Delayed Initial Crying in Newborns: Causes and Implications

What causes a delay in the onset of initial crying?

Dear Dr.
Tsai,
Our baby did not cry at birth and is currently in the neonatal intensive care unit.
It took about two hours for the baby to cry, but the sound was very high-pitched.
Now, on the third day, the baby's crying has normalized.
I would like to ask Dr.
Tsai what could cause a newborn to not have initial crying.
Is this related to the mother receiving epidural anesthesia during labor? What are the potential future health implications? Thank you.

Elvis Lin, 30~39 year old female. Ask Date: 2005/06/14

Dr. Cai Zhengxian reply Pediatrics

Dear Lin Mama,
I understand that you are very concerned about whether your baby’s delayed crying at birth may indicate neurological issues.
This is a question that requires careful observation and patience to answer.
There are many reasons why a newborn may not cry immediately after birth, such as meconium aspiration into the trachea, fetal distress prior to delivery, or slower absorption of amniotic fluid in the lungs, among other possibilities.
Generally, every newborn is assessed for their Apgar score at one minute and five minutes after birth.
This assessment includes five criteria: respiratory effort (including the presence of irregular crying), heart rate (whether it is greater than 100 beats per minute), muscle tone (whether limb tone is good), skin color (whether there is a healthy pink hue), and reflex response to suctioning of nasal secretions.

We have observed that many newborns may not cry immediately after birth and may have a low Apgar score at one minute (often due to the need to clear meconium or provide oxygen and positive pressure support for breathing).
However, these infants often show improvement in their Apgar scores by the five or ten-minute mark, and they do not experience long-term neurological effects.
It is important to closely follow up with a neonatologist or pediatrician during their growth and development for monitoring and any necessary interventions.
In general, the lack of crying at birth or a low Apgar score at one minute is more related to the intrauterine environment rather than the use of epidural anesthesia during labor.
Tainan Hospital cares about your health, and we wish you and your baby a smooth and safe growth journey!

Reply Date: 2005/06/14

More Info

Delayed initial crying in newborns can be a source of concern for parents, especially when it occurs immediately after birth. The absence of crying at birth is not uncommon and can be attributed to various physiological and environmental factors. Understanding these causes and their implications for the newborn's health is essential for parents navigating this anxious time.

One of the primary reasons for delayed crying is related to the newborn's transition from the intrauterine environment to the outside world. During this transition, several factors can impede the immediate onset of crying. For instance, if the baby experiences meconium aspiration—where the newborn inhales a mixture of meconium and amniotic fluid into the lungs—it can lead to respiratory distress, which may delay crying. Additionally, if there was any fetal distress during labor, such as a lack of oxygen, this can also affect the newborn's ability to cry immediately after birth.

Another factor that can influence initial crying is the presence of fluid in the lungs. Newborns typically clear fluid from their lungs during the birth process, but if this process is delayed or if the baby is born via cesarean section, the fluid may not be expelled as efficiently, leading to a temporary inability to cry. Furthermore, the Apgar score, which assesses the newborn's condition at one and five minutes after birth, includes criteria such as respiratory effort, heart rate, muscle tone, and reflex response. A low Apgar score at one minute may indicate that the baby requires assistance, but many babies who initially struggle can recover quickly and show normal development later on.

Regarding the question of whether the use of epidural anesthesia during labor affects the baby's initial crying, research indicates that while there may be some correlation, it is not a direct cause of delayed crying. The effects of epidurals on newborns are generally minimal, and any impact on the baby's immediate response is more likely related to the labor and delivery process itself rather than the anesthesia used.

As for the long-term implications of delayed initial crying, most newborns who experience this do not face significant health issues later in life, especially if they receive appropriate medical care immediately after birth. Continuous monitoring and follow-up with pediatricians are essential to ensure that the child develops normally. Parents should remain vigilant and communicate any concerns with their healthcare providers, as early intervention can address any potential developmental issues.

In summary, while delayed initial crying can be concerning, it is often a temporary situation influenced by various factors related to the birth process. Most newborns who experience this will go on to develop normally, provided they receive the necessary care and monitoring. Parents should focus on supporting their child's health and development through regular check-ups and open communication with healthcare professionals.

Similar Q&A

Understanding Hoarse Cry in Newborns: Causes and Solutions

Hello, Doctor. I would like to ask about my baby, who was born about a week ago (full term, weighing 2700 grams). I noticed that his crying was quite normal in the hospital, and he cried loudly at birth. However, since returning home for the postpartum period, I have gradually no...

Dr. Zhao Yongkang reply Pediatrics
Dear Ms. A-Wen's Mother, Hello! It seems that the issue of hoarseness has been troubling you for quite some time. If you notice that your baby has persistent hoarseness that is becoming more pronounced, and if there are any breathing difficulties, I recommend that you take ...

Understanding Developmental Delays in Infants: Key Concerns and Insights

The child was born weighing 2300g and is currently 8.5 months old. He appears to have some hypotonia, with a weight of 6 kg and a height of 62 cm, both below the 3rd percentile, while his head circumference is at the 85th percentile. We have consulted with specialists in neurolog...

Dr. Xiao Kaiwen reply Pediatrics
When can a child catch up to their same-age peers, and can hypotonia improve or recover? This depends on the underlying cause of their developmental delay. Conditions such as brain injury (e.g., birth asphyxia, meningitis, encephalitis, intracranial hemorrhage), chromosomal abnor...

Understanding Infant Straining: Causes and Solutions for New Parents

The infant is not yet a month old, and whenever he is awake, he seems to be straining his whole body. Sometimes, when he is unable to pass gas, he cries loudly, and usually, he can’t sleep for more than five minutes before it starts again. Seeing him in such distress, I, as a mot...

Dr. Zhao Yongkang reply Pediatrics
Hello, Ms. Hsiung: It may be necessary for the child to be evaluated during a pediatric check-up, as a physical examination by the physician would provide a better assessment for the child.

Understanding Your Child's Crying Episodes: A Pediatrician's Insight

Hello Dr. Wu: My child is currently one and a half years old and cries a lot. Since he turned one, at least once every one to two months, he has cried to the point where his lips turn purple, then he becomes silent, his face turns pale, and he appears dazed and unresponsive. Fami...

Dr. Liang Hongjian reply Pediatrics
Thank you for your inquiry, Mini. It is common for infants and young children to cry excessively and hold their breath when they are upset, which can lead to cyanosis (bluish discoloration of the lips) and pallor. This phenomenon is known as "breath-holding spells" and ...