Babies show pain through a combination of facial expressions, body movements, crying patterns, and changes in behavior. Since they can’t tell you what hurts, you have to read these signals together. No single sign is a reliable indicator on its own, but when several appear at once, they paint a clear picture.
Facial Expressions Are the Most Reliable Signal
A baby’s face is the first place to look. Five specific facial movements are consistently linked to pain: brow bulging (the forehead scrunching up), eyes squeezing shut, deepening of the fold between the nose and mouth, a horizontal stretch of the mouth, and a taut or cupped tongue. You don’t need to memorize these individually. In practice, a baby in pain looks distinctly different from a fussy or hungry baby: deep furrows appear in the forehead, the eyes close tightly, and the mouth opens wide with visible tension around the nose and lips.
A baby who is mildly uncomfortable might show a worried look, with eyebrows slightly lowered and cheeks raised. A baby in significant pain typically has a constant frown, a clenched jaw, or a quivering chin. If your baby’s face looks relaxed, makes eye contact, and shows interest in surroundings, pain is unlikely.
What the Cry Sounds Like
Pain cries are higher in pitch than hunger or fussy cries. Research confirms that the fundamental frequency of a pain cry is significantly elevated compared to hungry and fussy vocalizations. But pitch alone isn’t enough to identify pain, because colic cries can reach the same frequency. The difference lies in the overall pattern: pain cries tend to involve steady crying, screaming, or sobbing that is difficult to interrupt, while hunger cries typically pause when the baby is offered a breast or bottle.
A baby in mild discomfort may only whimper, moan, or let out occasional sighs. More intense pain produces frequent or continuous moaning, grunting, or vigorous crying. Some babies in severe pain produce what’s called a “silent cry,” where the facial muscles are clearly in a crying position but little or no sound comes out. This is still a pain signal.
Body Movements That Indicate Pain
Watch your baby’s legs, arms, and overall posture. A comfortable baby has relaxed limbs and moves freely. A baby experiencing pain often shows a distinct set of physical responses:
- Legs pulled up tight toward the belly, or kicking with exaggerated extension. This is especially common with abdominal pain, gas, and colic.
- Arms held rigid, either flexed close to the body or extended stiffly, sometimes with tremors.
- Arching the back, going rigid, or jerking. A tense, arched body is one of the strongest physical indicators of significant pain.
- Guarding, where the baby seems hesitant to move a particular body part, presses against it, or rubs it repeatedly.
- Rocking or fixed positioning, where the baby stays locked in one position or rocks side to side, sometimes rubbing their head against the mattress.
A baby with mild discomfort might simply squirm, shift back and forth, or seem restless without any of these more dramatic movements.
Changes in Breathing and Sleep
Pain often disrupts a baby’s breathing pattern. You may notice irregular breathing, faster breathing, brief pauses in breathing, gagging, or what looks like breath-holding. These changes can be subtle, so they’re easiest to spot when your baby is otherwise calm or trying to sleep.
Sleep disruption is another reliable indicator. A baby in pain has trouble settling, wakes frequently, or seems unable to reach deep sleep. Persistent sleeplessness that can’t be explained by hunger, a wet diaper, or overstimulation is worth paying attention to, particularly after a medical procedure, vaccination, or injury.
How Consolability Helps You Gauge Severity
One of the most useful things you can do is try to comfort your baby and observe the response. A baby who calms down within 30 seconds to a minute of being touched, held, or spoken to is likely in mild discomfort. A baby who requires constant comforting, or who cannot be consoled at all despite your best efforts, is typically in more significant pain.
This single factor, how easily your baby responds to comfort, is one of the clearest ways to distinguish between minor fussiness and something that needs attention. Inconsolable crying that persists despite feeding, holding, rocking, and diaper changes is a red flag.
Telling Teething Pain From Illness
Teething is one of the most common sources of baby pain, and it often gets confused with ear infections or other illnesses. A few differences help you sort them out.
With teething, you’ll typically see red and swollen gums right where a tooth is about to break through. Your baby may rub their gums, cheeks, or ears because gum pain can radiate to those areas, especially when molars are coming in. Teething can raise body temperature slightly, to around 98 to 100.3°F, but this falls below the threshold for a true fever. Extra drooling and an occasional cough or gag from all that saliva are also normal teething symptoms.
Ear infections, on the other hand, often come with a genuine fever (above 100.4°F), persistent ear pulling that doesn’t let up, and sometimes nasal or chest congestion. If your baby is pulling at their ears and also has a high fever or a persistent cough with congestion, teething is probably not the explanation.
The Five-Point Check Hospitals Use
Healthcare providers assess infant pain using a structured approach that you can adapt at home. The most widely used method scores five categories: face, legs, activity, cry, and consolability. Each gets a score from 0 to 2, with 0 meaning relaxed and 2 meaning significant distress.
You don’t need to assign formal scores, but running through these five areas gives you a systematic way to evaluate your baby instead of relying on gut feeling alone. Ask yourself: Is my baby’s face relaxed or tense? Are the limbs loose or rigid? Is the body moving freely or arching? Is there crying, and what does it sound like? Can I comfort my baby, or is nothing working? If you’re seeing 2s across most categories, your baby is likely in real pain.
Signs That Need Immediate Attention
Certain combinations of pain signals warrant urgent medical evaluation. For newborns under two months old, any fever of 100.4°F or higher requires an emergency department visit, regardless of other symptoms. Beyond that age threshold, watch for inconsolable crying that lasts hours, a rigid or arched body that doesn’t relax, refusal to eat, a high-pitched or unusual cry you haven’t heard before, or signs of pain after a fall or injury. A baby who becomes unusually limp, unresponsive, or difficult to wake is showing the opposite of the expected pain response, and that’s equally concerning.