By Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's

Recently I was helping one of my daughters prepare for surgery. We were up before dawn to do what is called a chlorohexidine bath the morning of her surgery. This is just a bath that helps to prevent infections and cleanse the skin of bacteria before surgery. We were standing in the bathroom, and I could slowly see her face changing. She burst into tears and uttered the only thing she was feeling – “I am so scared.” To which I burst into tears at almost 40 years old and replied, “I know you are, and I am too.” We both just sobbed as we finished the “bath.” Honestly, this was the first time in months of knowing about surgery that she had expressed fear or shed a tear. They were needed and necessary tears.

As a child life specialist, I am very comfortable with tears. The hospital is a combination of a new environment, painful procedures, and difficult experiences so tears are something that naturally flow. However, there is a stigma around tears and much of the world is not comfortable with or even accepting of them. 

We hear a lot of things about tears and children crying from parents, caregivers and medical staff. At the first sight of tears, an adult may say: “Don’t cry. Be brave,” “You’re a big kid. Don’t cry,” or “Crying isn’t helping anything.” As we explore emotional safety within the healthcare setting and elsewhere, we need to first establish that crying is OK. Not only is crying OK, but it is also actually beneficial and a needed part of the human experience for kids and adults. 

Let’s explore some of the truths about crying that may help us as parents, caregivers and staff as we respond to kids and their tears.

Crying is coping. 

Coping is how we handle difficult or stressful situations. Often crying is viewed as a sign of weakness or a negative way to cope with emotions. However, while there are many negative coping behaviors (anger, addiction, impulsivity, hysterical crying), crying itself is not a negative coping skill. It is a way of self-soothing and often helps our bodies relax. It can actually help kids find their bravery in the midst of challenging moments. Following crying, kids can move past that initial overwhelming feeling of “I can’t do this!”

While excessive crying (multiple times a day) can be a sign of depression and hysterical crying can create more stress, it is important to acknowledge that crying during a difficult or stressful experience is an appropriate coping mechanism and should be welcomed. Distraction, guided imagery, counting and many other things can be used to cope. However, tears can be trusted as a positive coping skill also, and accepting tears amid difficult experiences promotes an emotionally safe environment.

Crying does actually help. 

Often as a parent, our first thought when we see our kids cry is “Stop crying. That is not helping anything” as we are thinking of what they actually could do to help themselves. The truth is, though, that crying does actually help. Research tells us that crying releases oxytocin and endorphins. 

Oxytocin is a hormone that once released can immediately help lessen stress and anxiety. Its release can also help us to regulate our emotions more effectively. Also, when endorphins are released, they can help naturally lessen pain. Both of these effects of crying can help greatly during stressful or difficult experiences within healthcare, home or school. Research has also shown that when we over-restrict our emotions and hold in tears, it can contribute to poor emotional regulation in the short and long term. It is clear to see that crying can definitely help someone and often does.

Crying is not just something babies do. 

I’m sure you’ve heard an adult say in response to tears, “Don’t be a baby.” While in the early months of life, crying is a baby’s only means of communication, crying is not only meant for babies. Crying is a natural part of the human experience even into adulthood, and is developmentally appropriate at all ages. When we respond empathetically to tears, it can help our relationships with others. Between a parent and a child, a positive attachment can be established by responding compassionately to your child’s tears. 

Research has shown that a parent’s response to a child’s tears affects how the child can regulate their own emotions. Over time, if the response from the parent is consistently negative, the child will ultimately have poor emotional regulation. If we as parents can respond and validate our child’s tears, we have a better chance of also helping them establish good coping and emotional regulation over their lifetime. Some things that you could say are: “It’s OK to cry. Let’s also take some deep breaths,” “I know this is super hard and overwhelming. I’m sorry you have to do this. I am here with you,” or “This is super hard, but you can do hard things.”

It is also OK for you to cry. Something I witness often is a parent telling a child not to cry while also crying or attempting to hold back tears themselves. Sometimes parents or caregivers will leave a situation because they are crying. While a parent or caregiver crying can be unsettling to a child, it is OK for you to cry. I will say that this is only helpful if you can regulate your own emotions and communicate with your child what you are feeling. If your crying becomes hysterical or overshadows the person experiencing difficulty, it is not helpful or compassionate. True empathy and tears can validate someone else and make space for them to feel emotionally safe with their own emotions.

