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Crying as a sign, a symptom, and a signal.
  1. IAN ST JAMES-ROBERTS
  1. Thomas Coram Research Unit
  2. London

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    Crying as a sign, a symptom, and a signal. Edited by Barr RG, Hopkins B, Green JA. (Pp 228, hardback, £45) UK: Cambridge University Press, 2000. ISBN 1 898 6831 2

    Unexplained crying in young babies is a common and puzzling phenomenon. Stimulated by this, the last few years have brought paediatricians and developmental psychologists together, with the result that many traditional assumptions have begun to be questioned or overturned. This book is the first to draw this developmental perspective together, so that it is a welcome addition to the literature.

    The book's enigmatic title refers to the distinction between crying behaviour as a “sign” of an underlying disease, a “symptom” (which the editors define as a more subjective report or complaint by a patient), and a “signal” which has communicative purposes. Their introductory chapter proposes that crying can serve all three functions, but that distinguishing between them helps to uncover the different starting assumptions which parents, clinicians and researchers may bring to bear.

    As well as the editors' introduction and summary, the book contains 10 chapters which examine crying across a broad range of contexts. Three (Poole and Magilner's review of hospital emergency department practice towards crying complaints; Lehtonen, Gormally, and Barr's model of the aetiology and outcome of “early increased” crying, and Blackman's summary of crying in children with disability) are of obvious clinical relevance. Other chapters will be of most immediate interest to researchers. These include Hopkins' analysis of the development of infant crying behaviours, which discusses continuity with fetal behaviour and highlights the question of how cry behaviours originate and change in their function with age. Craig, Gilbert-MacLeod, and Lilley review the findings on infant crying as a sign of pain, pointing both to the advances in understanding and to the conceptual and methodological difficulties which remain. Potegal moves the focus to temper tantrums in toddlers, presenting a model of autonomic reactivity which parallels ideas elsewhere in the book about the aetiology of crying. Bard asks whether the crying “peak” found in western infants at around 6 weeks of age—now widely considered part of normal development—is also found in our evolutionary relatives, chimpanzees. The answer is a partial yes. A peak in maternal soothing of infant chimps was found at a comparable age. However, Bard observed none of the prolonged, unsoothable crying which characterises the situation in human newborns.

    The chapters are of a uniformly high standard, but two seem likely to have an especially lasting impact. One is Gustafson, Wood, and Green's review, titled “Can we hear the causes of crying?” They take issue with the conclusion, widely reproduced in textbooks, that young babies produce qualitatively distinct cry types—for example, “hunger”, “anger”, and “pain” cries, which a sensitive parent can interpret to identify the causes of the crying. The unfortunate corollary is that a parent who cannot work out the cause and resolve the crying is inadequate. As Gustafsonet al carefully point out, the evidence does not support this “cry type” view. Instead, the cries of young babies are “graded signals” which convey the degree to which a baby is upset, but not the specific cause of the crying. This is an important message, which needs to reach a general audience. An equally important message for researchers is carried by Barr and Gunnar's “transient responsivity” chapter. Prolonged early infant crying (or “colic”) has often been attributed to an infant's “difficult temperament”. Barr and Gunnar argue that the evidence does not support this, but is consistent with the notion of acute individual differences in infants' “reactivity” or “regulation” of responsiveness as a cause of prolonged crying. The importance of this formulation lies in avoiding the expectation that a crying baby will be difficult at later ages, and in operationalising the concepts of reactivity and regulation so that they can be tested.

    Depending on your point of view, this book's breadth of coverage and desire to interest clinical and academic audiences are either a strength or weakness. Its price of £45 does not seem designed to encourage individuals to buy it. However, because it is part of the “Clinics in Developmental Medicine” series, it is likely to be taken by university and medical school libraries which subscribe to this series. It is worth seeking out.

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