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Persistent, inconsolable crying in young infants is common, distressing but usually benign. This selective review examines perceptions and perceived origins of this phenomenon in babies where serious pathology has been excluded. Adult brains have evolved to become hypersensitive to infant cries. Babies respond to parental stress by crying more, thus setting up a vicious cycle. Most treatments appear to work largely through a placebo effect. The imperative for healthcare professionals is to reduce parental anxiety by offering reassurance and support., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aim: Therapeutic aerosols are routinely used in the management of infant obstructive airways disease. Infants often become distressed during administration. The aim of this study was to determine the influence of distress and disease severity on the absorption of aerosolised drug in this age group., Methods: Fifteen infants, eight with resolving chronic lung disease of prematurity (mean age, 13 months), and seven infants with normal birth histories (mean age, 11 months) were studied. Flow through small airways was assessed by measurement of partial forced expiratory flow volume curves. Each infant was then given a dose of 20 mg nebulised sodium cromoglicate via a Sidestream nebuliser and distress was graded as: 1, not distressed; 2, distressed. Infants were excluded if contact with the mask was lost for more than 10 seconds. Urine was collected for eight hours and analysed for excreted drug by radioimmunoassay., Results: Sodium cromoglicate is absorbed by the respiratory epithelium, and undergoes renal (43%) and hepatic (57%) excretion. A mean of 0.43% of the total nebulised drug dose was excreted in the urine of the non-distressed infants compared with 0.11% of total dose in the distressed infants. Flow through the small airways was significantly reduced in infants with chronic lung disease of prematurity. Maximum flow at functional residual capacity did not correlate with the amount of drug in the urine, but the degree of distress did., Conclusion: To maximise absorption, nebulised drugs should be given to settled infants. The degree of airways disease does not influence drug absorption in this age group.

Gastro-oesophageal reflux (GOR) disease may cause excessive crying in infants. The role of GOR was evaluated in infant irritability and an attempt was made to define clinical predictors of pathological reflux. Seventy consecutively admitted infants with irritability and presumptive GOR were retrospectively reviewed. All had undergone prolonged oesophageal pH monitoring. Pathological GOR was defined as a fractional reflux time of > or = 10% and was significantly less common in infants under 3 months (one of 24; 4.2%) than in older infants (10 of 46; 21.7%). All infants with pathological GOR presented with frequent vomiting, and 'silent' pathological reflux did not occur. Poor weight gain, feeding refusal, backarching, and sleep disturbance were not significantly associated with pathological GOR. The results suggest that pathological GOR is an unlikely cause of infant irritability under the age of 3 months.

A prospective study of minor reactions after the four combined vaccinations for diphtheria, tetanus, pertussis, and poliomyelitis (DTPP) was performed in 540 infants in the Netherlands. An analysis was made of the symptoms observed by the infants' parents after 2026 inoculations. The aim was to assess the frequency, association, and risk of recurrence of minor reactions. These were designated as fever (greater than or equal to 38.0 degrees C), local reactions, crying, and other general symptoms (changes in sleeping or eating patterns, vomiting, drowsiness, fretfulness). Fever occurred after 67.7% of inoculations, one or more local reactions after 66.2%, and increased crying after 64.4%. After 80% of inoculations, one or more other general symptoms occurred. Only 4.4% of inoculations were followed by no minor reaction. Fever rarely occurred as an isolated symptom; it showed a significant association (i) with one or more local reactions, (ii) with increased crying, and (iii) with two or more other general symptoms. Chances of fever, redness at the inoculation site, and crying after inoculation increased with repeat inoculations if these reactions had occurred after preceding inoculation(s).

This paper defines the normal range of respiratory rate in babies under 6 months of age. It was counted by two observers in 1007 babies of whom 709 were seen when presenting to hospital for assessment of an acute illness, and 298 on a random basis at home. Whether they were asleep, content, or crying was recorded and the severity of their illness graded. The diagnosis was also recorded. The mean (SD) for the respiratory rate in babies seen awake was 61 (18) breaths/minute at hospital and 61 (14) breaths/minute at home. The respiratory rate when awake did not correlate with the severity of a baby's illness or the presence of serious lower respiratory tract infections. Sleeping babies had a significantly lower mean rate than awake babies at 42 (12) breaths/minute. Crying babies had a significantly lower mean rate than awake and content babies: 51 (14) breaths/minute compared with 61 (18) breaths/minute.

Serial measurements of crying vital capacity (CVC), expressed as ml/cm chest circumference, were made by reverse plethysmography during the first 2 weeks of life. Clinically normal babies born at term by elective caesarean section had a smaller mean CVC in the first 2 weeks of life compared with clinically normal term babies born vaginally. In contrast, no significant difference was shown between the mean CVC in term babies born vaginally and those born by urgent caesarean section. Clinically normal term babies born by caesarean section (elective and urgent) had a smaller mean percentage rise of CVC in the first 24 hours of life and a significant delayed rise of CVC from 24-48 hours compared with those born vaginally. Clinically normal preterm babies born vaginally had a smaller mean CVC in the first 2 weeks of life compared with term babies born vaginally, and were characterized by a significant rise of CVC from 5-10 days. Babies with hyaline membrane disease (HMD) had a smaller CVC in the first 2 weeks of life compared with clinically normal preterm babies. Babies of various gestational ages with transient tachypnoea (TT) had a smaller mean CVC in the first 2 weeks of life compared with clinically normal term babies, but a similar mean CVC in the first 72 hours of life compared with clinically normal preterm babies. At each postnatal age the mean CVC of babies with HMD was less than the corresponding mean in babies with TT. All babies with TT had a rise in CVC from 24-48 hours, whereas CVC fell in all babies with HMD except one during this period. CVC is a simple, safe, rapid, and noninvasive test of neonatal lung function, and is a valuable aid to other methods of assessing pulmonary function in the neonate with respiratory distress.