Research tells us that persistent crying in babies is a potential trigger for some parents/caregivers to lose control and shake a baby. It also shows that around 70% of babies who are shaken are shaken by men. So, any prevention programme should include male caregivers and use the best opportunities to reach them as well as support all parents/caregivers with information about crying and how to cope with a crying baby.
ICON was created to help prevent abusive head trauma for infants and is an evidence-based programme consisting of a series of brief ‘touchpoint’ interventions that reinforce the simple message making up the ICON acronym.
I- Infant crying is normal and will stop. Babies start to cry more frequently from around 2 weeks of age. The crying may get more frequent and longer. After about 8 weeks of age, babies start to cry less each week.
C – Comfort methods can sometimes soothe the baby and the crying will stop. Think about:
- Are they hungry
- Are they tired
- In need of a nappy change
Try simple calming techniques such as singing to the baby or going for a walk. Comforting Your Baby
O – It’s OK to walk away if you have checked the baby is safe and the crying is getting to you. After a few minutes when you are feeling calm, go back and check on the baby.
N – Never, ever shake or hurt a baby. It can cause lasting brain damage or death. If you are worried that your baby is unwell contact your GP or call NHS 111.
Parents and carers should always be encouraged to speak to their family, friends, GP, health visitor or midwife if they need support.
There are 5 key touchpoints where the ICON message can be shared/reiterated by professionals:
Where and when: Hospital/Home based following birth and prior to discharge. Research shows this is where the message is more likely to reach men.
Who delivers the touchpoint? Midwives, anyone from the midwifery team, maternity unit volunteers. It is mainly midwives who prefer to deliver this touchpoint when they discharge the mother and baby from hospital or following a home birth.
Resources: This includes the provision of the leaflet or the easy-read version and a simple script to get the conversation started is also available. It usually takes midwives about 6 – 8 minutes to deliver this touchpoint.
If the baby was premature and is being discharged from the Neonatal Unit, the Neonatal team should deliver this touchpoint using the ‘premature baby’ ICON leaflet or the easy-read version.
Where and when: Within the first 10 days, post-discharge, at home.
Who delivers the touchpoint? Community Midwife
Resources: This is a reminder of the ICON basic message, and no resources are necessarily needed. The midwife may choose to show the parents/carers the ‘Infant crying is normal’ infographic to help reinforce this point. The normal crying curve is also a good resource to help the discussion.
Where and when: Within the first 14 days, the first visit at home by a Health Visitor.
Who delivers the touchpoint? Health visitor
Resources: This is a reminder of the ICON basic message and no resources are necessarily needed. The Health Visitor may choose to show the parents/carers the ‘Comfort methods can help’ infographic. A really useful resource that might be used is the ‘Crying Plan’ which could accompany a discussion exploring how the parent/carers are prepared for the rise in crying that is imminent.
Where and when: Around the 3-week period
Who delivers the touchpoint? Health visiting team
Resources: This isn’t normally a time when Health Visitors are routinely in touch with a family but it is a good time to check in with families that they are coping with the possible increase in crying from their baby and are coping. Some areas are choosing to raise the topic opportunistically at clinics whilst others are proactively sending text messages to both parents/carers as a reminder.
Where and when: At the routine 6/8 week check at the GP surgery
Who delivers the touchpoint? GP and this is sometimes supported by Practice Nurses.
Resources: This is the time the increase in crying is likely to become noticeable. A reminder of the ICON basic message, provision of the leaflet or easy easy-read version is useful at this point. GPs are asked to structure their session using the questionnaire included on the members portal. Although this is a defined touchpoint, many GP practices are using other opportunities during contact with men and women presenting to the surgery who are caring for babies who are crying a lot, to remind them of the ICON message.
These are additional touchpoints supported by ICON resources that any practitioner can deliver:
Opportunistic: Any professional involved with babies can provide opportunistic support/advice using the free resources available on ICON’s website.
Antenatal: This is another good opportunity to engage men in a conversation about normal crying and how to cope with it. It can be delivered by midwives, health visitors or GPs, practice nurses, nursery staff who are aware a new baby is expected etc. Describing Barr’s crying curve and explaining the basic message is often well-received at this point.
Schools: ICON resources include a PSHE (Personal, social, health and economic education) lesson plan and materials designed by teachers for 14 – 16-year-olds. Some of these pupils will have siblings who are babies, may babysit or may soon become or are already parents. The purpose of this lesson is to enhance the public health messaging around the normal crying behaviour of babies, when and where to seek help and advice and the dangers of shaking a baby. It can be delivered by teaching staff or health professionals.
Other useful links and support networks for parents and carers
DadPad: An essential guide for new dads, developed with the NHS
NHS: Advice on soothing crying babies
Cry-sis: Support for parents and carers with crying and sleepless babies
Brazelton Centre UK: Information on baby communication