So, as we strive for an emotionally safe environment for our kids, let’s remember that crying is OK. We are encouraging positive and appropriate coping skills when we allow children to cry. Tears can be physically and emotionally helpful amid difficult and stressful experiences. Babies, kids and adults all experience emotions that lead to tears. As I think about the times in my life that have been stressful and challenging, tears have accompanied all of those times even now as an almost 40-year-old woman. We shouldn’t fear tears. Crying is a natural and helpful part of the human experience that allows us to grow in compassion and empathy and cope with this crazy life. Cheers to tears!

Previously, I covered the bascis about infant reflux. If you missed that article, please click here. 

I have a few, more specific topics I promised I would go over in my previous post. 

Should We Try a Medication for My Baby’s Reflux?

This is a tough one for me to talk to parents about, because as a doctor, I really want to “fix” things for you.

I used to prescribe medications more frequently than I do now. This is because I have read recent large studies that make me worry about the future effects of these medications (see links below):

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528619/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137535/
• https://jamanetwork.com/journals/jamapediatrics/article-abstract/2676167

If we change the pH of the gut, what are we doing to the trillions of bacteria, the natural gut biome that lives inside?

Part of the job of this gut biome is to help our body learn “friend from foe,” and a large study recently found that children under 6 months who were put on medications like Prevacid, Nexium, and Zantac (there are many meds available) or any antibiotic were found to be more prone to food allergies and asthma later in life.

Is it worth the risk? In some cases, yes. Some babies are in pain daily. Some babies even lose weight because they are fighting meals to avoid the pain. If a baby is not in daily discomfort, however, I’ll often try to talk parents into trying other methods before medicating. And we talk often about weaning it off or stopping it after a few weeks.

What Is Cow Milk Protein Intolerance and How Does It Relate to Reflux?

Cow milk protein intolerance (CMPI, also known as cow milk protein allergy) happens when a child’s immune system reacts abnormally to proteins found in cow’s milk (either in formula or mom’s diet) and soy. It is NOT the same as lactose intolerance, and it leads to injury/inflammation of the stomach and intestines.

Symptoms of CMPI usually involve the GI tract, like vomiting, abdominal pain, blood in the stool, mucousy stool and diarrhea. Prolonged issues in infants could lead to wheezing, irritability and poor growth / failure to thrive and eczema. Frankly, these are sometimes my fussiest little patients, and they often cry more than most babies do.

CMPI and reflux come hand-in-hand in a lot of kids I see. I often find that eliminating dairy and soy in a mom’s diet will help the reflux as well. Sometimes, kids need to be on special hypoallergenic or amino acid formulas.

Do I Elevate My Baby At Night So They Won’t Spit Up?

I remember many a morning looking into my son’s bassinet and seeing him sleeping peacefully in a puddle of old vomit. The guilt would overwhelm me! And it happened a lot. It was hard not to want to do something different.

But no, we don’t want you to elevate your baby when they sleep. We want you to keep them flat on their backs because this is safest.

While it may seem like elevating the head off the crib makes sense, according to the American Academy of Pediatrics, “There is no evidence that healthy babies placed on their backs are more likely to have serious or fatal choking episodes than those placed on their stomachs. But there is strong evidence that babies placed on their stomachs are at higher risk for sudden infant death syndrome (SIDS).”

There is not a need to a wedge under the mattress, or elevate the head of the bed with blankets or pillows. Studies have actually shown this doesn’t actually help reflux symptoms, anyway.

I’m hopeful that the take-home point in this two part article about reflux is clear: reflux, to some extent, is a part of every baby’s life in the first year. And in MOST kids, it completely resolves by age 12 months. Talk with your pediatrician about how you can help your baby if some of the options we’ve talked about here don’t seem to help!

Hope this helps. Remember, if you still have questions about this topic to read my first article. 

Stay safe,

Dr. Diane