ICON – Supporting Parents to Cope with Infant Crying

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Many parents will admit that the first year of parenting can be challenging for a multitude of reasons – whether you’re welcoming your first child or the fifth! The ongoing parenting demands, lack of sleep, daily juggling of normal household tasks or other children, financial challenges, difficulties at work or other responsibilities, can all affect stress levels and the way we feel, and can impact the way we parent our children. But it can be harder to admit when you feel you are not coping, and this can lead to feelings of shame, isolation and escalating stress.

All babies cry, and although new or expectant parents know this, the reality of persistent crying, on top of other additional stressors, can feel overwhelming and frustrating, leaving some parents pushed to the limit and finding it difficult to cope.

This is why the national ICON programme was introduced in 2018, following research from Dr Suzanne Smith (PhD), who studied the effectiveness of various interventions into the prevention of Abusive Head Trauma (AHT), also sometimes referred to as Shaken Baby Syndrome.

The ICON program is an evidence-based program that aims to prevent AHT in babies. It is used by health and social care organisations across the UK to provide information to parents and carers about infant crying, including coping strategies, parental support and stress management. It aims to reduce serious injuries, illnesses and fatalities which can result from shaking a baby.

ICON is now used in 44 of 54 regions across England.

ICON Week – 23-27 September 2024

The fourth annual ICON Week is approaching, dedicated to raising awareness about infant crying, how to manage it and the dangers of shaking babies. We know we can’t always prevent or reduce the amount a baby cries, but we can support parents in how to manage it when it becomes overwhelming.

Research suggests that some lose control when a baby’s crying becomes too much, which can lead to shaking or injuring a baby, resulting in potentially devastating and fatal consequences. Dr Suzanne Smith found the most effective evidence based programmes studied, provided a simple message that supported parents and caregivers to cope with infant crying.

The ICON Message

There are 4 simple messages that the ICON programme promotes:

These messages are given to families by healthcare professionals on up to five occasions in the baby’s first 2-3 months of life.

Infant crying is normal

It’s normal for babies to cry. In fact, babies are designed to cry, and their cry is designed to be distressing to parents. This is nature’s way of ensuring a baby’s needs are taken care of, by alerting parents and prompting them to do something about it. Many parents will tell you that they can pick out their own child’s cry in a group of other babies, or that listening to other babies crying doesn’t affect them, but their own baby has a completely different effect. This is because as parents we’re hard-wired to take care of our own babies, ultimately to ensure their survival. This is our mammalian instinct. If you find your baby’s cry distressing, this is normal. Your baby is doing exactly what they are supposed to do, and it is working. As parents this makes us want to help our baby and facilitate their needs. Babies can cry for any number of reasons. This is because their brains have not yet developed the circuits that allow for self control or understanding. Therefore, they cry when they need help or reassurance. This is their way of communicating. However, it can feel frustrating when we’re unsure why they are crying. Sometimes there may not be an obvious reason why they are crying.

Most babies will cry more frequently from about 2 weeks of age, with each crying episode generally lasting longer too. If a baby was born prematurely, they’ll typically start to cry more from around 2 weeks after their expected date of arrival. After 8 weeks babies will start to cry less each week. Once babies reach around 5 months of age, crying tends to become more ‘purposeful’, meaning they cry when they need or want something, for example, when they are hungry or tired.

Comforting methods can help

Sometimes babies will cry if they are hungry, tired, in need of a nappy change, are feeling uncomfortable or unwell. Addressing these basic needs may help, but sometimes even after trying all the normal techniques for soothing your baby, they may still cry. This can feel frustrating, especially if your usual techniques are not working. It’s important to remember that babies change and develop so quickly, that something that works one day, may not work the next. This is normal, and it is ok. It’s easy to think that when a baby cries, there must be something wrong, or there must be a reason. But sometimes there may not be an obvious ‘physical’ reason why your baby is crying. Research supports that most of the time it’s not down to a physical reason. Babies cry because they are new humans getting used to their new world around them.

