CLAIM: A baby’s prolonged crying, particularly in the evening, may not always indicate acid reflux or cow’s milk protein intolerance. It may instead be part of the normal “witching hour”, a period of increased fussiness and crying commonly seen during early infancy.

FACT: True. Prolonged or evening crying can be a normal part of early infancy and is sometimes informally referred to as the “witching hour”. However, crying alone does not mean a baby has acid reflux or cow’s milk protein allergy. Experts say that parents should look for other symptoms and seek medical advice if the crying is persistent, unusually intense or accompanied by warning signs such as fever, repeated vomiting, poor feeding or poor weight gain.

In a viral Instagram reel, Dr Madhavi Bharadwaj, a paediatrician popularly known as ‘bacchon_ki_doctor’, who has over 1.7 million followers on the platform, addresses a common concern among parents of young babies: whether prolonged crying, particularly in the evening, necessarily means acid reflux or cow’s milk protein intolerance.

In the reel, Dr Bharadwaj enacts a conversation with parents who describe their baby crying continuously for three to four hours in the evening despite being fed and having a clean diaper. She highlights how parents may turn to medical explanations for persistent crying, saying, “I did a ChatGPT, he is saying that my child has acid reflux. I have stopped my dairy as well, but it is not making any difference.”

She then explains that young babies can become overstimulated as they gradually become more aware of their surroundings. According to Dr Bharadwaj, this can contribute to prolonged periods of crying, particularly in the late afternoon or evening. “They go to sleep, they don’t know how to process, sleep and relax their mind,” she says. “But in the late afternoon, evening or night, he gets so overstimulated that he starts crying, crying.”

Dr Bharadwaj refers to this period of increased fussiness as the “witching hour”, which she says can occur intermittently during the first three months of life. Rather than immediately looking for a medical cause, she advises parents to focus on calming both the baby and themselves. “The most important thing is to relax yourself,” she says, adding that changing the caregiver, room, lighting or surroundings may help soothe an overstimulated baby.

She also suggests measures such as a lukewarm bath, a quiet and dimly lit room, soothing music and contact napping. “Your smell, your voice, the sound of your heartbeat, your relaxed mind and vibes also relax the child,” she says, while advising parents to consult a doctor if they continue to have concerns.

The reel has garnered 4.77 lakh views, with users sharing their own experiences in the comments. One user wrote, “Such a good timing, my baby is doing it from a week at 9:00 PM daily. This explains a lot…” Another commented, “Such an important reminder Not every fussy evening means reflux or intolerance—proper assessment before treatment is so important.”

What do research papers say?

Evidence suggests that prolonged crying, particularly during the early months, can be part of normal infant development and does not by itself establish acid reflux or cow’s milk protein intolerance. At the same time, persistent or unusual crying should not automatically be dismissed as a “witching hour”. If crying is accompanied by symptoms such as feeding difficulties, repeated vomiting, poor weight gain, blood in the stool, fever or other signs of illness, the baby should be assessed by a paediatrician.

An older study examined crying patterns in three groups of infants at around six weeks of age: moderate criers (45 infants), infants with an evening crying peak (33 infants), and persistent criers whose fussing or crying exceeded three hours a day (54 infants). The researchers found that crying and parental concern about unexplained crying tended to peak around six weeks. They also found an association between prolonged crying and reduced sleep. The researchers reported that “the persistent criers slept an average of 77 min per 24 h less than the moderate criers” and concluded that “persistent crying at 6 weeks is associated with a sleeping deficit.”

However, subsequent research has challenged the idea that all babies experience a universal crying peak at six weeks. A 2017 systematic review and meta-analysis examined 28 diary studies involving 8,690 infants. The researchers analysed fussing and crying at different ages, from the first few weeks through 10–12 weeks. They found that “no statistical evidence for a universal crying peak at 6 weeks of age across studies was found.” Instead, mean fussing and crying remained relatively stable during the first six weeks, before declining significantly after 8–9 weeks. The review found that the mean fuss/cry duration was 117–133 minutes during the first six weeks and fell to about 68 minutes by 10–12 weeks.

