Stress Signs in Infants

(Note- This is from a pediatric physical therapy viewpoint today).

A brilliant comment from anthromama on my last post regarding “40 Days After Birth and Beyond” stimulated a small idea in my head!  Many of you know that I am a neonatal physical therapist by profession and in my work, recognizing and calming an infant in stress is a huge part of what I do.  So, with that in mind, I thought I would list the stress signs of an infant here for everyone to see because it never occurred to me that folks might not recognize stress signs in their own full-term infants (yes, a full-term infant can still have stress signs – remember, protect those 12 senses!)

Stress signs:

The baby will salute you – essentially this looks like a baby stretching out their hand toward you, (usually the back of the hand toward you) and up towards their face.  Parents will say, “How cute! He is waving at me!”  Nope, nope and nope.

The baby will extend the arm and splay the fingers apart.

The baby will frown, grimace, grunt.

The baby will all of the sudden start yawning, hiccupping, or sneezing multiple times.  (Yes, babies do yawn, hiccup, or sneeze but this is more like 10 times in a row or more all of the sudden).

The baby will arch the back and neck and push away (and yes, some babies with gastroesophageal reflux disease will also arch and push away).

The baby will look away suddenly and for a long period after having a period of wonderful eye contact on a caregiver’s face – think about this one carefully.  We ourselves do not maintain focused eye contact on others when we are in conversation, but often our eyes are scanning and resting, scanning and resting.   The looking away is a sign the baby needs a break and less focus.

The baby will cry.  This is usually a last sign when all other signs have been ignored.

The baby will become frantic and move all extremities wildly.

Or, conversely, the baby will just shut down, shut his or eyes and tune everything out.

What To Do:

Breastfeed and gently but firmly snuggle your infant

Try tucking your infant’s arms and legs close into their body.  See if you can help your infant clasp their hands together or to bring their hand to their mouth if they are not nursing.

Try talking to your infant before touching them – let them know you are there!

Hold your baby about 10 inches or so from your face – the distance they see best at first if  you are wanting to make direct eye contact.  Vision is not the most utilized sense in a newborn!

Turn down the lights; bright lights bother many infants


Most importantly, decrease the multiple inputs going on – if the other kids are screaming, the dog is barking, the phone is ringing – well, see if you can turn the phone off, calm the kids, let the dog go outside.

Let the baby hold your finger.

For “All-Out Crying”

Sometimes babies just need a release and that is okay while being held and soothed, but we really want the infant to establish trust in that a caregiver will meet their needs (in other words, no crying it out for a small baby!)   If nursing is not doing the trick, some babies enjoy being swaddled and held upright with motion such as  being walked around.  Some babies I have loved who had more severe neurologic challenges have responded best to being rather tightly swaddled, sucking on my gloved finger in a sidelying position with their head higher than their stomach and being “gently  rhythmically bounced” (ie, if they are on your leg, cross one leg over the other leg, put the infant on their side on the leg that is highest with their head away from you and tap your bottom leg to a  slow rhythmic beat).  I need to take a picture so you all can see it better.  Sometimes sucking along with a gentle rhythmical bouncing or rocking is very helpful for any infant in distress.

Babies that are happy:

Are in a quiet and alert state.

The face, arms and legs are relaxed.

The baby can focus on objects or people.

Their eyes are open and they try to smile.

There was a post I wrote quite awhile ago regarding why babies cry, typical crying patterns, etc:

Hope this helps stimulate some thought,


16 thoughts on “Stress Signs in Infants

  1. It’s hard sometimes to read infants: grimaces could be from gas, tuning out could be simply falling asleep, arching the back could be GERD, etc. But then sometimes it seems obvious — I remember my son flailing his arms wildly if he felt somehow unsafe, like being lowered backwards into a bath.

    I loved swaddling my son when he was an infant — he seemed to like it, and as a c-section baby I think he needed it.

    (Thanks for the compliment!)

  2. I think you should lead a Waldorf ante-natal class Carrie … (as if you didn’t have enough to do right!!!) where expecting mothers are encouraged to orient themselves to homelife, inner work and understand the true needs of infants!

  3. Acid reflux is actually a process which a lot of people will sense somewhat regularly. The difference betwixt every day acid reflux, and that of GERD patients is the acidity of the reflux as well as the length for which it persists in the oesophagus.

