Creating Waves of Awareness
Dr Muhammed Rafeeque, BHMS.
We all enjoy the smiling faces of babies. But when they cry excessively, we go out of mood. A good number of our midnight patients are crying babies brought by their panic stricken parents. Two things done by the doctor can handle the situation smoothly, i.e. diagnosing the cause for crying and giving a dose of indicated homoeopathic medicine. The former is to ease the tension of parents whereas the latter is to make the baby happy.
Crying is a normal phenomenon in the lives of all babies. When they come out of the mother’s womb, the first thing to do is crying by which some air is sucked in to the lungs for the first time in their lives. If the baby doesn’t cry after delivery, it should be initiated by gently pinching the skin or by stroking the feet. This indicates the importance of crying as a sign of good health. We know that a baby can't tell his needs or troubles in words. Hence crying is the only way for him to communicate with others. Of course, babies show some other signs such as feet kicking, fist clenching, leg flexing, hand waving, head turning etc. But the best attention-seeking tool is crying. Though it is considered as physiological, excessive crying causes tension to parents. Excessive crying may not have a firm definition because the crying habit differs from baby to baby and some babies can be calmed easily whereas it’s difficult to handle others. However, if the crying is distressing for the mother and family members, it can be called excessive.
The causes of crying extend from simple reasons to life threatening conditions. Hence crying of a baby should not be ignored. Sudden onset of excessive crying indicates that the baby is distressed and needs attention. Even though, in most cases crying baby can be managed easily, the cause for crying may be difficult to find out, especially in small babies. (1)
Most common reasons for crying:
1. Habitual cry: - Some babies cry without any real cause.
2. Hunger: - When they feel hungry.
3. Wetting: - When they urinate or defecate.
4. Company: - Majority of the kids need somebody near .If they feel lonely they cry.
5. Doll: When their favorite doll slips away from the grip they cry for help.
6. Stranger anxiety: - When any body other than mother or caregiver takes the baby.
7. Tired: - When the baby is tired and unable to sleep.
8. Extremes of Heat & cold: - If they feel too hot or too cold they become uncomfortable.
9. Tight clothing: -Tight clothing is intolerable.
10. Darkness: - Most of the babies are uncomfortable in the dark room.
11. Light: - They also get irritated by too much of light.
12. Mosquito bite: - This is a common cause for crying at night. It can also cause skin rashes.
13. Nasal blocking: - Can cause sleeplessness and irritability. Feeding also will be difficult.
14. Phlegm in throat: - This also causes difficult breathing resulting in cry.
15. General aching: - General aching is seen initially in infectious conditions.
16. Nappy rash: - May be due to prolonged use of tight nappy or due to allergy.
17. Skin lesions: - Eczema, ecthyma, candidiasis, miliary eruptions etc with itching.
18. Earache: - Usually pain comes at night. Foreign bodies (insects) in ear can cause pain.
19. Colic: - When the baby cries continuously mostly it is diagnosed as colic.
20. Infections: All infections cause some kind of pain or irritation.
21. Reactions to certain food: - Some baby food articles can be allergic.
22. Hard stools: - Babies with hard stools may cry while passing stool.
23. Regurgitation/vomiting: Spilling of gastric contents after feeding can cause crying.
24. Dentition: -In old babies dentition can be a cause.
25. Inability to suck: - Due to oral thrush, snuffles, absence of milk, cleft lip etc.
The mother is the ‘best doctor’ to differentiate the normal and abnormal crying of her baby and to make him comfortable. Most of the time, the baby becomes calm after giving breast milk and by carrying with a gentle rocking afterwards. Majority of cases can be managed successfully by satisfying their emotional needs. The mother’s soothing voice itself is enough to make them happy. By three months of age, a baby can recognize his mother. But if crying becomes out of control, medical consultation will become necessary.
