Inside a Colic Clinic

A Radical Approach, p.2

To define and diagnose colic, doctors have long used the "rule of three," first developed by pediatrician Morris Wessel, M.D., in 1954: at least three hours of crying a day for at least three days per week over a period of three weeks or more. Frustrated parents, meanwhile, tend to define colic by what it's not—not hunger, not a wet diaper, not fussing, not like other babies, and definitely, absolutely not normal.

People will often tell parents who come to the clinic, "Oh my baby had colic, it's so common," says Dr. Twomey, who's also an assistant professor of psychiatry and human behavior at Brown Medical School. "But these parents know there's something qualitatively different about their experience."

Barry Lester, Ph.D., the director of the Brown Center for the Study of Children at Risk and founder of the clinic, has pinpointed more specific characteristics of colic, culled from scientific research conducted there and elsewhere. A baby has colic if her crying episodes have a sudden onset; if the cry is high-pitched and intense; if she exhibits physical signs of discomfort, such as pulling her legs to her chest, doubling over, tightening the muscles in her arms and legs, clenching her fists, or holding her breath; and if she is inconsolable, meaning that she seems unable to respond to her parents' attempts to soothe her.

Because there's no cut-and-dried diagnosis for colic, there's no standard cure for treating it, says Dr. Lester. "There are colleagues of mine who think it's a waste of time to study colic because it's just a variation on normal development," says Dr. Lester, the author of Why Is My Baby Crying? "Oftentimes I'll say to those people, 'Have you ever talked to parents who have gone through this?'"

Dr. Lester has. Since founding the clinic in 1986, he and his colleagues have operated on the theory that an intensive, multifaceted approach to helping colicky infants, one that addresses both hurting babies and their weary family members, helps reduce tears in a way that no other approach could. "The departure we've made is to think about not just the baby but about how the crying impacts the whole family," explains Dr. Lester.

In other words, they take colic seriously. "A lot of pediatricians think the problem is complaining, irritating mothers who can't deal with their babies' crying, but we have evidence these babies are in pain," says Dr. Lester, citing a study done at the clinic that found that the cries of a baby with colic are acoustically similar to those of a baby in pain. "We acknowledge and legitimize parents' issues and feelings about their baby's crying."

There's evidence that the clinic's approach works. In a recent study of 71 families led by a team from the Brown Center for the Study of Children at Risk, babies receiving family-based care showed a decline in colic symptoms and an increase in feeding efficiency and time spent awake and content. And their mothers reported an improvement in depression symptoms as well. Babies started treatment between 4 and 8 weeks of age; within six weeks, their crying decreased by an average of 60%, compared to a 40% reduction in infants who got standard pediatric care.

Those findings constitute a compelling argument against the conventional pediatric treatment that often takes a "wait it out" approach to colic. "It's not useful to tell parents who are struggling to get through a day that this is an experience that will pass in a matter of weeks or months," says Dr. Twomey.