By Nelson Muhia, Research Assistant, APHRC
The birth of a baby has profound effects on any mother. They are gripped with a strong desire to hold the baby, keep it warm, safe and marvel at its tiny features. Unfortunately, this joy is short-lived as they begin to face the challenges of caregiving. While providing diapers, food and medical care are anticipated, most of them seem unprepared and are quite unsettled by a crying baby.
The World Health Organization (WHO) recommends that infants should be exclusively breastfed for the first six months and thereafter receive safe and nutritionally adequate complementary foods while continuing to breastfeed for up to two years or more.
The Exclusive Breast Feeding (EBF) rate in the developing world stands at 39 per cent while in Eastern and Southern Africa it stands at 52 percent. In Kenya, the EBF rate is 32 percent with 24% of children under two months receiving complementary foods and liquids. The median duration of exclusive breastfeeding is estimated at less than one month [1, 2]. The task ahead, as set out by the national Maternal Infant and Young Child Nutrition (MIYCN) strategy is to increase EBF rates from the current 32 percent to 80 percent by 2017 .
APHRC, through its Maternal Infant and Young Child Nutrition research project promotes maternal and child health through three studies which focus on Baby Friendly Community Initiatives (BFCI). This is in acknowledgement of the importance of optimal maternal infant and young child nutrition within the first 1000 days, from the start of a woman’s pregnancy, to the child’s second birthday with regard to child growth, health and survival . Findings from these studies indicate that crying in infancy is a major deterrent to optimal MIYCN practices.
Crying in infants is a cue for hunger or thirst
There was a general perception that breast milk alone is not a sufficient diet for children and that infants cannot survive without water. Breast milk is therefore supplemented with light porridge, mashed potatoes, bananas, fruits, water and cow milk.
“A baby shows characteristics of being hungry all the time and your milk is not enough for it. When you give such a baby the breast, it still cries…the more you give it the breast the more it cries and so I was forced to start giving the baby porridge at two weeks…“(FGD, Older Mothers, Vihiga County)
There were also some reported gender differences in infant feeding practices, where boys were believed to not get satisfied by breast milk alone in comparison to girls.
“There are some children especially boys who are too greedy and so they cry a lot such that you do not have peace. When you introduce foods like porridge they become relaxed and so as a mother you know that the child was not getting satisfied.” (FGD, Older Mothers, Korogocho Slum, Nairobi)
Crying in infants is a result of stomach disorders
Many care givers tend to associate the crying of a baby with stomach disorders such as constipation or diarrhea. While this is not completely farfetched, the preference of home remedies (plain water, sugar and salt solution, honey and gripe water) rather than seeking medical care from a qualified health professional is a huge cause for concern.
“After 2 or 3 days, if the child cries, they will boil water and put some salt and sugar, to give the child to stop its stomach ache and indeed the baby stops crying” (FGD, Community Health Volunteers, Viwandani Slum, Nairobi)
Distress to family and community members
The distress caused by a crying infant may extend to the rest of the family and to the wider community, increasing the probability of early introduction of supplementary foods. Picture a baby who often cries long and hard into the night, in a small single bedroom house that stands in close proximity to tens of others. In such instances, the ‘tested and proven’ remedy for many care givers is to introduce foods before the recommended six months.
“If you breastfeed and the baby doesn’t get satisfied then you get headaches and the baby cries a lot. Then you should give it food.” FGD, Young Mothers, Viwandani Slum, Nairobi)
The influence of family and peers
Most care givers especially young and first time mothers lack sufficient information on what to do when a child cries. Advice is sought from community members who are perceived to be more experienced in care giving, such as grandmothers of the child (i.e. mothers or mothers-in law) and peers.
More often than not, the advice given is early introduction of foods and drinks. The fact that some care givers fall for these kinds of misinformed interventions demonstrates their desperation and lack credible information on how to deal with crying babies.
“Mothers- in- law will tell them, ‘the baby is crying a lot give her some porridge’ and even when they are eating ‘ugali’ (corn meal) they are told to give the baby a little bit…some go to stay with their parents so at this point you will find that since the baby is crying a lot the first three days after birth then it is given water with some sugar”(KII, Health Professional, Kwale County)
Factors that may trigger infant crying include discomfort from heat , cold, dirty diapers, improper feeding techniques, allergies, fatigue from being passed around and illnesses such as fever. We reiterate the importance of exclusive breastfeeding for the first six months of life, early introduction of food and drinks to infants should not be the immediate solution to crying . Instead, simple soothing techniques such as swaddling, burping, movements to relax and quiet the baby should be encouraged . It will be a worthwhile effort to continually sensitize care givers, family members, male spouses, and community members on reasons why infants cry and optimal Infant and Young Child Feeding practices.
1. Central Bureau of Statistics (CBS) [Kenya], Ministry of Health (MOH) [Kenya], and ORC Macro, Kenya Demographic and Health Survey 2003. 2004, CBS, MOH, and ORC Macro: Calverton, Maryland.
2. Kenya National Bureau of Statistics (KNBS) and ICF Macro, Kenya Demographic and Health Survey 2008-09. 2010, KNBS and ICF Macro: Calverton, Maryland.
3. Ministry of Public Health and Sanitation, The World BreastfeedingTrends Initiative. 2012.
4. Kimani-Murage, E.W., C. Kyobutungi, A.C. Ezeh, F. Wekesah, M. Wanjohi, P. Muriuki, R.N. Musoke, S.A. Norris, P. Griffiths, and N.J. Madise, Effectiveness of personalised, home-based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial. Trials, 2013. 14: p. 445.
5. Pankaj Garg, infantile colic-unfolded. Indian Journal of Pediatrics, 2004. 71.
6. Neifert, M. and M. Bunik, Overcoming clinical barriers to exclusive breastfeeding. Pediatr Clin North Am, 2013. 60(1): p. 115-45.
7. Herman, M. and A. Le, The crying infant. Emerg Med Clin North Am, 2007. 25(4): p. 1137-59, vii.