Some rare reasons for continuous cry:
1. Bowel obstruction: - Severe pain, vomiting, absolute constipation, abdominal distention with borborygmi.
2. Septicemia: - Due to invasion of pathogenic microorganisms in to the blood.
3. Torsion of testes in male kids: -Pain in testes< on touching, pain>by pressing the affected testis upwards.
4. Meningitis: -Initially there may not be fever. Poor cry with vacant stare, alternate irritability and drowsiness, persistent vomiting, tremors, mild fever. Fontanel is usually bulging. Neck rigidity and seizures may appear later.
5. Retention of urine: - Absence of urination, agonizing pain
6. Major injuries: -In case of head injury reflex vomiting, convulsions etc.
7. Kernicterus: - Shrill cry and convulsions due to bilirubin encephalopathy.
8. Tetanus neonatorum: Excessive unexplained crying, refusal of feeds, apathy, muscle spasm, spasm of limbs, lockjaw, rigidity, opisthotonos etc.
9. Infant botulism: - Feeble cry, stop sucking, generalized muscle weakness.
10. Cri du chat syndrome: - Cry like a cat, microcephaly, hypertelorism, and mental deficiencies.
11. Cry encephalic or brain cry: Sharp shrieking with irritability.
12. Congenital defects: - Hiatus hernia, pyloric stenosis, tetralogy of fallot (dyspnoea, and cyanosis)
Breath holding spells: - This condition is seen in some children while crying. After crying most of the air in the lung is exhaled and vocal cords are narrowed and closed. This results in holding of breath for a few seconds and the child becomes blue and rigid. This phenomenon is seen in some children between 6 months to 5 years. (3)
(Drugs like Laurocerasus, Moschus, Cuprum etc. can be given for this condition on the basis of similarity)
Examination of a crying baby:
Dealing with a crying baby is a skill that can only be gained by experience. Before touching the baby he should be made comfortable. Babies coming from the hands of allopaths usually cry when they notice the stethoscope as it reminds the painful injections they received earlier. Therefore, it is essential to gain his confidence by showing a doll or a rattle or any colorful thing that can divert his attention. A pleasant atmosphere in the clinic is necessary. Care should be taken that our examination should not double his crying. Handling of the painful part should be avoided or done at the end.
Though there is no clearcut demarcation between normal and abnormal crying, an intelligent doctor can differentiate them and decide whether to give the medicine or to give the ‘second best medicine’. In case of normal crying, the vital signs are within the normal limit. In crying infants heart rate may become 160/minute (normal 120- 140/ minute) and respiratory rate becomes 60/minute (normal 30 to 40/ minute).
Apart from the routine methods of clinical examinations the following helps to identify the cause of crying:
1. Palpate the abdomen gently. The baby may twist or resist you: -Colic.
2. Pull the ears gently then the baby becomes worse or pushes your hands away: -Earache.
3. Measure the body temperature with a thermometer kept in the axilla: -Fever due to any infection, septicemia.
4. Examine the skin: -Eruptive disease, nappy rash, measles, rubella, vesicles, allergy etc.
5. See the nose for any discharge: -Coryza. Winging of alae nasi seen in breathlessness.
6. Move the head gently to feel any neck stiffness or see for kernig’s sign: -Meningitis, head injury etc.
7. Infections: All infections cause some kind of pain or irritation. Usually it is associated with fever, redness and swelling of affected part.
8. See the tongue for thrush/coating: - White patches caused by candidia albicans. White coating is also seen in indigestion.
9. Allergy to certain foods/external applications: - Manifested in the form of redness, edema, breathlessness, gastric symptoms and continuous cry. (Lactose intolerance, cow milk allergy).
10. Regurgitation/vomiting: Here baby cries with spilling of food after feeding. If this continues it may be due to gastro esophageal reflex (up to 1 year it may be normal) or rarely congenital pyloric stenosis.
11. Dentition: - Swollen gums, biting, salivation etc with gastric troubles and diarrhea.
12. Auscultation of chest: - Rhonchi (bronchiolitis, asthamatic bronchitis). Decreased breath sounds (pneumonia)
13. Respiratory distress: - Labored breathing, tachypnea, chest retraction, grunting, cyanosis, mottled cool extremities.
