According to the German Society of Paediatrics and Adolescent Medicine (DGKJ)1 and Austria's public health portal 2, a baby is considered a persistent crier if he or she cries for more than three hours a day on more than three days a week for more than three weeks. Babies cry suddenly for no discernible reason starting from around the second week of life, with the crying often abating toward the end of the third month of life. However, some persistent criers are still crying a significant amount when they are six or even nine months old. The baby cannot be soothed and exhibits symptoms such as clenching their hands into fists, drawing up their legs, a flushed face, a hardened abdomen, and/or flatulence.
After birth, the baby is especially susceptible to being overwhelmed and has to work through his or her prenatal and perinatal experiences. They will need more support from their parents than other babies whose pregnancy and birth were affected by less stress and fewer interventions. Because babies can only initially communicate by crying and screaming in addition to non-verbal communication, babies who are under stress cry more than others.
Many specialist articles mention that the exact cause of this crying has not been clearly explained, but knowledge of the subject has changed in recent years. It should be noted that not every baby that cries necessarily has a regulatory disorder. This term refers to the difficulties babies have in adequately controlling and adapting their behaviour in different situations, which takes the form of excessive crying, sleep disorders, or feeding problems. Based on prenatal and perinatal psychology, birth psychology, and epigenetics, we know that excessive crying on the part of babies can be attributed to how they process experiences. In addition, babies who underwent a lot of stress during pregnancy or whose birth was traumatic have a very tense nervous system. Babies normally start regulating while still in the womb. They do this for example by sucking their thumb. The polyvagal theory3 states that if the mother frequently exceeds the boundaries of the zone of "optimal arousal"4 (window of tolerance, Dr. Dan Siegel) during pregnancy, the baby may be continually inundated with cortisol. This can impair not only the structure of the baby's brain but also the central nervous system.
Another problematic factor is that this results in changes in the amygdala, which is responsible for processing emotions and stress.
A number of pioneers5 devoted their work to studying the experiences babies already have in the womb and during birth. This knowledge enables a better understanding of the correlations between a baby's experiences and crying behavior.
G. Hidas and J. Raffai found that applying prenatal bonding analysis during pregnancy results in fewer persistent criers6. This positive effect can be explained by the fact that prenatal bonding analysis helps to reduce stress on the child during pregnancy and birth. It also enables more intuitive communication between mother and baby, making it easier for the mother to understand her baby. This also means that the baby doesn't need to cry as much to be "understood" by the mother.
The psychological burden on parents is enormous, with the challenges they face including helplessness, excessive demands, frustration, stress, a lack of sleep, and emotional exhaustion, to name just a few. Parents are also at a higher risk of experiencing postnatal depression and separating. It is therefore important that doctors, midwives, and other specialists are attentive and make a point of asking after the well-being of the parents. If it becomes evident that a baby may be a persistent crier, it is helpful to refer the parents to specialists who can assist them. Identifying the situation at an early stage and obtaining targeted support can reduce the burden on the parents. A crucial aspect is that parents are given access to information, advice,and assistance in order to protect their mental health and support the family during this challenging time.
There are opportunities for prevention in this area. One measure that can be taken is prenatal bonding analysis, an approach developed by Hidas & Raffai which is still relatively unknown. This support during pregnancy promotes emotional communication between the mother and her unborn child. Specific exercises and conversations help the mother learn to pick up on her child's signals and respond to them. This leads to a deep and trusting relationship that offers both of them a sense of safety and comfort. The mother also focuses on her own prenatal and perinatal experiences as well as the birth, thereby reducing stress and anxieties. According to WHO7 , 20% of all women suffer postnatal depression. Women who received support in the form of prenatal bonding analysis, on the other hand, have just a 1.3%7 risk of developing postnatal depression. Prenatal bonding analysis decreases the stress of birth for the mother and child, lowers the rate of caesareans to 18%, and that of preterm births to just 1.7% 8 (EU Benchmark-Report 2009/2010: EU average of 7.1%)9, and reduces the probability of having a persistent crier to 0.3%7. By comparison, the German Society of Paediatrics and Adolescent Medicine states that around 20% of all newborns can be considered persistent criers10. Persistent criers are often the result of stress during pregnancy and birth, which places excessive strain on the child's nervous system and is communicated in the form of crying. "With prenatal bonding analysis, babies typically cry for less than 20 minutes per day after birth—which clearly shows that they were subjected to less stress during birth 11," writes Dr. Gerhard Schroth in his introduction to Jenö Raffai's theory of prenatal bonding.
