "YES" answer to any question above, SEE A DOCTOR. If the answers to all questions above are also "NO" consider over-stimulation and/or over-tiredness as possible reasons for your baby’s distress.

If your baby can be comforted in some way; such as being picked up, cuddled, fed or a change in position etc. it is unlikely that her behavior is due to pain. Pain rarely stops suddenly.

If your baby calms quickly once she has been picked up but after a short while she once again starts to cry (even in your arms) this may indicate that her need is for something more than a cuddle. If you have ruled out more obvious reasons for a crying baby then a common reason for this pattern of behavior to occur is over-tiredness.

If it's not pain then why does my baby behave like this?

Your baby cries to indicate a need for something.  If this need is not satisfied, both her crying and her behavior will continue to escalate, often to the point of distress.  Having reached this point many babies, particularly those under the age of 3 months, may find it difficult to calm (even with parents help).

Your baby's temperament will influence how quickly and to what degree her behavior will escalate.  (Temperament alone is sometimes blamed for distressed behavior, but it's not that simple.)

WHEN your baby displays distressed behavior can provide a clue to the possible cause.  If your baby's crying or distressed behavior occurs...

• During play, consider over-stimulation
• Soon after feeding, consider tiredness (see tired signs). Where gastric symptoms are present and your child is also gaining large amounts of weight also consider over-feeding (see hungry baby).
• Immediately on waking; during the night, after a brief nap or soon after you placed her into her crib asleep, consider a sleep association.
• In the evening; OR after a long period awake; OR following a day out (even 1/2 day out for babies younger than 6 months) consider over-tiredness.
• During feeding, see common bottle feeding problems OR how to tell when your baby is getting enough breast milk.

What you can do to help

The 'cure' for distressed behavior in healthy, thriving infants does not lie with medications (over-the-counter or prescribed).  In fact, the side effects of many medications can often make the problem worse.  Some medications commonly given to infants that contain a sedative or alcohol will provide a 'perceived cure'. In reality they do little more than sedate the child.

Where your baby is healthy and thriving the 'cure' for distressed behavior lies in making changes to the way you provide care.

1. When attempting to calm an already distressed baby choose soothing methods that are aimed towards reducing stimulation and encouraging sleep.
2. To reduce the occurrence of distressed behavior, encourage a flexible feeding and sleep routine for your baby.  By doing this you will provide the sensory cues to assist your child to organize her internal body clock.  It will also assist you to anticipate her needs and hence accurately interpret what her behavior means before she reaches the point of distress.

DISCLAIMER:  This brief article can my no means make a diagnosis as to the reasons for your baby's prolonged crying or distressed behavior.  If you are concerned that your baby has pain, please see a doctor. 

Written by Rowena Bennett
RN, RM, RPN, CHN, Grad Dip Health Promotion.

© Copyright www.babycareadvice.com 2004. All rights reserved.
Added Feb 2004.

We value your feedback!

If you would like to comment on this article or if you have a question regarding distressed behaviour that has not been covered in this article, feel fee to email us at info@babycareadvice.com.

How we can help!

If you have already seen a doctor and your child is healthy and thriving, then through a consultation at BabycareAdvice, we can assist you to identify the reason (or reasons) for your baby's distress and explain ways in which you can encourage her sleep and contentment.

If you would like more information about our consultation service click here.

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See also:
Colic
Crying

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Last updated: April 9th, 2005