14. Examine the anal orifice: - Anal erosion, rectal polyp, crawling of worms.
15. Examine the genitalia: - Any discharge or erosion. In male baby see the testicles, which may be swollen or tender (Orchitis, torsion of testis)
16. Body movements: - Convulsions, rigors, diminished spontaneous activity, lethargy, absence or persistence of fetal reflexes and decreased muscle tone.
17. Vacant stares, weak sucking, irritability, and convulsions: - Meningitis, kernicterus, and tetanus.
18. High-pitched shrieking cry: - Neurological deficit.
Treating a case may be easy but to tell the cause for a disease or any abnormal condition may not always be possible since there are many idiopathic causes. Even in the latest medical textbooks, we often come across the word idiopathic. Diagnosing the case as idiopathic is enough for a medical man but is not satisfactory for the common man. Hence, to ease their anxiety, some cases are tactfully “diagnosed” as nutritional deficiency, allergy, infection, climatic changes, indigestion etc.
Many consider homoeopathy as the medicine for kids. Though it acts well on all age groups, some factors favor a beneficial action on babies.
· They never hide the symptoms and somehow express them.
· The family members always observe them; hence we get a clear picture.
· Their body is comparatively less exposed to various toxins and pollutants.
· History of suppression or prolonged medication may not be there.
· Usually they take no substances that hamper the action of medicine.
· Since the vitality is strong in kids, they are more susceptible to our drugs.
The critics of homoeopathy have nothing to say on the “placebo effects” of homoeopathy on babies. As I started my practice with 50% faith in homoeopathy I was surprised many times by the action of homoeopathy on babies. I had even tried plane globules on crying babies to see weather they stop crying by the soothing effects of sweet pills or due to medicinal action. But many a time I have noticed that sick babies were not better by just giving non-medicated sweet pills but they got better only by pills medicated with the indicated medicines like chamomilla, cina, anti crud etc.
Some features that should be asked or observed for the selection of similimum are: -
1. When he cries more and how often?
2. When he is comfortable, in which position?
3. Activity and body movements
4. Expression of face
5. Type of respiration and sounds produced
6. When he sleeps well?
7. Coating on the tongue
8. Location of heat and sweating.
9. Color of face, Color of skin
10. How he reacts to: Surroundings, others, strangers, company, toys, dressing, covering, fanning, indoors, open air, sounds, carrying, light, climate etc.
11. Feeding habit, thirst, bowels, urination etc.
12. Nature of discharges: - Nasal discharge, ear discharge, saliva, vomitus, stool, urine, sweating, etc.
13. Past history: Previous treatments, any injury, change of diet, exposure to climatic changes, change of body oils, creams or dress items, history during pregnancy etc.
14. Concomitants symptoms: These symptoms should always be looked for an accurate selection of a similimum.
15. We should also differentiate crying from moaning, shrieking, weeping, sobbing, screaming, and sighing etc. because they all are well represented in our repertories.
· Bawling: Cry loudly
· Lamenting: To utter a mournful cry
· Moaning: To give expression of sorrow or pain in prolonged audible sound
· Shrieking: To utter a loud, shrill cry
· Sighing: Heave or utter a sigh; breathe deeply and heavily
· Sobbing: Convulsive gasp made while weeping
· Wailing: Loud cries made while weeping
· Weeping: Express grief or anguish by tears.
Repertory on crying (2):
Afraid of new atmosphere: ambr.g.
Brain cry (Cri encephalique): aml.n, apis, art.v, carb.ac, cham, cupr.act, glon, hell, hyos, kali.br, kali.i, lyc, merc, rhust, zinc.
Child cry with painful urge to urinate: apis, borx, lach, lyc, nux.v, sars.
Child desires to be carried: ars, bry, cham, chel, cina, kreos, lyc, kali.c, puls, rhust, verat.
Child desires to be carried & rocked: cina
Child good during day, screaming & restless at night: jal.
