"Does she doze between feedings?" Yes.
"And how often does she eat at night?" Every two hours.
Twomey restates the facts gently. "So you sleep for two hours, then get up for at least an hour to feed her, then put her down and get up again in two hours?" Nicole nods her head and starts to cry softly.
It's time to get down to business. Pamela High, M.D., medical director of the clinic, examines Alex. Then she and Twomey prescribe a plan of action for the next two weeks, starting with a cry diary. All parents who come to the clinic are instructed to write down their baby's behavior every 15 minutes during the day: sleeping, eating, awake, fussing, or crying. At the end of each day, they highlight the behaviors in different colors (e.g., yellow for fussing, red for crying), so patterns and fuss triggers begin to emerge.
The Colic Clinic's customized strategies don't apply only to extreme colic cases, however. They can be used for any baby who's fussy or having difficulty settling into a manageable sleeping and eating routine. Here's how you may be able to create calmer days and nights in your home, too.
Help the medicine go down. A baby with reflux -- and almost all babies spit up to some degree -- may experience burning in her throat and esophagus from the stomach acid. Antacids like Zantac can reduce the amount of stomach acid, but many babies spit up part of the dosage. To keep that from happening, Dr. High suggests Nicole -- and other moms -- use a slender syringe to squirt the medicine toward the back of the baby's cheek so she swallows more of it. It's also important to keep spitup-prone babies upright, or no more than semi-reclined, for at least 20 minutes after feedings. And elevate the head of the crib by rolling up a towel and placing it under the mattress.
Switch up the nursing routine. It's very common for babies to doze off at the breast, which means they don't get filled up and wake sooner looking to eat again. Twomey recommends nursing for between five and ten minutes on one breast, burping, then doing the same on the other breast. (At the next feeding, start on the opposite breast.) This transition helps keep the baby awake, so she can begin to separate sleeping from feeding. Fussy babies often have problems with overstimulation, so it's also important to reduce noise and other distractions during feeding sessions.
Use the breast mostly for feeding. It's tempting to nurse when your baby fusses, but then she gets in the habit of grazing. Sucking is calming, however, so offer a pacifier if she needs soothing when it's not mealtime. (Feedings should occur every two to three hours; watch for hunger cues such as increased alertness, lip smacking, and rooting.)
Pick a consistent bedtime. Young babies shouldn't be on a strict sleeping schedule, but it will help to create a nightly routine, says Twomey. The regimen could be as simple as dimming the lights, rocking, and playing gentle music. Exaggerate the difference between night and day feedings by keeping lights low and tucking your baby right back in afterward.
Downsize daytime sleep. It's tempting to allow a fussy baby to keep snoozing, but napping more than three hours at a stretch during the day means she won't sleep as long at night.
Step away when the going gets tough. During very tense periods, a baby will actually pick up on her parent's anxiety, which ratchets up her own distress even more. If nothing is working, put your baby in a safe place, like her crib, and take a 10-minute breather.
Nap, whenever, wherever. "It's hard to overestimate the role that sleep has on a mother's mental health," says Twomey, who notes that once the moms they work with start sleeping better, the improvement in their emotional state and energy level is amazing.
Getting back to bonding. After three visits to the clinic, 3-month-old Alex now cries for no more than an hour and a half spread throughout the day, which is completely normal. Nicole also reports that Alex wakes up only once or twice at night, so she herself is getting four- to six-hour stretches of sleep. What strategies worked best? Nicole got quick results when she began keeping Alex's nap sessions to a maximum of 2 1/2 hours and found ways to soothe her without resorting to the breast or bottle. "I got Alex a crib toy that plays soft music and has little moving fish -- it works like a charm," she says. "I loved my baby from the outset," Nicole adds, "but I was at my wit's end and didn't know what to do. Now I have so much fun being with Alex -- she's become a spunky, happy baby."
Tula Karras is a freelance writer in Brooklyn. Her work has appeared in Self, Real Simple, and Shape.