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Coping With Colic

At 6 P.M. the nightmare begins: You're holding your 2-week-old baby when she stiffens her limbs, arches her back, clenches her fists, draws her legs up against a bloated belly, and emits the first in a long series of ear-piercing shrieks. As the intensity of her cries mounts, so does your frustration. She's inconsolable, and soon you're both in tears. You cuddle her, but she goes rigid in protest; you try to nurse, but she pulls away; you rock and sing, but the soothing techniques that worked yesterday aren't working today. Inside your head, the familiar refrain plays over and over again: "What's wrong with my baby; what's wrong with me?"

Months later, when you've gone through the herbal teas, the dietary changes, and every conceivable comforting measure, the onslaught ends as mysteriously as it began, and you close one of the most difficult chapters of life with your new baby. That's colic.

Dr. William Sears is a contributing editor of BabyTalk and coauthor with his wife, Martha Sears, of Parenting the Fussy Baby and High-Need Child (Little, Brown).

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."

Could It Be Something Else?

As Amelia's parents discovered, inconsolable crying shouldn't always be chalked up to colic alone. A hidden medical cause for a baby's discomfort is likely if the so-called colic isn't getting better by the time your baby is 4 months old and your intuition tells you that he is in serious pain. Among the possible culprits:

Gastroesophageal reflux (GER). This occurs when a weak muscle valve between the baby's esophagus and stomach allows irritating digestive acids to back up into the esophagus. Your baby may be suffering from GER if he spits up after feedings, experiences painful bouts of night waking, cries after eating, draws his knees up to his chest and arches his back, has frequent respiratory infections, and is happiest when he's upright. GER is confirmed by placing a tiny tube in the baby's esophagus and leaving it there for 12 to 24 hours to measure the amount of stomach acid that's regurgitated. If crying coincides with episodes of reflux, GER is the likely culprit. Holding your baby upright after feedings, giving him smaller amounts more frequently, and administering medications that lessen the amount of acid and accelerate the emptying of the stomach will help alleviate his discomfort.

Food or formula sensitivities. Nursing moms have long noted a connection between their baby's distress and their own consumption of dairy products, caffeine, cruciferous vegetables (such as broccoli and cauliflower), spicy foods, wheat, and corn. Likewise, babies may become colicky if they're allergic to the milk protein in formulas or can't tolerate lactose. Suspect a sensitivity to formula or something in your breast milk if your baby begins to feed but pulls off and cries with pain; seems gassy, bloated, or uncomfortable after feedings; spits up profusely; or has constipation, diarrhea, or a red, circular rash around her anus.

If you're nursing, make a diary of possible "fuss foods." List the foods you eat for a week and see if you notice a link between what you consume and how much pain your baby is feeling. Be objective  -- in your desperation to help your baby, it's easy to pin the rap on food. But if a food allergy is to blame, she'll also show other signs (rashes, diarrhea, runny nose, or wheezing). Eliminate the most suspect foods from your diet for at least a week; then add them back one by one, a few days apart, to see if your baby's symptoms return. If you think that her formula is giving her trouble, ask her pediatrician about switching to a hypoallergenic or lactose-free brand.

Other possible culprits. Many conditions have symptoms that are easily confused with colic, including ear infections, urinary-tract infections, constipation, and a tight rectal opening. The last condition may be the problem if a baby grimaces, gets red in the face, or draws his legs up to a distended abdomen before moving his bowels, cries during bowel movements, and seems greatly relieved after passing a stool. If this is the case, your baby's doctor can perform a finger dilation of his rectum, which enables stools to pass more easily.

Tips for Comforting a Colicky Baby

If your baby is suffering from colic-like symptoms and no underlying cause has been identified, all that remains is to try to soothe her as best you can. Old wives  -- and new moms  -- swear by such remedies as simethicone drops, white noise, car rides, rocking, swinging, and fennel tea. In addition, the following strategies may help:

Smaller, more frequent feedings. Offering too much breast milk or formula can increase intestinal gas. Instead, try feeding your baby half as much but twice as often. An infant's stomach is the size of his fist. If you place your baby's fist next to a bottle filled with four ounces of liquid, you'll see why his tummy gets tense.

Colic carries. The football hold: Lay your baby stomach-down on your forearm, with her head cradled in your hand and her legs straddling the crook of your arm, and gently press your arm into her belly. The neck nestle: Snuggle Baby's head between your chin and your chest and croon a slow tune like "Old Man River" while swaying back and forth.

Colic dances. The type of choreography that works best to soothe colic mimics the motion that a baby experiences while in the womb: up and down, side to side, and forward and backward. My favorite dance is one that I call the elevator step. Holding your baby securely in the neck-nestle position, spring up and down, heel to toe, as you walk. Another comforting ritual is the dinner dance. Some babies love to breastfeed in a sling or carrier while you sway to music. Your movement plus his suckling will help settle even the most upset infant.

Baby bends. The gas pump: Lay Baby faceup on your lap and slowly pump her legs in a bicycling motion. The colic curl: Place Baby's back against your chest and encircle your arms under her bottom, then curl your arms up.

Baby bounces. Lay your infant tummy-down over a large "physio" ball (available through infant-product catalogs), place a securing hand on his back, and roll the ball in a circular motion (be very careful not to lose your hold on the baby). Or hold him in your arms and bounce up and down while you sit on the ball.

Tummy tucks. Place your baby stomach-down on a cushion or a warm (not hot) water bottle wrapped in a cloth diaper and rub her back.

Tummy touches. Sit your baby on your lap, place your palm over his navel, and encircle his abdomen with your fingers and thumb. Then lean him forward and gently press your hand into his tense belly. Or lay your baby on his back and picture an upside-down U on his abdomen. Using warm massage oil, gently knead his tummy with a circular motion, massaging clockwise (as you face him) along the lines of the imaginary U.

Warm caresses. A dip in the tub will relax both of you. Or try another proven fuss buster: While lying on your bed or the floor, hold your baby tummy to tummy and skin to skin with her ear over your heart.

Magic mirror. Hold your baby in front of a mirror and let him witness his own drama. Place his hand or bare foot against his image and watch him grow silent.

Babywearing. Think of pregnancy as lasting a year or more  -- nine months inside and several months outside. One theory is that colic is a side effect of disorganized biological rhythms. During pregnancy, a baby's biological systems are automatically regulated. Birth disrupts this organization, but if parents extend the womb experience by "wearing" their baby a few hours a day in a sling or carrier, they may provide external regulation that helps organize her biological rhythms.

SWEET RELIEF AT LAST

When will it stop? Colic with no diagnosed medical cause tends to peak at 6 to 8 weeks and diminish by about 4 months. What's so special about 4 months? Around then, a baby develops more internal organization; his digestive system matures, and food sensitivities may subside; he can see clearly and is distracted from his fussing by the visual attractions around him; and he can play with his hands and engage in self-soothing finger sucking as well as waving his limbs in order to blow off steam.

As heart-wrenching as your baby's colic is now, remind yourself that it won't last forever. If you can get through this, the terrible twos will seem like a piece of cake.

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