Child weep when will is not done: cina.
Cries before cough: arn.
Crying from retention of urine: acon.
Crying in infants: acon, ars, bell, bor, calc, cham, coff, ign, ip, jal, puls, rhod, senn, syph, thuj.
Cry when touched: ant.c.
Cry when kindly spoken to: sil.
Child grasps at others: ant.t, ars, camph, op, phos.
Child must be rocked in insomnia: carc, cham, cina, stict.
Child sleepless day & night: psor.
Convulsive weeping: mag.p.
Crying< by cough: arn, bell, bry, cina, hep.
Child obstinate yet cries when kindly spoken to: sil.
Child can’t be quieted: ars, calc.p, cham, cina.
Cry with grasping of genitals: acon.
Cling to parents: bism, bor, calc, gels.
Cry when his will is not done: calc.p, cham, cina, tub.
Cry on waking: zinc.
Cry without waking: hyos.
Crying with pain: acon, apis, bell, cact, cham, coff, cup, mag.p, plb, sep, zinc.
Crying with hiccough: cic.
Cry during sleep: apis, bor, cina, hell, hyos, ign, lyc, puls, rheum, tub, zinc.
Delirium with crying: acon, canth, caust, chin.s, cina, cupr.act.
Desire to be carried slowly: ferr, puls.
Fretful from bedtime to morning, next day lively: psor.
Grasps the nurse when carried: ars, bor, gels, puls.
Hard to please when crying: ip.
Hoarse voice when crying: bell.
Irritability at night in sick babies: psor.
Irritability with crying& weeping: nuxv, plat.
Quiet only when carried: cham, cina.
Screaming with fist in mouth: ip
Shrieking in children: apis, borx, calc.p, cham, cina, glon, hell, ign, kali.p, kreos, lac.c, nuxv, rheum, senn, tub.
Shrieking in children day& night: calc, rheum.
Shrieking in children at night: cham, chlol, kali.p, lac.c, psor, rheum.
Shrieking in children with colic: cham, nux.v.
Shrieking in children with fist in mouth: ip.
Shrieking in children when moved: zinc.
Shrieking in children when being nursed: borx.
Shrieking in children during sleep: apis, arn, calc.p, ign, lyc, psor, puls, sulph, tub.
Shrieking in children during dentition: apis, kreos, rheum, ter.
Spasmodic weeping: caust, phos.
Spasmodic weeping with asthma: bov.
Strangers<: baryta.c, silicea.
Violent weeping: hydr.ac, nat.m, stram.
Weeping at noise: aeth, ign, kreos, lach.
Weep before stool: phos, puls, rhust.
Weep before urination: borx, lyc, sars.
Weeping during coryza: puls, spig.
Weeping during heat: acon, bell, puls, spo.
Weep during stool: aeth, borx, cham, cina, phos, rhust, sil, sulph.
Weep easily: bell, calc, caust, kali.br, nat.m, op, puls.
Weeping in children: bell, borx, cham, coff, graph, hyos, ign, jal, kali.c, lyc, puls, rheum, seneg.
Weep when carried: cina, sil.
Weep when kindly spoken: iod, sil.
Weeping when looked at: ant.c, kiss, nat.m, puls, tarent.
Weeping with pain: coff, glon, lach, merc, nux.v, plat, staph.
Weeping with sobbing: cocc, hep, ign, lyc, mag.p, op, sep, stram.
Weep when touched: ant.c, ant.t, cham, cina, stram.
Weeping when waking on: cic, mag.c, stram.
Weep when washed in cold water: ant.c.
Weeping with sobbing: cocc, hep, ign, lyc, mag.p, op, sep, stram.
Few homoeopathic drugs: (5)
Aconite: - Constant crying; anxious look; great uneasiness; better by fast rocking; starts as if in a fright; sudden onset; one cheek red other pale; unquenchable thirst; urinary retention in newborn; stool green like chopped herbs; pulse full hard; sweating on parts lain on; skin red hot dry. < heat, warm room, dry cold, cold when over heated, motion, twilight; >open air, discharges.
