Fussiness in Premature Babies

Reasons Your Preemie May Be Fussy and Tips to Calm Your Child

Mom calming a crying baby in her arms
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Since premature babies often go home from the hospital before they reach their original due date, they don’t always behave the same as a baby born closer to forty weeks. Preemies show differences in the way they sleep, eat, and handle daily life. And, while some preemies are calm and sleep a lot, others tend to be very fussy. Here are some of the things that can cause fussiness in preemies and what you can do to help them.

Reasons for Fussiness

Some causes of fussiness are the same for full-term infants as they are for preemies. However, an early birth can lead to other reasons.

A premature nervous system: A baby born early has an immature nervous system. The nervous system controls the body’s movements, the senses, and the regulation of body functions. A preemie’s brain and nerves can have difficulty processing the world around them. They may be more sensitive and fuss in reaction to lights and sounds, being handled, or feedings.

Medications: Premature babies are more likely to leave the hospital on medications. Some medications are stimulants, especially those that prevent apnea. Stimulants increase activity in the body. They can make a baby jittery and irritable, and cause difficulty calming down and sleeping well.

Missing the NICU: After being in the neonatal intensive care unit (NICU) or special care nursery for weeks or months, your baby can get used to alarms ringing and a constant source of light throughout the day and night.

When you finally get home, the quieter, darker environment may be too different, so your child may be fussy while trying to adjust. Leaving a light on and keeping the radio or television on for some background noise might be helpful. You won’t have to do this forever. Try it for a few days, then gradually make it darker and quieter as your baby gets used to her new surroundings.

Reflux: When a baby eats, the food goes from the mouth, down the esophagus, and into the stomach. When the food and some of the acid that’s in the stomach moves backward and goes up into the esophagus, it’s called reflux. It’s uncomfortable, so your baby may fuss and cry after feedings. If your child has reflux, the doctor may recommend keeping his head higher than his stomach while he’s sleeping, making the formula or breast milk thicker, or using medications.

Food Allergies: A reaction to the protein in certain foods can cause an allergy in some babies. Preemie and infant formulas made from cow's milk or soy can cause stomach issues, pain, and fussiness. Breastfed babies can also have allergic reactions to dairy or other foods in their mother’s diet, although it’s not as common. If you suspect your child is fussy due to a food allergy, talk to the pediatrician about changing the formula or try to eliminate the common allergens from your diet if you’re breastfeeding.

Colic: Colic is excessive crying and fussiness that lasts for more than three hours at least three days a week for over three weeks. The cause of colic is not known, but it is thought to be related to a stomach issue such as gas, feeding intolerance, or an immature digestive system.

In full-term newborns, colic can start a few weeks after birth and it typically stops on its own by the time the baby is four months old. With preemies, colic can last longer. It's just a matter of time, but it will possibly go away closer to the corrected age of four to six months.

Illness: If your child is not feeling well because of a cold, fever, an earache, or an underlying medical issue he will try to let you know the only way he knows how. So, if your baby is fussier than normal, take his temperature and look for the signs that might indicate he’s sick or in pain. If your child has a fever or you suspect an illness, call the doctor.

Hunger: Just like full-term babies, preemies fuss when they're hungry, wet, or uncomfortable. So, it may seem obvious, but when your little one is fussy (even if it's a lot), you should always check the basics first. 

Babies tend to be fussier near feeding time, but sometimes they're hungry in-between feedings, too. If your child spits up after a feeding, or she’s breastfeeding and doesn't get enough at a feeding, she may still be hungry. Babies are also fussier during growth spurts because they need to eat more.

Dirty Diaper: Many infants don't like having a soiled diaper, and they fuss the second the diaper becomes wet or dirty. It can happen at any time, even immediately after the last diaper change. So, it doesn't hurt to check again. Try to keep your baby’s skin as dry and clean as possible and check for diaper rash, too. Diaper rash can be painful, especially when the diaper is soiled.

Air in the Stomach: If your baby didn't burp well after the last feeding, any air still trapped in his belly could cause discomfort. Even if he did give you an enormous burp after the last feeding, he might need to burp again, especially if he’s been crying.

Comfort: Make sure your baby isn’t fussing because she’s uncomfortable. Hair can get wrapped around little fingers or toes, or a tag on clothing can irritate your child’s skin and cause pain. Babies also fuss if they’re too warm or too chilly, so adjust the room temperature or your child's clothing if necessary.

How to Calm a Fussy Baby 

When you’ve met all your baby’s basic needs, and she’s still crying, what should you do? It can be difficult to figure out why your child is fussy or crying, and you might not find an answer. But, you can try to find a way to soothe her.

You may have to try many different things or a combination of techniques because what works for one baby will not always work for another. Here are some tips for how to calm a fussy preemie.

