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Inconsolable, but normal

Russell Mendiola squinches up his little face and emits an unhappy whimper in the hallway at the Family Nurturing Center in Medford Thursday afternoon. Within a minute, he is in a full, fist-clenched wail. His mother, Rebecca Mendiola, 24, gently bounces her 51/2-month-old son on her lap.

"Sssshhh, ssshhh," she whispers, before offering him a quick suck on her breast.

Mendiola had a simple fix for her crying baby. But sleepless nights caring for a red-faced, screaming infant who cannot be soothed can cause parents or caregivers to unravel. It's easy for them to assume there is something seriously wrong with the baby — or themselves.

"Crying can turn to screaming," said Mendiola, whose four other children are ages 2, 4, 5 and 6.

"It's very stressful. They scream and cry and scream and cry."

Doctors and researchers have discovered inconsolable crying is normal behavior for all infants, particularly during the first three months of life.

And they hope by educating parents on this part of a baby's development — and how to respond to it — they can help prevent abuse.

Known as the period of PURPLE crying (see related story), the cycle begins in the first month, peaks during the second month and tapers off at the end of three months, said Dr. Russell Barr, researcher for the National Center on Shaken Baby Syndrome.

"We want parents and caregivers to know three things about inconsolable crying: It is normal, it is not their fault, and it will pass," said Barr.

But research also has shown that inconsolable or frequent infant crying is a trigger for shaken baby syndrome, said Dr. Kerri Hecox, medical director for the Children's Advocacy Center in Medford.

"The number one trigger for all child abuse is crying," she said. "We need to change the culture. And that starts with education."

Parenting is hard work. Stressors can reach lethal levels. Before that happens, parents and caregivers need to step away, Hecox said.

"Know when you can't take it anymore," she said. "As long as the baby's safe, the crying is not going to hurt them."

Barr has spent 30 years studying crying patterns in babies around the globe. Across all cultures and in all countries, inconsolable crying behavior in infants is the norm, he said.

"Every baby will have inconsolable crying episodes," said Barr. "We don't know exactly what causes it. We do know you can't do much of anything about inconsolable crying."

Barr said some babies will have more episodes. Some will have fewer. And, unfortunately, closely shadowing the crying curve is the number of incidents of shaken baby syndrome, Barr said.

"Even if it only happens six times in their life, if you happen to be there when it does, you can lose it," he said.

Shaken baby syndrome is the leading cause of death in abusive head trauma cases among infants, according to the National Center on Shaken Baby Syndrome. An estimated 1,200 to 1,400 children are injured or killed by shaking every year in the United States. Locally, the numbers of shaken baby syndrome cases are on the rise, said Hecox.

"I have one case I'm dealing with right now that involves a skull fracture," she said.

To reduce the abuse, Rogue Valley hospitals and community agencies will launch a new initiative this summer, The Period of PURPLE Crying program. A 10-minute DVD will be shown to mothers of newborns at all four hospitals in Jackson and Josephine counties explaining normal infant crying, offering ways to reduce stress related to the crying, and informing them of the dangers of shaking an infant.

The information also will be provided to fathers, aunts, uncles and baby sitters, Hecox said.

"Anyone who is in the room," she said.

"We're going to give it to them to take home, along with a pamphlet," she added. "We want them to share it with their aunts and grandparents and teenage baby sitters. We want everyone to have this information."

Hecox said parents and caregivers should do what they can to soothe a crying baby. But they also must recognize it is stressful to hear a baby cry. And when attempts to soothe a screaming infant prove fruitless, nerves can fray and tempers can flare. Bouncing and jiggling, intended to soothe, can quickly become a life-threatening shake if parents or caregivers snap under the pressure, she said.

Research shows frustrated caregivers, males in particular, often feel that shaking a baby or small child is a harmless way to make the child stop crying.

"If you're upset, you don't really realize the force you're exerting. And it doesn't take much of a shake to seriously injure a baby," Hecox said.

