Crying at Night

Dear Lisa,

I HAVE A 9 MONTH OLD BABY, WHEN SHE IS SLEEPING SHE WILL ALL OF A SUDDEN WAKE UP SCREAMING. I HAVE TRIED EVERYTHING TO Calm HER DOWN BUT FOR 30 MIN. TO AN HOUR SHE SCREAMS LIKE SHE IS IN PAIN. SHE BECOMES WET AND CLAMMY, I WILL GIVE HER SOME TYLENOL, WHEN SHE DOES SETTLE DOWN SHE JUST LAYS THERE LOOKING AROUND, THIS HAS BEEN GOING ON FOR ABOUT TWO WEEKS NOW. IT IS NOT EVERY TIME SHE GOES TO SLEEP, BUT EVERY NOW AND THEN. IS SHE HAVING NIGHTMARES THIS YOUNG OR COULD SOMETHING BE WRONG WITH HER?

"WAKING AT NIGHT CRYING",

Dear “WAKING AT NIGHT CRYING”,

A 9 month old who wakes at night screaming is most likely in pain. The pain could be from a multitude of sources, with ear infections being on top of the list. Children with Otitis Media (a middle ear infection) have a lot of ear pain at night and tend to wake up crying. Other signs of an inner ear infection include runny nose, nasal stuffiness, cough, pulling at the ear or fever. (1) If your daughter is exhibiting any of these signs I would be suspicious of an ear infection. An examination by your daughter’s Doctor or Nurse Practitioner can tell you if this is the problem.

Infants may also cry and wake at night because they are teething. Nine months old is a common age for teething. When a tooth is about to erupt the gums become swollen and painful. Children that are teething tend to be irritable, drool, gnaw a lot and wake at night. (2) While sleeping some babies bite down hard on their swollen gums by accident which causes a lot of pain and can wake them from their sleep. This is especially a concern when there is a new sharp tooth in the lower gum that irritates the swollen gum above. This commonly occurs since the lower central incisors (bottom middle teeth) are typically the first to erupt followed by the upper central incisors (top middle teeth). (2) You can look inside your baby’s mouth to see if the gums are red or swollen. If it is too hard to see inside your baby’s mouth, a Doctor or Nurse Practitioner can do this for you. Giving a pain medication at bedtime such as Tylenol can help a child who is teething.

Abdominal pain is also a cause of infant pain and waking at night. Nine months old is the age when new foods are typically introduced into a child’s diet. Many children are first introduced to eggs or dairy at this time. If a baby develops a sensitivity to new foods they can experience abdominal pain and in some cases vomiting. (3) Signs of abdominal pain in a baby include crying, grimacing, pulling knees up to the chest and refusal to eat. (4) In some cases the abdominal pain can be due to gas. Certain foods such as oatmeal, beans, corn and certain vegetables tend to make babies gassy. If your baby has burbing and expels a lot of gas when she wakes at night crying this may indicate that she is having difficulty adjusting to a new food.

Many times abdominal pain in children is intermittent and not continuous. In cases where a child is sensitive to a food, the symptoms may come and go if the child is not eating the offending food everyday. For a child with intermittent abdominal pain, it is a good idea to keep a food diary in order to see if there is a relation between certain foods and symptoms. Babies with abdominal pain should be evaluated by their Physician and the abdominal pain diary should be brought to the Pediatrician’s office for the evaluation. If a baby experiences signs of constant abdominal pain that are continuous or seem to be worsening, this may represent a more serious problem and your baby’s physician should be contacted.

Another cause of intermittent abdominal pain in a child is Gastroesophageal Reflux (GER). Gastroesophageal Reflux symptoms are more predominant after eating and at night. Children with GERD tend to vomit, regurgitate, arch their back, have excess hiccoughing, irritability, nasal congestion, coughing or wheezing. (5) If your baby is exhibiting any of these signs or if she has a history of GERD, this diagnosis should be considered. An evaluation by your baby’s Doctor or Nurse Practitioner can help clarify the situation.

Whenever a baby wakes suddenly crying at night it is a good idea to do a head to toe check. You want to make sure that your child is not injured. Some babies can accidentally get their arm or leg caught in a slat of the crib. It is also very important to inspect each finger and toe while the lights are on. There have been cases where a long strand of hair or string accidentally wrapped around a baby’s finger or toe and cut off the circulation. This can cause a lot of pain and if it is not detected can be very harmful.

Dreams that scare and wake a child are more predominant in older children when a child’s imagination struggles with what is real and what fantasy is. Dreams are also means of expressing anxiety or fear. (4). Developmentally at nine months old, the psyche is not developed enough to experience enough turmoil or anxiety that would result in waking and crying from a dream. Night Terrors also occur in older children. They are repetitive in nature and usually occur at the same time each night. Children with night Terrors typically assume a crouching position in their bed while they are crying or screaming . They appear to be staring at something that is scary. During a Night Terror the child does not respond to an adult who tries to soothe them. The child falls back to sleep and has no memory of the episode in the morning. (4)

I hope you find the source of your baby’s crying soon so that everyone can get a good night’s sleep.

References:
(1)Niemela M, Uhari M, Junio-Ervasti K. Lack of specific symptomatology in children with acute otitis media. Pediatr Infec Dis J. 1994;13765-768.
(2)Grassia T. Talking teething: Start good oral hygiene early. Infectious Diseases in Children. 2006:44.
(3)Grassia T. Children’s allergy to cow’s milk lasts longer than previously thought. Infectious Diseases in Children. 2006;19(1):43.
(4)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1418, 254-255.
(5)Edmunds A. Gastroesophageal Reflux Disease in the Pediatric Patient. Therapeutic Spotlight. 2005:3-14.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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