Elimination communication contributes to a reduction in unexplained infant crying

Abstract

The Normal Crying Curve refers to infants’ unexplained crying from birth to a peak at about 6–8 weeks, and self-resolving by three months. However, it is known that infants signal their need to eliminate (micturate/defecate) through a variety of cues, including fussing and crying. Elimination Communication (EC) refers to a caregiver’s nurturant response to infant cues, while also using timing, to gently and non-coercively cradle the infant in a supported, secure squatting position to eliminate. Such practices have been reported in ethnographic observations of hunter-gatherer care of infants, who cry less than minority world (Western) infants. We hypothesize that the current minority world practice of delayed toilet training and lack of caregiver response to elimination cues results in excessive, unexplained infant crying as infants eliminate in the constraints of diapers and in non-beneficial postures. As a corollary, we hypothesize that EC will reduce unexplained infant crying in the early months, perhaps even planating the Normal Crying Curve. To evaluate our hypothesis, we designed a pilot study to collect empirical data from mothers who practiced EC with their infants, tracking crying and fussing at Weeks 4, 6, 8 and 12 primarily utilizing a 24-hour Baby’s Daily Diary. We computed baseline measures, compared our crying data with those from the literature, assessed our data for internal crying peaks, and used hierarchical multi-level modeling to evaluate cross-level interactions. We found that infants in our pilot study cried on average 50.3% less (p < 0.05), and up to 70.9% less in Week 6, compared to literature studies. Moreover, when we evaluated our data to seek out a significant crying peak across weeks, no such crying duration difference was found. Using hierarchical generalized linear modeling, we found that greater daily crying episodes predicted greater daily elimination opportunities. Shorter crying episodes predicted a greater number of daily elimination opportunities compared to longer crying episodes, especially among low baseline crying infants. Our results suggest that crying prompts caregivers to offer elimination opportunities, but when the crying continues, caregivers may try other behavioral responses, such as feeding. Additionally, our results suggest that with the practice of EC, unexplained infant crying may be significantly reduced and warrant future research with an expanded sample. If the practice of EC indeed planates the Normal Crying Curve, then such results will have a significant impact on our understanding of unexplained infant crying.