Ant. Crud: - Irritable; cross; cries when washed with cold water; fretful; peevish; cries when touched; cant bear to be looked at; vomit milk in curds; tongue coated as if white washed; complaints from over loading stomach;
Ant.tart: - Anxious; restless; irritable; a/f anger; a/v touched or looked at; clinging; peevish; loud rattling; vomiting in any position except lying on rt side; fanning of nostrils; white coated tongue with red edges.
Ammonium carb: - Uncleanness; a/v to bathing; irritable; puffy face; snuffles of children; starts from sleep as if smothering; dyspnoea and rattling; cracked corners of mouth.
Bellabonna: - Cries without cause and ceases suddenly; moaning with every breath; starts from sleep; happy when well, violent when sick; sudden violent onset; striking and biting; gritting of teeth; restless during sleep; hot red shiny flushed face; hot head with cold hands and feet.
Calc carb: - Soft; fatty; flabby; pale; wakes up screaming from nightmares; sour sweating of scalp; constipated.
Capsicum: - Capricious children; obese flabby; light hairs; blue eyes; obstinate; awakens frightened and screams; red cheeks; sleeplessness; unclean body.
Chamomilla: - Extremely irritable; peevish; restless; sensitive; spiteful; snappish; capricious; one cheek red hot other pale and cold; nightly salivation; dentition; pacified only by continuous carriage; stool green like chopped spinach.
Cina: - Irritable; screams and cries; not better even by carrying; cries when take hold of it; strikes all around him; ugly; cross; wants to be rocked; aversion to touch or to be looked at; vomit with clean tongue; grinding of teeth during sleep; boring the nose frequently; worm troubles.
Colocynth: - Cries hard; cant be pacified; baby stops crying when abdomen is pressed; extremely irritable; screams with pain; face distorted with pain.
Jalappa: - Child good all day but screams and restless and troublesome at night; tongue smooth and glazed; anus sore; face cold and blue; pinching colic with diarrhea; thin muddy stools; perspiration of upper part of body.
Mag phos: - Sleepless from indigestion; hiccough with retching; baby draws up the legs from colic; dentition; colic>rubbing, warmth, pressure.
Natrum mur: - Cries much more from rage than from terror; weeping when looked at;
Psorinum: - Sleepless from itching; sensitive to cold; filthy smell; profuse sweating; scalp eruptions; fetid stools; very hungry; wants warm covering.
Puls: - Piteous cry; changeability; soft; weep easily; wants to be carried slowly; weep from coryza; cry from earache; yellowing discharge; >in open air.
Silicea: - Large head; sweating; aversion to milk; cold clammy extremities; cry when kindly spoken;
Staphysagria: - Sensitive; ugly; cross; capricious; habitual colic in pot bellied children; extreme hunger even stomach is full; early decay of teeth; throw away things when given; child cries from every wry look or harsh word; child cries as soon as eats.
Sulphur: - Untidy looking; aversion to being washed; filthy smell; prone to skin affections; lips and anal orifice bright red; afraid to pass stool from pain; awakened from slightest noise; crying from itching, stops crying when scratching.
Tuberculinum: - Wakes easily; irritable when awakening; takes cold easily; sensitive; irritable; can’t remain in one place; lean and thin.
1. Medical E books: - Dr Muhammed Rafeeque. Published by Noor overseas.
2. Synthesis repertory: - Dr Frederick schroyens. Published by B Jain publishers
3. Textbook of pediatrics: By Dr O P Ghai.
4. Hutchinson’s clinical methods. Dr Michael swash. Published by W B Saunders Company LTD.
5. Homoeopathic therapeutics: Dr Samuel Lilienthal. Published by B Jain publishers.
6. IHK News: Published by The Institution of Homoeopaths Kerala.
Dr Muhammed Rafeeque, BHMS.
Family Homoeopathic Clinic
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