The Colic Chronicles
If you're dealing with colic, you probably feel like crying as much as your baby does. It may help you to understand what can make a child better -- and what usually won't.
When Lia Horita was born in December 2008, she was praised by the nurses for her "great disposition." Jinx. Within two weeks, Lia started to shriek and cry inconsolably for hours at a stretch -- a classic sign of colic. "Parents talk about it, and you read about it in magazines and books, but you will never, ever know exactly how terrifying it is until you experience it," says Lia's mom, Evelyn Perez-Horita, of Chicago. Swaddling, swinging, and other commonly used remedies didn't work. Perez-Horita remembers tearfully telling her husband, "I am such a bad mother." (The only plus: Thanks to all the stress, she dropped 30 pregnancy pounds.) She "counted down the seconds," she says, until her daughter turned 3 months old, the age when colic often magically ends. And it did. "Just when I thought I was destined to have a crying baby forever, it stopped," she says.
A colicky infant can be like a tiny Dr. Jekyll and Mr. Hyde. By day, he may seem normal. But in the evening, he'll typically scream?...?and scream, and scream. He'll stiffen his body, clench his fists, and pull his legs against his stomach. For years, colic -- which affects as many as one in five babies and usually lasts three to four seemingly endless months -- has stumped doctors and baffled parents. It often kicks in, alarmingly and mysteriously, when babies are 2 to 3 weeks old and peaks when they are around 6 weeks old. Over the years, doctors have blamed immature digestion, the still-developing central-nervous system, allergies, hypersensitivity, and personality mismatches between parents and babies, but these are primarily theories from the scientific community.
There is no blood test to confirm colic, and experts can't agree about the cause, treatment, or even the definition. Many doctors still use the "rule of three" description from pediatrician Morris A. Wessel, M.D., back in 1954: healthy babies who cry for more than a total of three hours a day, for more than three days a week, for more than three weeks. But a growing number of experts say those figures are arbitrary and outdated.
Put simply, "colic is crying too much," says Barry Lester, Ph.D., director of the country's only colic clinic -- at the Brown University Center for Children at Women & Infants Hospital, in Providence -- and coauthor of Why Is My Baby Crying? "If a child's crying is affecting her development and her relationship with her parents, it's a cry disorder, like a sleep disorder or a feeding disorder. When this happens, it's colic." His symptom checklist includes sudden onset, a high-pitched, screechy "pain cry," and inconsolability. But Dr. Lester says you shouldn't get hung up on any official definition. You suffer when your baby cries a lot. Period.
Regardless of what it's called, you know colic when you hear it. "It's not the same kind of cry you'd get with 'I'm hungry,' or 'I'm dirty,' or 'I'm tired,'?" says Parents advisor Jennifer Shu, M.D., coauthor of Heading Home With Your Newborn. "With a hunger cry, babies feel better when you feed them." With colic, you don't know what your baby wants.
So desperate parents have tried a slew of purported remedies -- midnight car rides, massage, acupuncture, battery-operated swings, white noise in the form of vacuum cleaners, DVDs of heartbeats, chamomile tea, and anti-gas Mylicon drops and "gripe waters" such as Colic Calm and Colic-Ease. It's very easy to find parents who have found success with any of these so-called remedies -- but there's little to no science to back them up, and many babies keep shrieking anyway. Researchers are actively working to solve the mystery of colic, but their answers can't come soon enough.
In the meantime, this is what leading colic experts know about the possible causes and the best ways to try to soothe your child.
What's Behind the Cries
The word colic comes from the ancient Greek word kolikos, for colon. "For thousands of years, people have thought it's an intestinal problem because babies typically double up and cry after eating," says Parents advisor Harvey Karp, M.D., a pediatrician and creator of The Happiest Baby on the Block book and DVD. Some experts think the Greeks were spot-on. Dr. Karp doesn't. "How could it be pain," he argues, "if so many colicky babies calm down while hearing a vacuum cleaner or going on a drive? When I get a stomachache, I don't say to my wife, 'Honey, my stomach is killing me. I gotta go for a car ride,'?" says Dr. Karp. He believes that colic is actually the result of babies adjusting to our world, which is too quiet and still: "Babies were accustomed to the calming rhythms of the womb."
