HIGH PITCH CRY
One of the most common symptoms of Neonatal Abstinence from any substance exposure is a high pitch cry. This is a monotone shrill type of cry. It is persistent and does not allow for varied communication through cry. It is important to know that making sounds and how your baby moves their body is their primary communication since they do not have words. This communication can be made more difficult when it does not vary AND it is also more irritating to the listener when it is high pitch. This cry can be disturbing and ear-piercing. Infants with high pitch cries may have other medical concerns, so it is important to determine the root cause of the high pitch cry (remember it could be more than one cause).
NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.
STRATEGIES BY DISCIPLINE
NEURODEVELOPMENT
It is important that your baby’s doctor looks for any other root causes for the cry.
It will be hard to read your baby’s cues since there will be no variation in their cry. You will need to rely on the motor system more than the baby’s cries. Also, you may need to use a schedule (monitor feeding times, diaper changes, and sleep) since the cues will not be as clear.
To soothe your baby and reduce crying one of the best calming strategies is the SOOTHE technique developed by Dr Kiti (a video demonstrating the SOOTHE is available under TimeIn Parenting Strategies (TIPS) in this kit).
Swaddling is a very important and helpful tool in calming an infant and reducing cry (the Ollie swaddle was specifically designed with the NAS baby in mind as it offers moisture wicking and stretch with pliable restriction). Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Provide what we call a low threshold environment – low lighting, warm/swaddled, no noise/calming music (see music offered here in the kit that were developed specifically to not be overwhelming), limited movement or rhythmic rocking.
MAKE sure to read and respond to the baby’s cues to inform your intervention or interventions. Remember that sometimes you may need to help your baby learn to calm with step by step calming techniques…
MEDICAL
It is important to determine the root cause of high pitch cry. You may need to call your baby’s doctor if it was not already discussed at time of discharge from hospital at birth.
Check to see if your baby is in pain. If you think that the baby is in pain, you should call your baby’s doctor for assistance.
Recommended interventions:
Comforting/soothing techniques (offered in this kit)
Your baby may not be getting enough food.
make sure your baby’s suck is productive (they are able to attain breastmilk/formula and swallow it)
If your baby is having trouble with a productive suck - shorten the feeding intervals to not tire the baby out
You may need to put the infant on a schedule with frequent, less amount feeds
Reduce the stimulation in the environment; lower lights, lessen noise, and use soft materials.
Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
NURSING
It is important to determine the root cause of the high pitch cry with your baby’s doctor.
Monitor temperature so you don’t miss if your baby has a fever.
Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Look for formula sensitivity and constipation that may be promoting more distressed crying. You may need to change the formula.
Change the infant’s position to make them more comfortable.
Reduce the stimulation in the environment. Limit noise. Lower lights. Make sure the baby is comfortable (temperature and fabric).
Give the baby a warm bath.
OCCUPATIONAL THERAPY
Evaluate for any tummy/bowel issues that may be creating discomfort.
Swaddle (helps to provide calming) Make sure it is not too tight (fabric should provide stretch so it doesn’t harm shoulders or hips) but provides flexible restraint. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Change the position – some positions may actually feel painful while the infant is going through abstinence. Be aware of what positions are more calming and produce less crying.
Look at all the senses – are they overwhelmed? They may need you to decrease artificial lighting, background noise and eye contact to calm. Think about hearing (noise – even background noise might be increasing more irritation), touch (is your touch stimulating or is gentle but firm, fabric of clothing (soft textures) etc), movement (do they seek movement or does it make them more irritable) vision (is the light too bright or in their eyes, are you trying to make eye contact and they need a break right now). *note: eye contact is important but may be too much for an infant when they are crying, during calmer moments reengage with eye contact.
SPEECH PATHOLOGY
Crying is communication but when it is high pitch it will not be able to be specific to a certain need, but it is important to respond to the baby’s cries. Finding out if the baby has a need and soothing will both be important.
Soothe your baby with the techniques offered in this kit.
Swaddle your baby when they are crying to reduce the amount of crying and create some calmer moments. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
It can be that they are hungry but remember that crying alone should not be interpreted as being hungry.
Shorter and more frequent feeds may be important to help them with endurance when they are irritable and crying.
It will help to teach them to use a pacifier. Sucking is very calming to the nervous system. You will need to teach them to use a pacifier when they are calmer, so they learn to coordinate their sucking rather than just spit it out. “Spitting it out” is due to not being able to coordinate the suck, swallow, breathe (SSB) rhythm resulting in the pacifier fall out and/or frustration.
They can be overwhelmed by what is going on in the environment. Hearing background noise, talking, TV, radio, even the sound of lights – this, especially, when they are all happening at once can cause the baby to be fussy and cry.
Most importantly, read your babies cues to inform your strategy.
© 2025 Dr. Kiti Freier Randall