8/28/2013

08-28-13 - Crying Baby Algorithm

Diagnosis and solution of crying baby problem.

1. Check diaper. This is always the first check because it's so easy to do and is such a conclusive result if positive. Diaper is changed, proceed to next step.

2. Check for boredom. Change what you're doing, take baby outside and play a new game. If this works, hunger or fatigue are still likely, you're just temporarily averting them.

3. Check hunger. My wife disagrees about this being so early in the order of operations, but testing it early seems like a clear win to me. After diaper this is the test with the most reliable feedback - if baby eats, that's a positive result and you're done. You can do an initial test for hungry-sucking with a finger in the mouth (hungry-sucking is much harder and more aggressive than comfort-sucking); hungry-sucking does not 100% of the time indicate actual hunger, nor does lack of hungry-sucking mean no hunger, but there is strong correlation. Doing a test feed is much easier with breastfed babies than with bottles (in which case you have to warm them up and find a clean nipple and so on). If baby is extremely upset, then failure to respond to a test-feed does not mean it is not hungry, you may have to repeat with stronger measures (see below).

4. Check for obvious stomach pain. Crying from stomach pain (gas, burps, acid, whatever) can be hard to diagnose once it becomes constant or severe (we'll get to that case below). But in the early/mild stages it's pretty easy to detect by testing body positions. If baby cries like crazy on its back but calms down upright or on its stomach (in a football hold), stomach pain is likely. If baby quiets down with abdomen pressure and back-patting, stomach pain is likely.

5. Look for obvious fatigue. The signs of this are sometimes clear - droopy eyes, yawning, etc. Proceed to trying to make baby sleep.

This is the end of the easy quick checks. If none of these work you're getting into the problem zone, where there may be multiple confounding factors, or the factors may have gone on so long that baby no longer responds well to them (eg. hungry but won't eat, gassy and patting doesn't stop the crying), so you will have to do harder checks.

Before proceeding, go back to #1 and do the easy checks again. Often it's the case that baby was just hungry, but after you did #1 it pooped and so wouldn't eat. It also helps to have a different person do the re-check; baby may not have responded to the first person but will respond to the next person doing exactly the same check the second time.

This is worth repeating beacuse it's something that continues to be a stumbling block for me to this day - just becaues you checked something earlier in the crying process doesn't mean it's not the issue. You tested hunger, she wouldn't eat. That doesn't mean you never test hunger again! You have to keep working on issues and keep re-checking. You have not ruled out anything! (except dirty diaper, stick your finger in there again to make sure, nope that's not it).

If that still doesn't work, proceed to the longer checks :

6. Check for overstimulation. This is pretty straightforward but can take a while. Take baby to a dark room, pat and rock, make shushes or sing to baby, perhaps swaddle. Just general calming. Crying may continue for quite a while even if this is the right solution so it takes some patience. (and then do 1-5 again)

7. Check for fatigue but won't go to sleep. The usual technique here is a stroller walk. (and then do 1-5 again)

8. Check for hungry but won't eat. You will have to calm baby and make it feel okay in order to eat. Proceed as per #6 (overstimulation) but stick baby on a nipple, in its most secure eating position. For us it helps to do this in the bedroom where baby sleeps and eats at night, that seems to be the most comforting place. Swaddling also helps here. Baby may even turn away and reject eating several times before it works. (and then do 1-5 again)

9. Assume unsignalled stomach pain. Failing all else, assume the problem is gastrointestinal, despite the lack of a clear GI relief test result (#4). So just walk baby around and pat its back, there's nothing else to do. (and keep repeating 1-5 again)

10. If you reach this point, your baby might just be a piece of shit. Throw it out and get a better one.

4 comments:

Aaron said...

Teething and periods just preceding developmental milestones will jack you too. On the flip side, these also work really well as semi-bs relief explanations between the 'why can't I figure this baby out' and the 'throw it out' stages. "Oh, well, we can't figure it out, she's probably teething, or about to do something mind-blowing in the next week or two". Very handy.

SteveP said...

Really nerdy Charles. After a while you should get to know your baby's different cries. No algorithm necessary.

SteveP said...
This comment has been removed by the author.
cbloom said...

Nonsense Steve. In the early days I thought could tell the difference between the cries (*). In my now much experienced and more mature parenthood, I see that the strict algorithm is far superior to the heuristic "I know what this is".

It's sort of like the way "expert investors" are almost always worse than very simple algorithms. Human judgement is not good.

(* = there certainly still are cases where the cries are different. There's a distinct "really hungry" cry. However, absense of the "really hungry" cry does not eliminate hunger as a cause of crying. etc.)

old rants