If your baby is still crying after addressing basic needs and trying the usual comforting measures, and the crying is getting to you, it is ok to ask for support. This is a really positive step you can take for you and your baby.

This does not make you a bad parent, or mean that you are doing anything wrong. Equally, some babies cry more than others, and this does not make them a ‘bad’ or ‘naughty’ baby.

If you think your baby is unwell, call NHS 111 or speak to your GP.

When should you worry about your baby’s crying?

You should seek urgent help from medical professionals if you notice your baby has any of these:

A rash that does not fade when you press a glass against it. This needs URGENT medical help and may be meningitis. More information can be found here.
A fit (seizure or convulsion)
A very high-pitched cry
Breathing is a struggle or noisy or unusually fast;
Skin is greyish, mottled, blue or unusually pale;
A high temperature:
Babies UNDER 3 months: 38º C/ 100.4º F;
Babies BETWEEN 3 – 6 months: 39º C/ 102.2º F.

It is okay to walk away if the baby is safe and the crying is getting to you

If the crying is getting to you, it’s important to recognise this within yourself. After ensuring your baby is safe, know that it’s ok to walk away for a few minutes to calm yourself down. Their distress in addition to your own stress can make it difficult to cope and manage. In these moments, remember this is a normal phase and it will pass. Supporting yourself during these moments to feel calm, will mean that you are more able to help your baby once you feel calmer and the feelings of stress have reduced a little.

Never, ever shake a baby

Never, ever shake or injure a baby. This is highly dangerous, and can have catastrophic consequences.

Experts report that even a minimal amount of shaking can cause catastrophic effects which can be fatal. When a baby is shaken, the brain accelerates backwards and forwards against the skull, causing damage to the brain tissue and rupture of the vessels on the surface of the brain. It can also cause damage to the spine and neck as the force is transmitted upwards.

If you are worried about your baby or yourself, put them down somewhere safe, and call NHS 111 or the GP.

Studies have shown that a key trigger to a baby being shaken is the care giver’s inability to stop an infant crying.

The Data

Brain trauma caused when a baby is hit or shaken, is the most common severe injury in babies.
This form of abuse affects around 35 in 100,000 babies and is almost completely preventable with clear education and support messages to families about normal crying, especially if given on numerous occasions.
Injuries such as these can lead to lifelong learning, visual and hearing disabilities.
Approximately 65% of affected infants will have significant neurological disabilities, and between 5-35% of infants die from the injuries they sustain. Most survivors will have both cognitive and neurologic impairment.
AHT is most common in babies under the age of one where a baby’s crying is at its most. Normal infant crying peaks between 6-8 weeks of age and then declines. As a consequence AHT peaks during this same time frame.
70% of babies that are shaken are shaken by men.
AHT affects all ethnicities, socio-economic groups and races, however, multiple factors can increase a child’s risk of abuse including; parental depression, maternal smoking, unmarried mothers, domestic violence at home, isolation and poverty.
Societal pressures and times of global stress also increase incidences of AHT. This was seen following the global financial crisis in 2009, and following the 2020 Covid-19 pandemic.

Is ICON Helping?

There is currently an ongoing evaluation to establish the effectiveness of the national ICON programme. Dr Mark Lyttle (University of the West of England) in collaboration with University of Bristol and NIHR ARC West (National Institute for Health and Care Research, Applied Research Collaboration West) will investigate whether AHT occurs less frequently since the ICON programme was rolled out. The evaluation also aims to identify barriers and facilitators to its implementation and reach.

Key Points

It’s ok to admit when you feel like you are not coping
It’s ok to ask for support
Infant crying is normal
It’s ok to walk away if you’ve ensured your baby is safe
A key trigger to a baby being shaken is the care giver’s inability to stop an infant crying
It’s never ok to shake or injure a baby
Abusive Head Trauma is preventable.