For Cryin' Out Loud!
"What's wrong with your kid?" That's what I thought all of my friends and family were silently asking me every time we brought my firstborn around for a visit. Call it paranoia, but if you're the parent of a baby with colic, you know what I'm talking about. You're at your parents' house for a family dinner. Your beautiful (and thin) cousin, who had her baby just days after you, joyfully passes her 2-month-old around the house from person to person. Her baby smiles and coos, and then quietly closes her eyes and drifts off to sleep as the family dinner begins. All the while, you've worked up a full-grade sweat, trying to rock, bounce, and shush your baby to stop her wailing and screaming. You're lucky to gulp down a lukewarm dinner roll in between the pacing and patting, and you're trying not to cry as you wonder what your cousin has done so right and what you've done so wrong. Sound familiar?
When faced with a colicky baby, even the best and most attentive can feel exhausted, overwhelmed, resentful, and guilt-ridden, but you can formulate a strategic plan to manage those cries and reclaim your sanity!
Why All the Tears?
The true medical definition of colic is unexplained crying for longer than three hours a day, more than three days a week. The first time I read this, I had to laugh, because looking back, my daughter blew this guideline out of the water! Was there a "super" category of colic for babies who cried all day and all night? She'd have definitely taken the award if that were the case! The truth is, all babies cry periodically, but colicky babies cry with a force and focus that is unparalleled. It's thought that up to 25 percent of babies fit the description of colic. Symptoms usually begin around 2 to 3 weeks of age, peak in intensity around 6 to 8 weeks of age, and begin to subside around 3 to 4 months of age.
So what specifically sets a baby with colic apart from a baby who's just fussy? It's a matter of degree. Because colic isn't a disease, but rather a behavioral pattern of excessive crying, the diagnosis is very subjective. There is no "test" for colic, and we've struggled to understand what even causes colic. For all of these reasons, making the diagnosis is tricky. Some doctors avoid the term altogether, feeling like it is a label that is too ambiguous and fraught with misconceptions. Other doctors favor more descriptive terms like "high-needs baby" or "immature nervous system." Ask five different doctors to describe what colic is and you'll undoubtedly get five different answers. They will all probably touch upon the same basic features (length of crying time and age of the child) but ultimately, whether or not a baby is diagnosed with colic is a matter of opinion.
Even the actual cause of colic is ambiguous. Once thought to be a digestive problem, because of the way in which many colicky babies frequently draw up their legs and cry out as if in pain, there has never been any proven link between stomach ailments and colic. It is certainly true that colicky babies tend to be more gassy, but this is probably more a result of the crying, not a cause of the crying. Some experts believe that colic may be a combination of a baby's inborn personality and an immature nervous system that leads to their inability to handle stimulation from the world around them. Think of it as a circuit overload: These babies take in information from their environment but quickly become overwhelmed by even the simplest of things, including being fed. The result? Seemingly unexplained crying that only worsens with the well-meaning attempts of the caregiver to provide comfort.
Maybe you're thinking to yourself right now, My baby does seem to cry a lot. How do I know if he has colic? First, consider his pattern of crying. Many (but not all) babies with colic become predictably inconsolable at the same time each evening. I had one parent say that 6 p.m. was her child's witching hour. Her baby was relatively high maintenance during the day, but somehow she seemed to manage, until about 6 p.m. each night. It was right around the time when her husband came home from work. Her son's crying would ramp up in intensity, her husband began to think his own son hated him, and she would drop into a sobbing mess on the floor, feeling like a complete failure for not being able to create her ideal "happy home."
Next, look at how your baby cries. Colicky babies often look like they are in terrible pain. They arch their backs and grimace, often seeming to try to crawl right out of your arms. Consider how they respond to your attempts to soothe them. Colicky babies characteristically don't respond easily to basic attempts to calm them, such as holding and cuddling. This is one of the most frustrating parts of parenting a baby with colic. Doing what comes naturally when these babies cry often only makes them more upset. We laugh because we had a beautiful rocking chair in my daughter's nursery that never got used. She hated being held and rocked. Swaddle her up and sit with her on top of the washing machine with it running, though, and she would inevitably fall asleep within a matter of minutes.
How to Soothe Baby
Because we don't know the exact cause of colic, it's one of the most difficult conditions to treat. What we do know is that conventional medications can't "cure" colic. Anti-gas medications, antacid medications, medicines designed to soothe irritable tummies, and pain medication all have no role in managing a baby with colic. The same is true for dietary modifications. Because less than 10 percent of colic cases can be linked to food allergies, attempts to change formulas or ask nursing mothers to not eat potentially allergenic foods are usually fruitless and often only add to the already high level of exhaustion and frustration felt by parents.
