When is it just crying and when is it colic?

By Grace Monfort

An Inconsolable Baby

For the first two weeks of her life, our firstborn, Elizabeth, indulged our fantasy of parenthood -- Mom and Dad reclining dreamily, one moment dissolving into the next in a placid composition. Then the scenery changed dramatically. At around 5 p.m., she began to fuss, then cry, then howl, until about 7 p.m. She wasn't hungry, sleepy, wet, or bored.

I knew babies cried when they wanted to be held, but when I picked her up, she cried even louder. It was profoundly demoralizing: If I couldn't do something as basic as console my own baby, how would I maneuver through teething and tantrums, to say nothing of the vast, treacherous road beyond?

Since I was breastfeeding, the pediatrician suggested I eliminate coffee, dairy products, and certain vegetables from my diet. When that had no discernible effect, he shrugged. "She probably has a touch of colic," he said.

Colic. The very word struck terror in my new mom's heart. I had no real idea what it meant, of course, other than that it was bad and sounded vaguely gastrointestinal. To me it said, "Your baby is going to be tuned to the crying channel for the next three months."

I had every reason to be confused. Even among the medical community, colic is less a condition than a classification, defined by the rule of threes: inconsolable crying that begins and ends for no apparent reason, lasts at least three hours, occurs on at least three days a week, and continues for at least three weeks but seldom more than three months. By that definition, some 16 to 26 percent of infants are categorized as colicky.

What Is Colic?

What does the term actually mean? Not much, it turns out. Dozens of theories -- some of them mutually contradictory -- have been advanced to account for the excessive crying we call colic, including gas, lactose intolerance, maternal smoking, reflux, low birth weight, maternal stress, protein allergy, bottlefeeding, over- and under-stimulation, and any number of gastrointestinal disorders. Any of these could explain baby's crying, as could hunger, a room kept too hot or cold, or a need to be held.

But none account for more than a small percentage of cases of excessive crying. Nor do any explain the cyclic pattern of such crying -- the fact that serious bouts tend to occur in late afternoon or early evening. In fact, a growing body of research suggests that colic is not an illness or syndrome but merely the high end of normal crying.

The mystery began to unravel back in the 1960s, when T. Berry Brazelton, MD, founder of the Child Development Unit at Children's Hospital Boston, identified a universal infant crying curve that accounts for all crying in the first few months of life, including so-called colic. In subsequent studies, Ronald Barr, MDCM, professor of pediatrics at the University of British Columbia, in Vancouver, demonstrated that infant crying begins at about 2 weeks of age, increases until it peaks at about 6 weeks, then gradually decreases until it stabilizes at 3 or 4 months. Dr. Barr, the lead editor of Crying as a Sign, a Symptom & a Signal (Mac Keith), also noted that crying tends to be clustered in late afternoons, particularly at the 6-week peak period.

In other words, normal crying and colic follow exactly the same developmental pattern. The difference is one of degree, not kind. Although crying manifests itself as full-fledged howling in one baby and mild fussing in another, each is simply one side of the same developmental coin. The observation of clinicians supports this research. "Colicky babies cry no more frequently than other babies," says Henry Bernstein, MD, associate chief of general pediatrics at Children's Hospital Boston, "but each episode is longer and more intense."

Maybe It's Gas...

But what about the red face, the distended belly, the clenched fists, and the passing of gas that often accompany excessive crying? Don't they indicate that colic is caused by gas? Well, no. Air is always present in the colon, and studies have shown that colicky babies have no more gas than calm babies. "When the baby cries, he contracts his abdominal muscles, putting pressure on the colon," points out Dr. Barr. "The air has to go somewhere." Moreover, crying itself contributes to gassiness because the baby swallows air. That is not to say that babies can't get tummy aches -- merely that tummy aches don't account for colicky crying.

Unfortunately many doctors are unaware of these distinctions. Jill O'Sullivan, a new mother from Concord, Massachusetts, took her daughter, Anna, to the pediatrician because she was screaming 14 hours a day. "The pediatrician said it was just colic, but I knew Anna was in pain," says O'Sullivan. "She'd take a sip of milk, start screaming, and then go back to the bottle because she was really hungry, but that would make her start screaming again." After several doctor's visits, a frantic O'Sullivan demanded a referral to a specialist, who found blood in Anna's stool. The diagnosis: an allergy along with gastroesophageal reflux (GER). Now that Anna is on a special formula, says O'Sullivan, she's a different baby.

Anna is one of the less than 5 percent of babies whose excessive crying is due to disease. How can you tell the difference? Generally a baby with a physical ailment will cry constantly, whereas normal crying increases at the end of the day. Other signs are excessive vomiting, crying that coincides with feeding, and weight loss. Also, a colicky baby will have periods during which he's perfectly calm and content; a sick baby may not.