These findings suggest that while crying may be particularly pronounced during the early weeks of life, the timing and intensity vary between infants. Therefore, the term “witching hour” is commonly used to describe periods of prolonged evening fussiness, but it should not be treated as a formal medical diagnosis or as an explanation for every episode of crying.

The research also provides some context for the common assumption that prolonged crying must be caused by acid reflux. Another systematic review of randomised controlled trials examined the use of proton pump inhibitors (PPIs) in infants with crying or irritability, based on the assumption that these symptoms were caused by gastroesophageal reflux. The researchers concluded that “the data from a systematic review of randomised controlled trials do not support the use of proton pump inhibitors to decrease infant crying and irritability.” This does not mean that gastroesophageal reflux never occurs in infants, but rather that crying or irritability alone should not automatically be attributed to reflux or treated with acid-suppressing medication.

More recent research has further demonstrated how common crying is during infancy. A 2022 meta-analysis combined data from 57 studies across 17 countries, involving 7,580 infants. The researchers found that crying remained a common form of communication throughout infancy, with the pooled estimate for crying and fussing at the traditional 5–6-week period being about 126 minutes. The authors noted that there was substantial variation between studies and that “the duration of crying remains substantial in the first year of life, after an initial decline.”

There is also evidence that physical contact and soothing can help regulate an infant’s stress response. A 2021 literature review examined 22 studies on skin-to-skin contact and its effects on stress regulation in mothers and infants. The review found that skin-to-skin contact was associated with changes in biological measures of stress regulation, including the autonomic nervous system, heart-rate variability, cortisol and oxytocin. The researchers concluded that skin-to-skin contact has an important role in regulating stress within the mother-infant relationship.

What experts say

Dr Parimala V Thirumalesh, Lead Sr. Consultant, Neonatology and Paediatrics, Aster CMI Hospital, Bengaluru, says prolonged crying, particularly in the evening, can be a normal part of early infancy, especially during the first few months. She explains that “witching hour” is an informal term rather than a medical diagnosis, generally used to describe predictable periods of increased fussiness, often during the late afternoon or evening.

“Healthy babies commonly cry for several hours a day, with crying generally increasing during the first weeks and peaking around 6 weeks before gradually decreasing by 3–4 months,” she says. According to Dr Parimala, several factors, including overstimulation, tiredness, hunger and an immature ability to regulate emotions, may contribute to this pattern.

She adds that the pattern is generally reassuring when the baby is otherwise doing well. “If the baby feeds well, grows normally and is comfortable between episodes, this pattern is usually reassuring.”

However, Dr Parimala cautions that prolonged crying or fussiness alone should not be taken as evidence of acid reflux or cow’s milk protein allergy. “No, crying or fussiness alone does not establish acid reflux or cow’s milk protein allergy,” she says.

While reflux is common in infants and may present as effortless spit-up or regurgitation in an otherwise healthy, normally growing baby, cow’s milk protein allergy can involve a wider range of symptoms. These may include vomiting or regurgitation along with blood or mucus in the stool, diarrhoea, eczema, feeding difficulties or poor weight gain. Persistent symptoms, particularly when associated with feeds, may warrant further evaluation.

“Reflux is considered an uncommon explanation for unexplained crying in an otherwise healthy infant,” Dr Parimala says, cautioning parents against assuming that every fussy baby has reflux or starting treatment without medical advice.

Parents should also watch for signs that may indicate that the crying is not simply part of a normal developmental pattern. Dr Parimala recommends medical assessment when crying is persistent, unusually intense or different from the baby’s usual cry, particularly if it is accompanied by symptoms such as fever, repeated or projectile vomiting, breathing difficulty, poor feeding, fewer wet nappies, lethargy, a swollen abdomen, blood in the stool, poor weight gain or signs of significant pain.

“A baby under 3 months with a temperature of 38°C or higher needs prompt medical evaluation,” she says. She adds that breathing difficulty, blue or pale skin, seizures, extreme weakness, difficulty waking or a continuous unusual cry warrant emergency medical attention.

Even in the absence of these warning signs, Dr Parimala advises parents to consult a paediatrician if the crying is frequent, difficult to console, worsening or causing concern.

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