  4. my newborn daughter does sort of “kung fu” moves with her hands when there’s a sudden voice she doesn’t like. First we thought of funny but after reading up on it, we realized she needs some comforting straight after it happens

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  8. Hi!
    This is an old post, but here is my question anyway:
    My 2 month baby girl exhibits most of the stress signs listed here anytime she is not in someone’s arms. I’ve only seen her with legs and arms relaxed for very, very short periods of time, for example.
    Could there be anything wrong with her/me/us that she is in constant stress mode?
    I wear her most of the day, we cosleep, breastfeed, did 30-something days stay in, live in a quiet home…

  9. Hi Carrie,

    I hope you can share some insight with me as I am a first time mom and my 4-week old baby boy displays all these stress signs every feeding!! It has become very stressful for my husband and I to feed him. I am feeding him breastmilk through a bottle. We started breastfeeding but was unable to continue so now I am exclusively pumping and bottle feeding. These stress markers have only been in the picture the last couple weeks and are now present at every feeding. Nothing has changed in our routine but it typically takes 1 1/2 to 2 hours to feed my baby!! That is just way too long, leaves us little time between feedings. He does exhibit a lot of grunting and pushing like he has a bowel movement or gas, spits up a lot, and will push and grunt so much he will make himself vomit or choke. I know this a lot but I would appreciate any suggestions.

    • Denise,
      I am sorry things are not going well with feeding. That must be very stressful for you! I have worked with a lot of infants, both breastfed and bottle fed as an IBCLC and a neonatal/pediatric PT in the NICU. However, this is an instance where I cannot advise you over the Internet. When I worked in the NICU, we expected a bottle feeding to take no more than half an hour. Great feeders that were full term usually took a bottle with no problem at all within 10-15 minutes. So, I think you really, really need to get medical help who can lay eyes on your baby in person and see what is going on. What does the pediatrician say? does your infant have GERD at all (reflux disease) or was a preemie or has any other things that might impact feeding? A feeding therapist that is NOMAS certified or Beckmann certified would be helpful A speech language pathologist or OT who specializes in feeding would be most helpful.
      Hope that helps, feel free to email me at

  10. could this behaviour be due to baby getting too much lactose and not enough lactase?

    I see this a lot in my practice – please be reassured that this is NOT a medical issue

    As milk leaves the breast either through the baby drinking or through pumping, the fat content of the milk gradually increases.

    This means that when a mother is pumping, the milk that she gets at the END of the pumping session is often higher in fat than the milk she gets at the beginning of the pumping session

    The milk mother gets at the beginning of the pumping session contains less fat and is high in lactose (sugar) – we call this bit of the milk “the soup”

    As mother reaches the end of the pumping session, the milk she is pumping contains more fat and is high in lactase (the enzyme that babies need to break down the lactose) – we call this bit of the milk “the cheesecake”

    Sometimes mothers have so much “soup” that they stop pumping before they have pumped very much “cheesecake”

    This means baby gets lots of “soup” (lactose) but not much “cheesecake” (lactase)

    The higher-fat milk (“cheesecake”) is an excellent stomach-settler, because it slows the passage of milk through baby’s intestines as well as containing lactase (the enzyme that breaks down lactose).

    Without the extra fat and the lactase, milk travels through baby’s intestines without breaking down fully, and can ferment in her large intestine, causing gas, discomfort, and frothy green stools. This is NOT a medical issue but baby is unsettled and uncomfortable when feeding

    I see this a lot in mothers who are pumping milk for their baby – baby is gassy and uncomfortable due to the fact she is getting lots of “soup” and not enough “cheesecake”.

    The advice would be that if mother is regularly pumping a fixed amount from each breast – for example, four ounces (120mls) – she would stop as soon as she had pumped approximately ONE THIRD of what she usually pumped (for example, just over one ounce/40 mls) and she would discard this milk.

    Then mother would continue pumping until she got four ounces (120 mls) and would feed this milk to the baby.

    Now that mother has thrown away some of “the soup”, the milk that is left for baby will contain more “cheesecake” (lactase) and baby will be less gassy/uncomfortable

    well done on amazing breastfeeding work – pumping is STILL breastfeeding!

    Caroline Neale Infant Feeding Midwife London UK

    • Hi Caroline – Thank you for sharing your thoughts. The concept of hindmilk and foremilk in the United States is probably being driven right now by some of the thoughts embodied in this article (Peter Hartmann’s research): I understand exactly what you are talking about clinically, and these stress signs may reflect links to fussiness, gassiness, etc from this sort of scenario, but many of these signs are the “stress” signs or self-regulating signs of an immature nervous system irrespective of feeding method. Premature infants tend to have more difficulty in these areas, as to be expected.
      Thank you for writing from across the pond! Love my U.K. readers. Thank you for being here.

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