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Colic 101: What It Is and What to Do

mother holding crying baby

We expect babies to cry. But some newborns, about 15 to 25 percent, cry a whole lot more than others. When these otherwise healthy babies cry excessively and inconsolably for no apparent reason -- they're not sick, hungry, wet, tired, hot, or cold but are inexplicably miserable -- pediatricians call that colic. "It's not really a diagnosis; it's a behavioral observation," says Harvey Karp, MD, creator of the DVD and book, The Happiest Baby on the Block.

Colic is somewhat subjective, and whether your baby's crying is "average" or "excessive" may depend on how much you can endure. But pediatricians generally use the "rule of threes" to determine colic: crying bouts that start when a baby is about 3 weeks old (usually late in the day, although they can occur anytime), lasting for more than three hours a day, on more than three days a week, for more than three weeks in a row. It typically peaks at 6 to 8 weeks and subsides by 3 to 4 months.

Colic isn't a sign that your baby is sick, although things such as reflux, food allergies, and exposure to cigarette smoke can cause further aggravation and tears. Nor is it a sign that your baby has belly pain, although the way she grimaces, clenches her body, arches her back, pulls her legs up, and screams till she's purple can make it seem so. Colicky kids can be gassy. But pediatricians now believe that crying causes gas, rather than the other way around, because babies swallow air when they cry. One way to tell if your baby is in pain or has colic: distract her. "Bad stomach pain doesn't go away when you dance, turn on the hair dryer, or go for a car ride," Dr. Karp says. "So if your child gets better, you know it's not gas or pain."

What causes colic -- and why some babies experience it and others don't -- remains a mystery. Some doctors view it as a natural developmental stage that babies can go through as they adjust to all the different sensations and experiences that come with life outside the womb. (Dr. Karp calls this "the fourth trimester.") Others attribute it to an imbalance of bacteria in the gut.

Yet another theory is that colic stems from an imbalance of the brain chemicals melatonin and serotonin. Colicky babies might have more serotonin, which makes intestinal muscles contract, says Marc Weissbluth, MD, professor of clinical pediatrics at Northwestern University School of Medicine and author of Your Fussy Baby (Ballantine). (One reason colicky babies can fuss more at night, he explains, is that serotonin levels peak in the evening.) This imbalance, the theory goes, naturally resolves when babies start making melatonin, which relaxes intestinal muscles. Babies get ample melatonin from Mom in utero, but levels drop after birth until baby starts producing it on her own at 3 to 4 months -- interestingly, around the same time that colic typically disappears. "This hypothesis should reassure mothers that they didn't cause colic," Dr. Weissbluth says. "It takes away the guilt that you're doing something wrong and aren't able to soothe your baby."

Although it's not harmful in itself, colic can still take its toll. For starters, it puts terrible pressure on new parents. "It sent my husband and me into therapy," confesses Catherine McManus, a mom from Oviedo, Florida. Excessive crying is also associated with giving up breastfeeding, overmedication of babies, postpartum depression, and shaken-baby syndrome.

Colic is nerve-racking, but it's helpful to remember that it's also temporary. Your child might have an underlying medical condition (such as reflux, allergies, a hernia, or a urinary tract infection) that remains to be diagnosed -- a strong possibility if he's still crying inconsolably after four months. But barring that, the good news is that there's probably nothing wrong with your baby. The bad news is there's not much else to do but wait it out and try some calming tactics.

Some of these techniques might help calm your crying baby while you wait for colic to pass. Just remember that a lot of this is trial and error. "Some babies will respond to many of these interventions, some babies won't respond to any, and a lot of babies will respond only sometimes," says Larry Scherzer, MD, assistant professor of pediatrics at the University of Connecticut Health Center, in Farmington. "Usually by the time you try everything, the baby is old enough that a lot of the crying has ceased."

Follow the Five S's

Babies have an innate reflex that's triggered when we do things that mimic life inside the womb. "It's like an 'off' switch for crying," Dr. Karp says. The Five S's include swaddling, shooshing loudly in baby's ear, swinging baby, allowing baby to suck on a pacifier, and laying her on her side or stomach (across your forearm or lap with her head resting in your hand). "I've never had a child follow the Five S's and not calm down, unless she was ill," Dr. Karp says.

Although Dr. Karp maintains that the calming reflex is best activated when you do all Five S's together, parents also get results by cherry-picking strategies. And you can try endless variations of these rocking, holding, swaddling, noisemaking tactics. Christy Smith, of Jacksonville, Florida, says that all three of her older children stopped crying when she tried this technique: place baby belly down on your forearm, her head resting in your palm, and then gently sway her from side to side while rubbing her back. Smith plans to try this on her 2-week-old if he develops colic. "It gets tiring, but hang on because they usually fall asleep within five minutes," she says.

When her infant daughter Jesse, now 2, routinely screamed from 3 p.m. until 10 p.m., Carla Pennington-Cross found that exaggerated swinging mollified her. "My husband would swing Jesse as far as his arms would go," the Milwaukee mom says. "If someone did that to me, I'd be vomiting. But Jesse would lie there, peaceful in her father's arms until the second the swinging stopped. Then she'd start screaming again." For Isadora Kaye, now 2, being cradled in Mom or Dad's arms while they gently bounced on an exercise ball did the trick. "Bopping her along when you're walking works well, but it gets exhausting," says mom Caroline, of Cold Spring, New York. "This quieted her, and I was able to get off my feet. It was awesome."