The Anatomy of Crying

But why do babies who are not in pain cry so much? Clearly some crying is an attempt to communicate something -- hunger, a wet diaper, boredom. That still doesn't explain why some babies shriek and others merely fuss, or why the shrieking doesn't stop once the problem is remedied. Interestingly such crying is unique to Homo sapiens. "All primates exhibit Brazelton's crying curve," says Joseph Soltis, PhD, a research scientist at the National Institutes of Health, "but only human babies have the extreme manifestation we call colic."

Blame biology. Most mammals are relatively self-sufficient at birth. A horse gives birth to a foal that will walk and even run on its first day. "Because of our large brains, the head of a fully developed baby would be too large to pass through the human pelvis," explains Dr. Soltis. Pediatrician Harvey Karp, MD, author of The Happiest Baby on the Block (Bantam), calls the first months of life the fourth trimester. "A newborn human is more like a fetus than a baby," he says. "The best way to calm her is to replicate as closely as possible the conditions of the womb."

Humans' early eviction from the womb means we are born with lots of still-developing neural connections. So erratic circadian rhythms -- in common parlance, having days and nights mixed up -- may be behind the pattern of babies' crying. "A grown-up's rhythms keep us alert until early evening, at which time the calming drive takes over," says Dr. Soltis. "A baby's 'alertness drive' kicks in at three weeks, but its opposite, the calming reflex, doesn't develop until three or four months. That's why an infant may start crying in late afternoon (after a full day of stimulation) and be unable to stop -- because she has no way to calm herself. (Significantly, in Dr. Karp's research, premature babies don't develop colic until two weeks after their due date.)

While it's impossible to know what an infant is thinking and feeling during a wailing session, the body is a fairly reliable indicator of stress. And in research conducted by Barbara Prudhomme White, PhD, assistant professor at the University of New Hampshire in Durham, colicky infants' physiological indicators of stress (such as heart rate and levels of the stress hormone cortisol) were no different from those of other infants. As for parents' stress levels during these crying bouts, it's a safe bet they'd be sky high.

The Power of Preparation

Every new mom is bound to have days when nothing she does can soothe her baby. "It's just the way babies are," says Dr. Barr, "and it has nothing to do with being a good or bad mother." But this difficult period is easier to get through if parents are aware of how normal crying is. "We health professionals need to do a better job of educating parents about this fact," says Dr. Bernstein, who notes that an average baby's formula is changed three-and-a-half times, to no evident effect. There are as many remedies for crying as there are mothers: offering a pacifier, nursing, rocking, infant massage, burping, adding white noise, singing, and swinging. All of them work -- sometimes.

But the best technique is preventive. No, you can't actually avert a baby's crying, but you can minimize it. How? Respond immediately and try to keep her in constant physical contact with you for the first few months. The infants of the Kung San tribe in Africa, whose parents carry them continuously, cry half as much as Western babies -- that is, though they have as many bouts of crying, they are more easily calmed. It's not magic: Dr. Barr's research shows that when Western babies are held constantly, the result is the same -- half the crying.

Shannon Greer

Light at the End of the Tunnel

Even if yours is the most colicky baby on the block, you'll be glad to know you're not looking at 18 more turbulent years. A colicky baby does not predict a difficult child. "Parents sometimes perceive them as more difficult later on," acknowledges Dr. Barr, "but in actual behavior, they're no different from other kids."

And crying nearly always subsides by the fourth month -- at which point it becomes a signal that your baby wants something. "Crying at this stage is no longer simply a reflection of a baby's internal state, but the foundation of communication and language." (It's worth noting that approximately 3 to 5 percent of babies are still doing lots of crying at 4 and 5 months. They may be what developmental experts consider temperamentally difficult children -- sensitive to their environment.)

As you become more familiar with your baby, you'll be able to interpret what each of her cries means -- "I'm hungry," "I'm wet," "I don't feel well." There will inevitably be times when you can't figure it out, but by and large you'll become an expert at decoding her signals. By the time your child is a toddler, her crying will have morphed into a totally different phenomenon: She'll cry out of frustration or separation anxiety or to protest her independence being thwarted. Soothing may simply be a matter of acknowledging and helping her manage her emotions.

But the need for soothing isn't limited to little ones. Until you've lived it, it's impossible to grasp how stressful a baby's incessant crying can be. That's why every new parent needs plenty of empathy and support -- as well as breaks from childcare. These early months may feel like the longest of your life, but the crying will pass. Remember it's part of normal development, not an indication that something is wrong. And it's not your fault.

Grace Monfort is a mother of two and a writer in New York City.

Originally published in American Baby magazine, April 2004.

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.

American Baby


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