The other parent can also play a positive role in bonding during pregnancy, which might include:
As the parents' first point of contact, it is important that you have services and a network to which you can refer parents. These referral services might include organisations specialising in persistent criers13 , craniosacral therapists, baby therapy consultants14 , prenatal bonding specialists , midwives with specific additional training, and other specialists15 and groups. A network that works effectively will help parents to access the resources they need.
1https://www.dgkj.de/eltern/dgkj-elterninformationen/elterninfo-schreibaby#:~:text=Man%20spricht%20von%20einem%20Schreibaby,nur%20als%20grober%20Richtwert%20dienen (last accessed: 9 Aug 2023)
2 https://www.gesundheit.gv.at/leben/eltern/nach-der-geburt/schreibaby.html (last accessed: 9 Aug 2023)
3 Porges, S.W. (2021). Die Polyvagal-Theorie und die Suche nach Sicherheit. Traumabehandlung, soziales Engagement und Bindung. Gespräche und Reflexionen zur Polyvagal-Theorie. [The Polyvagal Theory and the Search for Safety. Trauma Care, Social Engagement, and Bonding. Conversations and Reflections on the Polyvagal Theory.] G.P. Probst Verlag.
4 https://www.attachment-and-trauma-treatment-centre-for-healing.com/blogs/understanding-and-working-with-the-window-of-tolerance (last accessed: 9 Aug 2023)
5Otto Rank (Das Trauma der Geburt) [The Trauma of Birth], Karlton Terry (New Parenting Can Change Your World: More Wisdom - Less Stress - Including the Cure for Colic), Ray Castellino (WombSurround Workshops), William Emerson, Christian Rittelmeyer (Frühe Erfahrungen des Kindes, Seele des Kindes vor, während und nach der Geburt [The Child's Early Experiences, the Child's Soul before, during, and after Birth]), György Hidas and Jenö Raffai (creators of prenatal support during pregnancy based on prenatal bonding analysis), David B. Chamberlain, et al.
6https://www.schroth-apv.com/Bilder/BindungsAnalyse_dt_schroth-apv.pdf (last accessed: 8 Aug 2023)
7https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/maternal-mental-health (last accessed: 5 Aug 2023)
8Görtz-Schroth, A. Fortschritte in Schwangerschaft und Geburt durch Bindungsanalyse [Advances in pregnancy and birth through prenatal bonding analysis] (pp. 10–17)
9 https://www.efcni.org/wp-content/uploads/2018/03/german_translation_of_benchmarking_report.pdf (last accessed: 9 Aug 2023)
10Blazy, H. (2022). Bindung im und Trennung vom ersten Zuhause [Bonding in and separation from the first home], (pp. 10–17). Mattes Verlag. (
11Einführung in die Bindungsanalyse [Introduction to Prenatal Bonding Analysis]. Website of Dr. Schroth 31210 rev.) (schroth-apv.com) (last accessed: 8 Aug 2023)
12VRANNI: Questions: V (adVantages): What are the advantages of the measure?, R (Risks): What are the potential risks/consequences?, A (Alternatives): Are there any alternatives? If so, what are they? What risks/consequences do they involve?, N (do Nothing): What might happen if we do nothing?, N (emergeNcy): Should this be considered an emergency? How soon does the decision need to be made?, I (Instinct): What does our gut tell us?
13https://www.familienhandbuch.de/unterstuetzungsangebote/beratung/schreiambulanzen.php, https://www.elternsein.info/suche-schreiambulanzen/, https://www.gesundheit.gv.at/leben/eltern/nach-der-geburt/schreiambulanz.html, (last accessed: 8 Aug 2023)
14 https://www.ippe.at/babytherapy/ (last accessed: 8 Aug 2023)
15www.kelaridis.at (last accessed: 8 Aug 2023)
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