What's In a Name?

My perspective on colic changed years ago when a mother brought her baby to me to find out why he was crying so much. After I diagnosed colic, she asked bluntly, "Do doctors call it colic when they don't know why a baby's hurting?" She was right. As one gastroenterologist I know says, "Colic is a five-letter word for 'I don't know.'" Still, although no one fully understands what causes colic, we can make two assumptions: First, the baby has pain in the gut. (The term comes from the Greek kolikos, meaning "suffering in the colon.") Second, the whole baby is upset as a result.

Many parents of fussy babies are confused about what constitutes colic and wonder whether their child has the condition. I tell them that if they need to ask, he doesn't. The outbursts of inconsolable crying that characterize colic leave no doubt that an infant is in pain. Pediatricians diagnose colic when the "Rule of Threes" applies: The baby's crying begins in the first three weeks of his life, lasts at least three hours each day, occurs at least three days a week, continues for at least three weeks, and eases within three months.

So what can you do about it? Attempt to get to the root of your baby's colic, and offer him the best comfort you can:

1. Keep a colic diary. You may be surprised by the correlations you find, and you may uncover clues that will help your baby's doctor diagnose a medical problem. Some factors to look at:

• What seems to trigger the outbursts?

• Do the crying jags occur at the same time each day? How frequently? How long do they last?

• Are they staying the same or getting better or worse?

• Does Baby spit up? How often? How soon after feeding, and with how much force? If you're nursing, is there a link between what you eat and how much your baby fusses? If you're bottle-feeding, is there a relationship between her crying and the type of formula, bottle, or nipple you use? What changes have you tried?

• Does she gulp air or pass a lot of gas?

• How frequent are her bowel movements? Is her stool soft or hard? Does it seem to change in response to a feeding change?

• Which soothing strategies have you tried? Which ones work? Which don't?

2. Get a medical evaluation. Don't settle for a quick appointment; it takes time to evaluate a colicky baby. Prior to your visit, send the doctor a letter describing your baby's crying jags. To help her appreciate how devastating these are, you might want to include a videotape of one of them. Fathers should attend the appointment, too; while some mothers tend to downplay the problem, dads usually tell it like it is. I didn't realize the toll colic was taking on one family, for instance, until Dad blurted out, "I had a vasectomy last week. We'll never go through this again!"

3. Don't give up. If your instinct tells you that your baby is hurting, continue pressing her doctor to look for a cause and keep experimenting with comforting remedies. Such persistence can lead to a happy ending, as this mother's story demonstrates: "Life began to unravel for my husband and me when our daughter, Amelia, was 2 weeks old. Her crying lasted for hours, and nothing calmed her. She was obviously in pain, slept less than four hours a night, and would eat very little. When her pediatrician insisted that 'all babies cry,' we switched pediatricians. The new doctor said that the problem might be caused by my milk and suggested that I quit nursing. I did, yet the crying continued, and our marriage and emotional well-being began to suffer. Combing the library on our own one day, we came across a description of gastroesophageal reflux and felt, at last, that we had an answer. A third pediatrician determined that Amelia did indeed have this condition and prescribed medications that reduced her discomfort. Amelia is now 6 months old, and I'm finally beginning to enjoy motherhood."

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