Help! Will somebody hush that crying baby on this plane?!

(This is an update of an article I wrote some years ago. It also appeared in the New York Times.)

When traveling by air, a lasting nightmare is sitting near a cuddly little baby that suddenly morphs into a nonstop noise machine, emitting high decibel, ear-piercing, headache-producing, sleep-preventing discomfort. An even worse nightmare: it’s your baby.

1. “Crying infants” is one of the more objectionable features of air travel. Surveys show it rivals foul language, being seated next to an obese passenger, body odor, boisterous behavior and inappropriate displays of affection.

[An Australian airline settled a lawsuit by a passenger who said a screaming child caused her to lose some of her hearing. The incident occurred before the aircraft left the ground.]

2. In fact, the vast majority of infants do NOT cry while traveling by air. I base this on (1) my personal observations during hundreds of flights, (2) fifty years of questions from parents in my pediatric and travel medicine office, and (3) a questionnaire regarding crying that I distributed years ago to parents who recently had traveled by air with infants less than three years of age. (True, not a scientific study.) The consensus: most infants sleep like the proverbial baby, sometimes better than they do at home. The droning of the aircraft may lull them to sleep.

3. Yes, some infants do cry during flight. Surprisingly few, though, considering that air travel disrupts their eating and sleeping schedules and places them in new surroundings, away from their own cribs, in new and often uncomfortable sleeping positions and among strange noises and unfamiliar faces. If they are resting on an adult’s lap, they are disturbed every time the adult moves. However, the rare infant who does cry is so disturbing to us, say psychologists, that the event is ingrained into our psyches and remembered for years, the result of mixed feelings of anger at the helpless baby, anger at the hapless parent(s), and guilt for feeling such anger.

4. There are many theories but few facts regarding crying during air travel. “My baby cries all the time” is a common complaint at routine pediatric checkups. Likely, there are many causes that can be lumped together as “general discomfort.” Serious illness as a cause for such crying is an extremely rare finding. Our surveys suggest in-flight criers generally cry excessively at home and often at about the same hour on the clock. (Theories to explain excessive crying come and go. Acid reflux is currently in vogue.)

5. Some parents unwittingly contribute to inflight crying. They give infants lots of fluids, to prevent dehydration. In fact, dehydration during air travel is a myth. Adults erroneously interpret their own parched mouths and throats as dehydration. In fact, this dryness is due to air conditioning removing moisture from the cabin air. Moreover, changes in atmospheric pressure at cruising altitudes increase air in the stomach and intestines by about 20%. (This gives many adults a bloated feeling.) In infants, excessive fluids may cause colic. Feed infants no more inflight than at home.

[From a website for nursing mothers: Carry a lightweight blanket. Nurse discreetly. When someone objects, offer them the blanket so they can cover their eyes.]

6. Ear pain may be a culprit in inflight crying. Again, blame atmospheric pressure. And blame an air sac in the inner ear. Normally, the Eustachian tubes connect that sac with the nose and the outside, equalizing pressure. However, if the tubes become clogged with mucus from colds or allergies, the air in the middle ear is trapped. Atmospheric pressure expands the air, causing it to impinge on surrounding tissue and cause pain. Moreover, infants’ tubes are narrower than those in adults and mucus accumulation is more common. Fortunately, as far as is known, crying does not damage the ears.

7. Can parents prevent inflight crying? Sometimes. Sedating infants for air travel, once commonly done, is no longer recommended. Infants were given antihistamines to make them drowsy. However, this rarely helped. Additionally, antihistamines have many side effects and are now rarely used for any purpose in young children. Also not very helpful is waking sleeping infants for takeoff and landing when crying may be somewhat more common; awake infants swallow more frequently than sleeping ones and swallowing may help open clogged Eustachian tubes. Also, awake infants can be given bottles or be breastfed which also increases the frequency of swallowing. However, more liquids may cause colic. And why wake sleeping infants to prevent crying (though, ironically, crying also increases swallowing)? An age-appropriate dose of acetaminophen or ibuprofen may relieve ear pain.

[To misquote Shakespeare: To sedate or not to sedate infants for air travel, that is an oft-raised question. Is it truly nobler to spurn sedatives, risk a crying child and bravely suffer the scorn of outraged fellow passengers? Or is it more virtuous to sedate infants, perchance they’ll sleep, but endure the thousand humiliations that parental guilt is capable of self-inflicting?]

8. Airlines claim they have no solutions for the “crying infant dilemma.” Proposals include banning infants from scheduled “quiet” flights, setting aside a section of planes for families, and partitioning the back of aircraft with soundproof curtains. Presently, some airlines ban infants from first class. However, in an article asking, “Will new airline seating proposals create ‘baby ghettos?’,’’ the Wall Street Journal says that, likely, segregation won’t “fly.” If family sections are full and seats are available elsewhere, would families be barred from that flight? Must families with well-behaved children sit in the family section? Will adults traveling alone accept seats near children?

[A flight attendant allegedly secretly added Xanax, an antidepressant, to juice and told the mother that it will make her screaming infant sleep. It is unclear if the infant drank the juice; no side effects occurred. Later, the mother noticed that the juice was foamy, contained blue specks, and tasted bitter. She submitted the juice to authorities. Analysis revealed Xanax. The FBI charged the flight attendant with assault, charges he denied. He was fired. The outcome of the charges is unknown.]

9. Try every trick you can think of, bribery included. Bring toys, familiar blankets, bottles, appropriate treats, a DVD player and a pacifier (even if you don’t use one at home). Nurse them. Sing and hum. Walk up and down the aisle – but watch your step. Holding your infant in your arms blocks your view of protruding feet and luggage.

10. Ignore the scorn of fellow passengers. Stay calm, if possible. Infants may feel adults’ stress and cry in response. While fellow passengers may become angry with you, most of them, at some level, realize that no parent is oblivious to a screaming infant in their arms. Attempt to make peace with your neighbors before they make an enemy of you. Apologize for the disturbance. Tell them that you are doing your best to quiet your baby. Likely, they will sympathize with you. Listen to their suggestions; you need not act on them. Politely suggest they ask the flight attendant for another seat, if possible, or for earplugs or earphones.

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