Studies so far have failed to even figure out which babies are more likely to suffer from colic. It's an equal-opportunity condition that does not discriminate based on sex, race, color, birthweight, or type of delivery. Still, research indicates a potential association between parental depression and colic. A study published in Pediatrics found a slight increase in excessive infant crying among babies whose fathers reported being depressed before their babies were born. Researchers concluded that the link could be due to genetics, or the result of interacting with a depressed dad. "After all, babies sense parental stress, and they, in turn, become stressed," says Robert Block, M.D., chair of pediatrics at the University of Oklahoma-Tulsa School of Community Medicine and immediate past chair of the American Academy of Pediatrics' committee on child abuse and neglect. "It can become a downward spiral." Also, you're best able to reduce your baby's crying when you're most responsive to him -- but it's tougher to be responsive when you're depressed. Research has yet to determine which comes first: a depressed parent or a colicky baby.
What makes colicky babies unable to stop crying? When any infant gets upset, her heart rate increases. But one with colic may be less able to lower her heart rate back to a normal level. To test this hypothesis, researchers are outfitting babies with a special vest that measures heart rates before, during, and after a specific stressor, such as Mom not smiling. "If an infant isn't able to reduce his heart rate following a brief period of stress, he'll be upset longer," says Stephen Porges, Ph.D., director of the Brain-Body Center in the department of psychiatry at the University of Illinois at Chicago.
Rule Out Physical Causes
When you suspect colic, you and your doctor need to first consider other problems. These are common crying culprits.
Constipation: Your baby may be fussy because he is straining to eliminate hard stools, says Bryan Vartabedian, M.D., author of Colic Solved. Don't worry much about how many hours or days have passed since his last dirty diaper; constipation is defined more by the effort than by time, he explains. So watch for signs that your baby is straining to have a bowel movement, and discuss it with your doctor.
Milk-protein allergy: It can develop if you're feeding a baby milk-based formula, or nursing and consuming dairy. It tends to peak two to four weeks after a child is born. Babies who suffer from it typically have mucus or red streaks of blood in their stool and cry a lot. They also may develop a dry, scaly rash anywhere on their face or body, says Dr. Vartabedian. If you suspect a problem, talk to your doctor about whether you should try cow's milkDfree or more easily digested varieties of formulas such as Alimentum, or if you should eliminate dairy and proteins like casein and whey from your own diet.
Reflux Gastroesophageal reflux -- aka regurgitation or excessive spitting up -- may play a role in some inconsolable crying. Reflux is usually pretty normal. A 2009 study from Italy found that a whopping 12 percent of all Italian babies met the official criteria for infant regurgitation. When 210 of those children were reexamined at age 2, only one still had the problem and suffered from actual gastroesophageal reflux disease with esophagitis. Reflux is referred to as reflux disease when routine spitting up results in choking, extreme difficulty feeding, poor growth, or profound irritability, says Dr. Vartabedian. For normal reflux (which he says affects about half of babies), he suggests conservative measures like keeping your baby upright for 30 minutes after he eats or asking your doctor about a prescription acid-reduction medication.
What You Can Do
Until researchers crack the colic code, test-drive a few techniques that may help. They include:
Try the five S's. Dr. Karp recommends swaddling, holding your baby in a side/stomach position, shushing noises, swinging, and sucking. "They all imitate the baby's comforting sensations in the uterus and flip on the baby's calming reflex," he explains. You'll probably need to vary your techniques, since no method works every time.
Ask your doctor about probiotics. A specific type of probiotic called Lactobacillus reuteri may help. In an Italian study of 83 babies, crying decreased 75 percent after 28 days for those given L. reuteri vs. 25 percent for those given simethicone (Mylicon). Unfortunately, in another small study, researchers in Finland who gave colicky babies other probiotics for two weeks found no relief from symptoms. It's believed that L. reuteri may help decrease inflammation in the gut. Parents can also try probiotic-containing Nestlé Good Start or Nutramigen with Enflora formula, though neither has been proven to reduce irritability.
