Dear Doctor, My one-year-old daughter cries a lot at night, yet she is always jolly during the day. At first I thought she had some sickness but when I took her for a check-up I was told she was fine. What could be the problem and how do I go about it? Mbabazi - Dear Mbabazi, It is common for many small babies and toddlers to cry in the night. There are several reasons a small child cries in the night without any apparent medical problem. Since they are not able to express their discomfort or need by speaking, crying remains the only outlet for their discomfort, pain or some physical or emotional need. Children at this age have a developing digestive systems, hence digestion is weak. They tend to consume more of milk than fibre in the diet. This can cause flatulence and uncomfortable sense of bloating in the stomach, making them cry. Acid reflux can also cause this problem. Constipation adds to this problem. Toddlers depend on their parents for feeding them and are not able to express their sense of satiety after meals. If they are overfed, the resultant indigestion wakes them cry at night. If underfed, they may feel hungry and cry in the night. A small child may have slept enough in the day time and may get up in an hour or so, after being put to sleep. She wants to play at that time, whereas parents want her to sleep. Also the sleeping hours of a baby are reduced as they grow up, hence, if put to sleep in day time, she would not get sleep for long in the night. Sometimes it may be just an emotional need to be held and given due attention. This can happen in situations where both parents are working and the child is left in day care centres or with nanny in the day. Try spending more time with the baby in the day and do not let her sleep much during day time. Give her some solid food at night to ensure a full stomach and prevent her from being hungry at an odd time. Food should include fresh vegetables, whole grains and fruits, so that she gets enough nutrients as well as fibre. It is useful for digestion as well as preventing constipation. This can be given either as soup or in any semi-liquid form which can be eaten by her easily and relished. Freshly prepared food is always better than ready to eat cereals and baby foods. Make her play and be active as per her age in the evenings. With adequate physical activity, she is bound to get a good undisturbed sleep in the night. Try to put her to sleep and wake her up at a fixed time, so the body’s clock gets set. Keep her bed room quiet with no distractions like a TV or bright lights or talking adults. When she gets up and cries, you can ignore it for a few minutes. If it is only for attention seeking, she will become quiet after some time. If the crying continues, assess her for any flatulence. Compression of the belly by a soft lukewarm towel or lukewarm hot water bottle helps in relieving the discomfort. Drinking small quantity of water mixed with asafoetida or carom is also useful. Constipation can be cured by using glycerine suppositories or just pushing little glycerine inside the rectum with a clean finger. Dr. Rachna Pande is a specialist in internal medicine.
