Constantly crying

Crying is a normal, accepted part of a child’s development in the first 3 months of life and it is the primary means of communication between infants and their parents/carers (NLM, 2021;Roberts et al 2004).

Healthy newborn babies cry and fuss, on average, for around 2 hours a day which usually reaches a peak around 4 - 6 weeks of age. After this the crying gradually lessens, and by around 12 weeks it is closer to around an hour a day (Zeifman & St James-Roberts, 2017; Vermillet et al., 2022). But all babies are different!

There is little consensus about the definition of an abnormal cry such as that of the inconsolable cry. The most widely used definition is “fussing or crying lasting for more than three hours per day, for more than three days, for at least one week.” (Weskind PS. and Barr RG 1997).

The incidence of an inconsolable cry is high in infants below 3 months of age and decreases considerably beyond six months of age (Von Kries et al 2006). If an infant cries for more than three hours per day, for more than three days per week and for more than three weeks, then they may be suffering from colic (Link to Colic).

As infants develop, they cry less frequently and become better at communicating their needs through other means, such as facial expressions, signal/gestures, and vocalizations (Pelaez, et al., 2018).

Constantly Crying & CMPA

What causes infants to cry constantly/inconsolably?

Common reasons for infants to cry include hunger, tiredness, discomfort (for example, their nappy is wet, or they are too hot or too cold); over stimulation can also cause infants to cry or if they need comforting. Newborn babies will also cry when experiencing discomfort and pain such as reflux (link Reflux and Regurgitation), colic (Link to colic), constipation (link to constipation), or during illness (NLM, 2021; NLM, 2022).

Cow’s Milk Protein Allergy (CMPA) can also cause inconsolable crying (Freedman et al 2009). Other possible causes include a urinary tract infection, gastroesophageal reflux disease (GERD) (link Reflux and Regurgitation, GERD), a viral illness or bacterial meningitis (Freedman et al 2009).

Could it be a symptom of Cow’s Milk Protein Allergy?

CMPA can present with a number of clinical manifestations, which may result in symptoms such as inconsolable crying in newborn babies and infants (Brill H. 2008).

However, when considering the diagnosis of CMPA, it’s important to consider that the majority of infants with CMPA have at least two symptoms affecting at least two different organ systems (Lifschitz C. and Szajewska H 2015; Høst & Halken 1990; Høst et al 1994).

Therefore, it is important to consider the individual child as well as the magnitude of their symptoms. This can be achieved using an awareness tool such as the Cow’s Milk Related Symptom Score (CoMiSS®) which will help you determine if CMPA might be indicated (Vandenplas et al 2015;Vandenplas et al 2022).