There are a couple of approaches you can use that appear to be somewhat helpful. Past research that looked at the crying patterns of babies within various cultures where babies almost exclusively spend the day in a papoose worn by their mother has found that babies who are held and carried more by their caregivers during the daytime hours cry less at night. Now that baby carriers have become trendier, we're seeing the positive effects here as well. Holding your baby more during the day, before they become fussy, seems to curb their appetite for crying in the evenings.
To me, as the mother of a colicky baby, this seemed almost counterintuitive at the time, as my daughter's few quiet times during the day seemed like opportune times to put her down and get some housework done, or better yet, get a well-deserved nap. However, based on the advice of my pediatrician (yes, even the child of a pediatrician has her own doctor), I gave it a try, and the results were surprising. My method certainly wasn't scientific. I simply went about my day and tried to either hold her or place her in her infant carrier while I vacuumed, did laundry, and prepared meals. I loved the closeness, and she definitely seemed to be a calmer baby, not just during the day, but in the evening hours as well. To this day, baby carriers are my favorite gifts to give at showers and the number one piece of baby gear that I always recommend to parents in my practice.
Mimic the Womb
Another method of managing colic is to "mimic the womb." This means creating environmental surroundings that make your baby feel like he's still incubating inside you. This can include "white" background noise, such as making a "shushing" sound or running a vacuum cleaner. It can also include re-creating the movement that he felt while he was inside you. Before he was born, he went for walks, changed positions frequently throughout the day, maybe even did prenatal yoga or aerobics. Use things like infant swings or gently bumpy rides in a stroller for varied movement.
In addition, re-creating the prenatal environment may include the soothing effects of water. He was "swimming" in a soothing bath of fluid for nine months, so he may enjoy the calming effects of a warm bath. I had one mother use this technique 20 times a day. She knew that whenever her daughter began having a crying spell, putting her in a baby tub with warm water would calm her every time. She swore she had the cleanest baby on the block!
Stay Calm, Parents
Finally, remember to take care of yourself. Babies with colic are difficult at their best moments and downright exhausting the rest of the time. Put your baby down and walk away if you feel yourself getting agitated. Never allow yourself to become angry or frustrated to the point of shaking your child. The delicate blood vessels in babies' brain can tear and bleed with a violent shaking movement, causing brain damage and sometimes even death. Shaken baby syndrome is a tragedy that too often results from frustration and anger directed at a crying baby. Remember that colic isn't something you've caused, so give yourself a break from time to time, whether it's scheduling to have a neighbor babysit for a few hours, or coming up with a schedule of "duty" between you and your spouse.
Right now, it may seem hard to believe, but there is an end in sight to the continuous crying, and having colic might even offer some advantages. Many behavioral and developmental specialists theorize that highly intense and persistent babies, such as those with colic, probably harbor a temperament that leads them to be high-achieving, motivated, successful children and adults -- all qualities that are commonly admired and rewarded as we grow up.
That's my professional pep talk. My personal testimony? That same exhausting and difficult baby is now a precocious preschooler who is always the first of her friends to do everything, from reciting The Cat in the Hat from memory to mastering a forward roll. All that energy spent crying now will be the same spark that will entertain and delight you sooner than you know it!
Is It Colic or Just Normal Crying?
Pattern: Cries usually related to a need (to be fed, held, changed, etc).
Timing: No particular pattern throughout the day and night.
Intensity: May sound distressed at times but easily consoled.
Soothing Techniques: Tends to like "typical" baby things like cuddling, being held, or being rocked.
Pattern: Cries are seemingly "unprovoked."
Timing: Tends to peak in the evening.
Intensity: Sounds like a painful cry that is difficult to console.
Soothing Techniques: Has to have very specific circumstances to calm down.
When Should You Call the Doctor?
Since you'll be seeing your pediatrician at least once or twice during the first month or two for routine checkups, this is the perfect time to mention your concerns about your baby's crying. It's helpful for you to discuss coping strategies with your doctor to rule out more serious conditions that can cause babies to cry excessively.
Frequent vomiting, in association with painful crying, can be indicative of gastroesophageal reflux, and in this instance, antacid medicines can be beneficial. Also, bright green vomiting with colicky crying can indicate a serious intestinal blockage requiring immediate medical attention. Babies with milk allergies tend to be fussy, presumably due to stomach pain from drinking formula made from cow's milk or nursing from a mom who drinks cow's milk, but this is rarely the only symptom. Typically, these babies will also have other symptoms, such as blood or mucus in their stools and frequent vomiting after feedings. Finally, fever, refusal to eat, and poor weight gain are never consistent with colic and always warrant a call to the doctor.
Sara DuMond, MD, is a pediatrician in Mooresville, North Carolina, and the mother of two children.
Originally published in American Baby magazine, December 2006.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.