Inside a Colic Clinic

Pinpointing The Problem, p.3

Over the years, Dr. Lester has amassed a collection of commercial colic "cures," none of which he believes work to address true colic. Displayed prominently in his office at the clinic, they include white-noise machines, CDs of a mother's heartbeat, vibrating baby seats, aromatherapy oils, and from England, commercially packaged Gripe Water (the original homemade recipe calls for dill oil, sodium bicarbonate, and 3% to 5% alcohol—do not try this at home).

Along with these over-the-counter products, certain colic-soothing techniques have been used by multiple generations of parents. While putting a baby in his carrier on top of a running clothes dryer or turning on the vacuum cleaner or shower to soothe him to sleep isn't likely to cause harm, it won't quiet a truly colicky baby for more than a short period of time, says Dr. Lester.

Other myths about the condition are more toxic, to both babies and parents, Dr. Lester says. Contrary to popular belief, colic isn't inherited and isn't caused by genetics, isn't more common in boys or firstborn babies, isn't caused by bad parenting, and isn't untreatable.

So how does the clinic treat its young patients? According to research done there and elsewhere, babies with colic nearly always have an interrelated set of feeding, sleep, and stimulation problems. On the medical side, the clinicians' goal is to unravel those interdependencies, decide which symptoms to treat first and how, and prescribe behavioral changes to address the remaining issues.

Typically, feeding problems are the first item on the agenda, says Dr. High, simply because babies won't thrive if they're not eating well. In a 2004 study, researchers at the clinic found that when they submitted two groups of infants to abdominal ultrasound, babies with colic were more likely to exhibit a wide range of feeding difficulties. Their problems included disorganized feeding behaviors, less-rhythmic sucking, and GER—the condition in which milk and gastric acid flow back up out of the stomach into the baby's esophagus, causing pain and, often, excessive spitting up—and its chronic manifestation, gastroesophageal reflux disease, or GERD.

Other studies indicate that some babies with colic may suffer from food allergies. When Jeannette Levenstein, M.D., a Los Angeles-based pediatrician not affiliated with the Colic Clinic, analyzed the stools of babies in her practice who seemed in distress, she discovered that many samples contained microscopic amounts of blood, an indication of allergic colitis. The informal study found that as many as 75% of crying infants in Dr. Levenstein's practice had GER, an intolerance to the protein found in lactose and/or soy, or both conditions.

Feeding-related treatments the clinic prescribes can include, for GER or GERD babies, thickening the formula with cereal and prescribing medications like Zantac, which reduces the amount of acid the stomach produces (measures that should only be taken in consultation with a physician, notes Dr. High). Other treatments include changing to hypoallergenic formula or eliminating certain foods from breastfeeding women's diets. Behavioral changes can help eliminate disordered feeding habits like "grazing"—that is, feeding every hour or so—which can cause some babies to cry or sleep poorly because they never feel full. Finally, keeping the baby upright for 20 to 30 minutes after eating, using wedge pillows, and propping up the crib mattress can help GER babies, who are often in pain when they lie flat after a feeding.

On the sleep side of the equation, while many newborns experience typical day-night confusion with little fussiness, others, for reasons that still aren't fully understood, react with bouts of inconsolable crying. Indeed, it's not unusual for babies at the Colic Clinic to have their difficulties with crying and GER resolved but continue to have sleep difficulties, Dr. Twomey says.

For those infants, Colic Clinic doctors recommend schedules, routines, and the encouragement of self-soothing techniques. Parents are advised to help their babies form solid sleep associations by establishing a consistent, calming bedtime routine even for the youngest infants and later using a shortened version of the same routine for daytime naps. That means making nighttime feedings all business, with low lights and minimal talking; using the same place for day and night sleeping; and putting the baby down when awake but drowsy.

Do these strategies make a difference? Yes, absolutely, says Tiffany Munro, 36, a Harrisville, RI, mother of twins. Munro's daughter, Amelia, was an easy baby—she slept and ate happily and cried only when she was hungry or her diaper needed changing. Amelia's twin brother, Blake, was another story. He cried more than other babies in the hospital when born and cried excessively after Tiffany and her husband, Chris, brought him home. "It wasn't a cranky cry, it was a cry of severe pain," recalls Tiffany. "He would grab at our chest as if saying, 'I'm in pain, please help me.'"

On the advice of the twins' pediatrician, the Munros switched formulas, perhaps six times in total, tried over-the-counter anti-gas drops, and put Blake on Zantac (but took him off when it didn't appear to make a difference). Blake wouldn't sleep unless held, which was difficult enough with twins but impossible for Tiffany by herself once Chris went back to work.

Sometimes, visitors would say, "I'll hold the good baby," meaning Amelia. "I'd think, Blake's not a bad baby, he's just crying," says Tiffany. "I'd sit and cry with him. I was a new mom, I wanted what was best for him, and I knew something was wrong. I just wanted somebody to give us some answers."

Finally, Blake's doctor suggested the Colic Clinic. Tiffany spent 30 minutes on the phone with Cynthia Miller-Loncar, Ph.D., a clinic psychologist, and got an appointment within 48 hours. Before she hung up, Dr. Miller-Loncar said, "I think we can help you."

Blake was diagnosed with GER, put back on Zantac, and prescribed changes to his environment (his parents held him upright after eating and put a wedge under his head in his crib) and to his feeding and sleep routines. Within three weeks, "he was sleeping 100% better," says Tiffany. "He was still having crying fits, but they were much less severe." Now 10 months old, Blake is a good eater and sleeper, and his mother is grateful they got help when they needed it.