The early days of a baby’s life are full of wonder and excitement, but let’s face it – they can also be filled with bouts of crying and fussiness, and newborns aren’t exactly known for their ability to clearly communicate their needs. We sat down with pediatrician Dr. Cara Kaupp (known as Dr. Cara by her patients) to sort out what’s up with the fuss.

The first 3 months of life are called the “fourth trimester” for good reason. “This is a period of tremendous change,” Dr. Cara says. “For nine months, her environment has been very stable with minimal changes in temperature, noise, and light, and she has had a steady stream of food. Loud, startling noises have been muffled, bright lights have been shielded, and her skin has been bathed in a warm bath. Now outside her mother’s womb, she is adjusting to noise, bright lights, clothes or cold air on her skin, and even hunger. Realizing this can really help new parents understand the many causes of crying.” The basics of newborn fussiness “relate to being overstimulated by sights, sounds or touch, being too hot or too cold, wanting a clean, dry diaper, the need for a nap, and of course, hunger.” All sound reasonable, right?

When attempting to soothe a fussy newborn, Dr. Cara explains the most tried-and-true methods mimic the womb (that happy place a mama’s mind wanders to when you meditate? It’s like that). This is why swaddling can be so effective, when done safely. Baby not into the swaddle? “Wearing your baby and walking around the home, or rocking your baby provides calming movements resembling his environment before birth,” Dr. Cara says. “Calming sounds like white noise, a fan, or the recording of a heart beat can also help soothe him.” Suspect baby might have the tummy troubles? “Babies with belly discomfort often feel more comfortable with pressure on their belly. Laying him across your knees and rubbing his back may help, but remember that back to sleep is always safest for him.” While hunger very well may be the culprit, Dr. Cara warns not to overfeed. It can cause stomach distention, gas, and discomfort, all of which could prolong or intensify the fussiness. And remember, one of the first ways babies soothe themselves is by sucking. “Introduce a pacifier, as long as he is feeding well,” she says. (Newborns may need a little help getting started with a pacifier, but most find their groove eventually.) If baby is especially prone to over-stimulation, Dr. Cara recommends avoiding busy places during the fourth trimester.

There’s crying and fussiness to be expected, and then there’s that c-word every pregnant women learns to fear: colic. But rest assured, a colicky baby isn’t a sign of parenting failure. “[Colic] is extremely common and occurs in up to 40 percent of all infants. It starts between the third and sixth week after birth and ends when a baby is 3-4 months of age,” Dr. Cara says. And colic isn’t picky: “It occurs equally in boys and girls, breast and bottle-fed infants, full and pre-term infants, and siblings (but it isn’t thought to be hereditary).” Excessive crying is defined as three hours per day, at least three days per week. A colic cry is more intense, louder, and higher pitched, and can sound like the baby is in pain or screaming. “Colic episodes have a clear beginning and end and frequently happen in the evening hours between 6 and 10pm, when most parents are exhausted,” she explains. Dr. Cara advises parents to call their pediatrician if the suspect the baby might have colic. “Many times, there are treatable causes of extreme fussiness, including a change in mother’s diet if breastfeeding or formula changes if bottle fed, treatment for gastroesophageal reflux (GERD) if present, or other treatments for more rare causes of fussiness and crying.”

Worried something more than run-of-the-mill newborn fussiness or colic might be happening? Call the pediatrician. In the first three months of life, Dr. Cara urges parents to call your pediatrician immediately if they notice continuous crying for more than two hours, refusal to eat anything for more than a few hours, a change in baby’s behavior, such as acting lethargic or not responding as she usually does, crying as a result of an injury or fall, a fever over 100.4, vomiting or diarrhea. Less urgent, but still warranting a call to the doc are concerns the baby isn’t gaining weight, excessive crying, concerns with frequent spitting up, or concerns about stool, and if the excessive crying lasts beyond four months of age.

Dr. Cara’s most important tip of all? “It’s also important to realize this period doesn’t last forever and to ask for help when you are feeling overwhelmed or exhausted.”

After all, it takes a village.

Cara Douville Kaupp, MD, FAAP, affectionately called Dr. Cara by her patients, is a board-certified pediatrician who has been in practice nearly 14 years. She is passionate about foster care and adoption (both domestic and international) as well as integrative medicine. She resides in southern New Hampshire with her husband (also a physician), their 4 children and 2 dogs. She is an adoptive mother of twin girls (age 10) born in China and birth mother to two sons (ages 9, 7).

DISCLAIMER: The information in this article is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.  This information is for general information purposes only. You are encouraged to review all information regarding any medical condition or treatment with your pediatrician.