Reduce Stimulation: Some babies need a little light and noise after being in the NICU for weeks. However, most preemies need less stimulation. When there's too much going on it can be bothersome to a baby with an immature nervous system. A quiet, simple environment that doesn't overwhelm the senses is more likely to be calming for your child. Leaving a room with a lot of people or action, lowering the lights, and reducing the noise can all help.

Swaddle: Swaddling can help a baby feel warm and secure. When you snugly wrap a baby in a thin blanket, he will startle less and possibly sleep better.

Hold: Another way to help your preemie feel safe, warm, and secure is holding her close to your body with her arms and legs tucked in. A carrier or sling can also keep your baby close to your body while allowing you to have your hands free. Just be sure to use the sling or carrier correctly and safely.

Non-nutritive sucking: Sucking is soothing for some babies. Breastfeeding is comforting, so if you’re breastfeeding, put her to the breast. If you’re not breastfeeding, you can offer a pacifier.

Steady Noise: The constant repetitive noise of the vacuum or the washing machine seems to help calm some babies. Music may work, too. Research suggests that playing music can help relieve stress, ease crying, and reduce fussiness in preemies. So, you can try to sing a lullaby, put on a classical CD, or shuffle through your iPod until you find a song that your little one enjoys.

Movement: The gentle movements of walking, rocking, or dancing with your baby can help settle her down. If your child doesn’t like to be held and rocked in the traditional cradle hold, put her up to your shoulder or try holding her face down over your forearm while rubbing her back with the other hand.

The motion and sound of the car are calming for some babies and may put them to sleep. If you can’t go out in the car, put the baby in the stroller and go for a walk. The fresh air is good for both of you, and the movement of the stroller may be soothing for the baby. If you have to stay in the house, try an infant swing or a vibrating infant seat.

Just be sure use a car seat, stroller, infant seat, or swing safely. Your baby should fit in it properly so that he’s secure and able to breathe without difficulty.

Bath: Some preemies do not like to be in the water at all, but others do. The sound of running water and the warm sensation on the skin can soothe and calm a fussy baby.

Taking a Break 

If your baby tends to be fussy most of the time, it can be exhausting and stressful. If it’s possible, arrange for someone to give you a break. Your mom, a friend, or your partner can stay with the baby so you can get away, even if it’s just for a little while. An hour to yourself can make a big difference, so you can get back to the baby feeling calmer and refreshed.

If your baby is on a home monitor, your relief should know how to handle alarms and emergencies. If not, you can still take a little break, but don't go far in case you're needed. 

When It Gets to Be Too Much 

Sometimes babies cry inconsolably. It may seem like you tried everything and you just don’t know what to do. It’s always a good idea to take the baby to the doctor for a check-up to be sure there isn’t a medical issue. Of course, sometimes a specific problem cannot be found, and you’ll just have to deal with the crying and fussiness until your child grows out of this stage.

If you ever feel that you can’t take it anymore, you can put your baby in a safe place and walk away for a few minutes. It’s OK to take a moment if you need it, and it’s definitely OK to ask for help. Of course, if your baby has episodes of apnea with crying you shouldn’t leave her alone. You can put her down to cry, but stay close to monitor her while you call for help. And, remember, you should never shake a baby. Shaking a baby is very dangerous. It can cause serious harm or the death of a child.

A Word From Verywell

Not all preemies are demanding and hard to comfort, but many preemies require more care than expected. As a parent, it’s only natural to want to comfort your child when he’s unhappy. So, when it’s difficult to help your baby calm down and get settled, it can be heartbreaking and frustrating. It can make you feel as though you don’t know how to care for your child. Then, when you finally find what works, it may not work the next time.

Preemies can certainly be unpredictable, and it may take some patience and persistence to get you through the first few months. Thankfully, it will get easier as your baby grows. Not only will your child’s nervous system become more mature and less sensitive, but as the days go on you’ll learn to understand your little one’s cues and the things that work to help calm her. It may just take a bit longer than it would if your baby was born at full-term, so hang in there.

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Czinn SJ, Blanchard S. Gastroesophageal reflux disease in neonates and infants. Pediatric Drugs. 2013 Feb 1;15(1):19-27.

Douglas P, Hill P. Managing infants who cry excessively in the first few months of life. BMJ. 2011 Dec 15;343:d7772.

Keith DR, Russell K, Weaver BS. The effects of music listening on inconsolable crying in premature infants. Journal of music therapy. 2009 Oct 1;46(3):191-203.

Zenk KE. Neonatology: management, procedures, on-call problems, diseases, and drugs. Gomella TL, Cunningham MD, Eyal FG, editors. McGraw-Hill Education Medical; 2013.

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