Shaken baby syndrome is the shaking of an infant or child by the arms, legs or shoulders with or without impact to the head. This trauma can result in bleeding and brain injury with no outward signs of abuse. After the shaking, swelling in the brain can cause enormous pressure within the skull, compressing blood vessels and increasing overall injury to its delicate structure.

Approximately 25 percent of babies with the syndrome die as a result of their injuries. Of those who survive, 80 percent suffer permanent disability such as severe brain damage, cerebral palsy, mental retardation, behavioral disorders and impaired motor and cognitive skills. Many survivors require constant medical or personal attention. Medical costs associated with initial and long-term care for these children can range from $300,000 to more than $1 million.

Previous studies done by Dr. Mark Dias in New York state proved that giving mothers information about shaken baby syndrome decreased incidents of abuse by 50 percent, said Barr.

Inconsolable crying may be normal. But it's still tough to handle when the cultural norm expects a crying baby to be instantly soothed.

"People stare at you, like, 'what did you do to him?' " Mendiola said. "I didn't do anything. He's just crying. It's normal."

Apple's introduction of a new iPhone application called "Baby Shaker" created a furor in April after child protection groups launched protests about the program's take on a deadly serious subject. For 99 cents, users of the iPhone and iPhone Touch received images of a crying baby. The object of the "game" was to shake the baby until red Xs appeared over its eyes and a calm baby appeared.

Apple pulled the application within two days and offered a four-sentence apology, said Marilyn Barr, founder of the National Center on Shaken Baby Syndrome and wife of Russell Barr.

"(Apple) said it somehow slipped through the cracks," she said. "And I find it hard to believe they thought it was appropriate. But they put this up during Child Abuse Prevention month, and during Shaken Baby Syndrome Awareness week."

Marilyn Barr said she wished her husband and other researchers had discovered inconsolable crying was normal when her children were infants.

"My first child was a high-crier," she said. "If I had only known it would come to an end. Just having that information would have helped so much."

Russell Barr lectures across the U.S. and Canada. Many doctors, nurses and child-welfare specialists also express relief that inconsolable crying is normal, he said. One 53-year-old nurse told Barr she'd carried around guilt for decades after being told her baby's cries meant she wasn't bonding well with the infant, he said.

"We now know you can't do much of anything about inconsolable crying," he said.

We all need to take a look at our response to crying babies, said Mary-Curtis Gramley, director of the Family Nurturing Center. Pounding on an apartment wall and hollering for a parent to shut a child up isn't going to do anything to alleviate crying. Nor will glaring, muttering or heaving huge sighs while witnessing an adult struggling with an inconsolable crying infant.

"We judge without understanding," Gramley said. "When you stop and think about the cumulative effect of stressors that families can face, you come to understand the humanity of this."

Russell Barr studied cultures in Africa where babies are swaddled and carried constantly by their mothers. At night, parent and infant sleep skin-to-skin, nestled against each other. Every whimper is responded to within 15 seconds, and the babies are fed every 15 minutes. Although the duration of the infants' crying episodes were reduced by half, these babies still experienced bouts of inconsolable crying. And their peak crying patterns remained the same, said Barr.

"If you had a baby that was crying for three hours every night, you might get it down to one and a half hours," Barr said.

Mendiola is glad her son has exited the peak crying period. But that doesn't mean he doesn't still cry. And when he does, she hopes everyone, including herself, will understand.

"I try to keep myself in that zone," Mendiola said. "I go pick him up and rock and sing. And if that doesn't work, I can leave him in his crib."

Reach reporter Sanne Specht at 776-4497 or e-mail sspecht@mailtribune.com.

A fussy Russell Mendiola, 5 12 months, approaches full volume at the Family Nurturing Center in Medford Thursday before his mom, Rebecca Mendiola, feeds him. The center is taking part in a new program aimed at preventing abuse by educating parents on how to respond to infants when they become inconsolable, a normal part of infant development. - Jim Craven