Experiment with your diet. If you're breastfeeding, consider eliminating dairy or gas-inducing vegetables like cabbage and cauliflower and see whether that makes a difference. Rachel Hilyar, of Elk River, Minnesota, remembers giving up broccoli and dairy when her oldest child, Gavin, now 6, had colic. "That was tough. I grew up in Wisconsin, and I eat a lot of cheese," she says. The two-month dairy ban didn't work as well as swaddling and shushing did. "But I did feel like I was trying things to help, which is important," she points out. Also limit your caffeine intake, and consider giving up spicy foods, at least for a week or so. If your baby's crying doesn't improve in a couple of weeks, you can go back to enjoying Indian food.
Talk to your doctor about your medications. Some can end up in your breast milk. Certain types, such as antipsychotics, have been associated with hyperactivity in babies. Others affect how much milk your baby gets: A recent University of Cincinnati study that found that taking selective serotonin reuptake inhibitor antidepressants may lead to a delay in milk production.
Call on friends and family. "You need a break," insists Dr. Shu, who recommends using relatives and experienced babysitters so you can get out of the house. They can handle it: After all, they get to go home afterwards. (But warn them!)
Join a neighborhood playgroup. True, your child may start to wail while all the other babies are peacefully gurgling on the floor. But maybe not. By talking to other moms and dads, you'll realize that no one has a perfectly calm baby. You might meet other people whose babies are colicky too.
Walk away for a few minutes. This point is critical. If you aren't able to calm your baby and you feel like you might really lose it, put her in a safe place like a crib. "The trick is to do that before you get frustrated," says Dr. Block. It's especially important for single parents to take time-outs, he adds. "When you are alone, that really magnifies the problem."
Check out colic support groups -- in person or online. Chatting with parents who understand will help you feel less isolated. Staci Gansky-Wagner, of Warminster, Pennsylvania, experienced colic with both of her children. After joining the Facebook group "Help! My Baby Has Colic," she felt better: "It's hard to get out with a colicky baby, so this was a good place for a new mom to vent and get some tips."
Consider professional help. "Crying and fatigue can be triggers for marital distress, postpartum depression, breastfeeding failure, abuse, excessive visits to the doctor, or overuse of baby medication, as well as smoking, car accidents, and probably obesity, because when you're so tired you make bad food decisions," says Dr. Karp. So think about asking your doctor for a referral to a mental-health specialist who can help you deal with the impact of your baby's crying.
Beware of over-the-counter products. Dr. Vartabedian's not a fan of gripe water, a generic term for a whole variety of folksy, naturopathic liquid drops. And certain preparations can be dangerous: A recent study in Pediatrics found that a homeopathic colic remedy in Israel called Gali-col Baby was associated with apparent life-threatening events in 11 infants. The drops contained alcohol -- but that wasn't listed in the ingredient list. Small doses of anti-gas drops like Mylicon probably won't help or hurt, says Dr. Vartabedian. A remedy that may have a positive effect, however, is chamomile tea. It's been shown to reduce intestinal spasms and therefore may help with colic. One study showed that 57 percent of colicky infants who were given tea containing chamomile cried fewer than three hours daily. Talk to your doctor before trying any alternative treatment, though.
Do not blame yourself. "When you can't calm your baby, it's easy to think that there's something wrong with your baby -- or with you," says Linda Gilkerson, Ph.D., executive director of the Erikson Institute's Fussy Baby Network, in Chicago. This was Christine Garbowski's experience, when her first child, Matthew, had colic from 6 weeks to 12 weeks. "At first I blamed it on my pregnancy and what I did and didn't do right," says Garbowski, of New Fairfield, Connecticut. "Our pediatrician reassured me that it was nothing we did."
Wait for time to pass. Colic generally lasts only a few months. But don't mark 90 days on your calendar. "It's not always like a magic switch," says Dr. Shu. "Often the crying will get less and less, and one day you'll realize it's not so bad anymore."
You might even find yourself ready to try for another baby. Jennifer Lutgert, of Evanston, Illinois, had a daughter with colic and then a son without. Pregnant for a third time, she waited anxiously to see what kind of child she'd get next. In April 2009, Gemma Rose Pollard arrived. She was so quiet compared with her siblings that Lutgert wondered if Gemma was okay. She was. After all, whether your baby is colicky or not, you'll always worry. You -- and your child -- will always cry too. And that's normal.
Originally published in the June 2010 issue of Parents magazine.