Jessica Ziegler, of Highlands Ranch, Colorado, used her car seat as a modified swaddle when her son Holden, now 3, was at his most colicky. "He slept better in his car seat than anywhere else," she says. "He didn't have to be in the car, but he had to be in the car seat." And for Andrea Raymond, of Oak Grove, Missouri, an infant carrier was only a starting point for her oldest daughter, Bayley, now 5, who "cried from the moment she was born until she was 3 months." The real magic was noisy vibration -- Bayley slept soundly if she was in her carrier atop a running dryer, with a parent holding her steady.

Other parents have had success with white noise CDs or radio-station static, a running vacuum cleaner, or even the sound of running water in the shower or dishwasher. Though you may find these noises loud, babies find them comforting because they approximate what they heard in utero. "Inside the uterus, noises are louder than a vacuum cleaner," Dr. Karp says.

Good ol' regular music may work too. Shari Smith, an Orlando mom, found she could settle her eldest son, Eli, with the Winnie the Pooh theme song. "His nursery had a Pooh theme, so he had a lot of toys that played the song," she says. "The mobile over his bed played it, too, so he heard it from the time he was born. Because he recognized the melody, he was soothed when we played it or sang it."

For some babies, crying may be curbed simply by holding them as much as possible in a front pack or sling. "Holding and rocking won't spoil the baby," Dr. Karp assures. "In the uterus, babies were held and rocked 24/7, so even if you hold your baby 18 hours a day, which seems like forever to you, it's a significant cutback for your baby." Indeed, a study in the journal Pediatrics found that babies held by their parents for about 16 1/2 hours a day cried half as much as those whose parents held them for about 8 hours daily.

McManus still vividly remembers the day when her daughter, Caitlin, was 7 weeks old and was squalling so inconsolably she finally put her in the crib and walked away. "I couldn't deal with it anymore," McManus admits. "I said, 'I love you, but I have to get away from you right now.' It's terrible, saying this to your little baby. But you're exhausted, you've done everything you can, and you've reached your limit." Sitting outside for 10 minutes, while still within earshot, allowed McManus to regroup. "I told myself that it was going to be okay. And then I went back inside, picked her up, and tried to calm her down again."

New moms often feel guilty or self-indulgent for wanting a break from their newborns. But doctors say that putting the baby in a safe place, such as the crib or the playpen, and walking away -- even for a couple of minutes -- to take a shower, brush your teeth, make some tea, or call a friend or a counselor is exactly what you should do when crying threatens to push you past your limit. "It's not selfish, it's smart," Dr. Weissbluth says. That's because there's a strong association between excessive crying and infant injury. A survey of parents of more than 3,250 infants in the Netherlands revealed that more than 5 percent had slapped, smothered, or shaken their baby at least once because he or she was crying.

Find at least half an hour a day that's yours alone. Enlist your spouse, the grandparents, your siblings, trusted friends, or a sitter to help with the baby -- although it's a good idea to warn them of what to expect so they won't overreact. Pennington-Cross ceded the nighttime routine to her husband. "He would wear Jesse in a carrier, and I would get an hour to 90 minutes each night to read the news or hang out on the computer and play video games," she says. Another idea: connect with a moms group, in person or online, so you don't feel isolated (try the discussion forums at americanbaby.com or mamasource.com). "It's easy to convince yourself that you're the only one, that there's something wrong with you, and that people think you're a bad parent because you can't get your baby to stop crying," says Laura Jana, MD, coauthor of Heading Home with Your Newborn (American Academy of Pediatrics). "Getting support lets you maintain your sanity and gives you some distance and a little perspective."

If your baby's crying is incessant, no doubt you've already had several powwows with your pediatrician. "Even though colic is normal, it's not something you should keep quiet about, because there will be babies who do have something else," says Dr. Scherzer. Apart from fussiness, additional red flags that could indicate a more serious medical condition include frequent vomiting, fever, loose or bloody stools, poor weight gain and feeding, eczema, and lethargy. Keep a diary that tracks how often your baby cries, sleeps, eats, and poops and pees. Any difficulties with feeding or spitting up may help you discover if there's a pattern to the crying.

Myth: Colicky babies grow up to be unhappy kids.
Fact: "Colic is not your baby's defining personality trait," says Dr. Jana. "Once the colic is gone, your child can have a completely different personality -- spunky, sensitive, crabby. But colic is not going to tell you which, because it doesn't carry over."

Myth: Colic results from overstimulation.
Fact: Colicky kids cry because they miss all the noise and stimulation they got in the womb. "If you take them to a noisy basketball game, they usually go to sleep," notes Dr. Karp.

Myth: Your new-parent anxiety is making your baby cry.
Fact: "Babies aren't sharks in the water, and they can't smell your anxiety," Dr. Karp says. What they can pick up on: body temperature and how relaxed you are -- or aren't. "When you're anxious, you may jump from one thing to another because you're uncertain, and they can sense that," he adds.

Myth: Medications can relieve colic.
Fact: Some parents think that diphenhydramine, an antihistamine also sold as a sleep aid, will help calm tears. But it makes some babies cry more. Reflux meds also don't often help -- only about 2 percent of colicky babies have the type that warrants medicine. "Doctors know better, but under parental pressure they often medicate these kids," says Dr. Weissbluth.

Originally published in the July 2008 issue of American Baby magazine.

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