Step inside the nation's only "colic clinic" and learn expert tips for soothing your colicky baby.
Nicole Cardin anxiously shifts her 7-week-old daughter, Alexandra, from her shoulder to her lap and fishes a bottle out of her diaper bag while she sits in the pediatrician's exam room. The baby seems poised to break into a full-blown scream at any moment. Nicole's mother, Patricia, is next to her, patting her daughter on the leg whenever she starts to tear up.
"In a 24-hour cycle, how many hours does Allie cry?" the doctor asks during the initial visit, in which a detailed history is obtained. Nicole and her mother agree: an astounding eight to 12 hours every day. "Does she arch her back when she cries?" Yes. "What does her crying sound like?" It starts off quietly and then escalates to an ear-piercing pitch. Nicole describes the few things that sometimes work to quiet the baby for brief periods of time--burping, a pacifier, the infant swing with the heartbeat sound turned on.
The final diagnosis: Allie is a tired baby whose days and nights are confused, and she has colic and gastroesophageal reflux disease (GERD). The prescription: Zantac to treat the GERD. Additional recommendations are made to further help with the infant's inconsolable crying and sleep problems. "The baby nurses practically around the clock," explains Patricia, crying a little herself. "And when you put her down, you have to tiptoe around. I take her for a few hours, but even then Nicole can't relax. Nicole can't take a nap--it's like she has posttraumatic stress disorder."
Who Says You Have to 'Suck it up'?
Desperate for help, the Warwick, Rhode Island, mom has turned to the Infant Behavior, Cry and Sleep Clinic, commonly known as the Colic Clinic, in Providence, Rhode Island. This one-of-a-kind clinic, founded by Barry Lester, Ph.D., in 1986 and part of Brown University's Alpert Medical School and Women and Infants Hospital, has a dream team of pediatricians, psychologists and social workers, and offers intensive, research-backed treatment for colic and related disorders.
The experts here focus not just on the colicky baby, but on the parents as well, who are typically devastated (and exhausted) by their inability to soothe their infants. The revolutionary approach has succeeded in calming tears--babies' and parents'--like nothing else in the pediatric field. A study here found that babies who received the clinic's family-based treatment approach began crying less, sleeping more and had fewer nonroutine contacts with their community pediatricians compared with infants who were simply left to outgrow their colic (the usual strategy).
"The idea that colic is normal and you just have to suck it up is simply not true," says Lester. He doesn't focus on the standard "rule of three" definition of colic: crying that occurs for more than three hours a day, three days a week, for three consecutive weeks in a well-fed, healthy baby. Instead Lester considers any prolonged or intense crying that interferes with a baby's development or affects the parent-child relationship as worth treating.
Before each visit to the clinic, all parents are instructed to keep a three-day "cry diary," which means describing in writing their baby's behavior every 15 minutes for 24 hours: sleeping, eating, awake, alert, fussing or crying. At the clinic, the behaviors are color-coded (e.g., yellow for crying, pink for sleep), so patterns can begin to emerge and be identified. Patterns may include a lot of crying or fussing in the early evening that could indicate baby needs an earlier bedtime, Lester says. For Nicole, the cry diary she kept helped her realize that Allie was actually crying much more than she had originally thought.
After three visits to the clinic over six weeks, Allie at 3 months old was crying no more than an hour and a half spread throughout the day, which is completely normal. Nicole got quick results when she began limiting Allie's nap sessions to a maximum of two hours and found ways to soothe her without resorting to the breast or bottle. "I got Allie 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 Allie-she's become a spunky, happy baby." And mom is getting more sleep too: four- to six-hour stretches a night now that Allie is sleeping better.
Calming Tips from the Experts
Any baby who's fussy or having difficulty settling into a manageable sleeping and eating routine may benefit from the strategies used at the Colic Clinic.
Help the Medicine Go Down
A baby with reflux-and almost all babies spit up to some degree-may experience burning in his throat and esophagus from stomach acid. Antacids like Zantac may help reduce the discomfort, but if your baby spits up part of the dosage, ask your pediatrician how much your baby should take. Using a slender syringe to squirt the medicine toward the back of the baby's cheek may help him swallow more of it. It's also important to keep spit-up-prone babies in a semi-reclined position for 20 to 30 minutes after feedings, and elevate the head of the crib by placing a rolled-up towel under the mattress.
Keeping baby awake during feedings can help parents better determine when their babies are hungry. It can be challenging to read the signals of a baby who "grazes" because the baby may not be quite full or quite hungry. Feeding and sleep schedules can get thrown off when babies take very long, interrupted feeds or small frequent feeds. Babies also may come to associate the breast or bottle with falling asleep and call for the breast or bottle even when they are not hungry.
Put the Paci to Work
It's tempting to nurse when 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. (During the day, feedings should occur every two to three hours, depending on the infant's age. Watch for hunger cues such as increased alertness, lip smacking and rooting.)
Lots of colicky babies benefit from soothing bedtime routines, says Jean Twomey, Ph.D., a clinical social worker and assistant professor of psychiatry and human behavior and pediatrics at the Alpert Medical School. The regimen should help the baby to distinguish bedtime from the rest of the day and could be as simple as dimming the lights, rocking and playing gentle music. Emphasize the difference between late-night and day feedings by keeping lights low and tucking your baby right back in afterward.
It's tempting to allow a fussy baby to keep snoozing, but napping more than three hours at a stretch during the day means he won't sleep as long at night.
During very tense periods, a baby can pick up on her parents' stress, which can contribute to more crying. If nothing is working, put your baby in a safe place, such as her crib, and take a five- to 10-minute breather.
"It's hard to overestimate the role that sleep has on a parent's mental health," says Twomey, adding that once moms and dads start sleeping better, the improvement in their emotional state and energy level is amazing.
How to Keep Your Sanity
It comes as no surprise that 45 percent of moms who visit the Colic Clinic are dealing with some level of postpartum depression. if you're feeling overwhelmed, try these feel-better strategies:
Call for Reinforcements
Family and friends will want to help, so don't be afraid to ask. If someone can relieve you for even just an hour a day, that breather will decrease your stress.
Go to our community boards and commiserate with other moms. Just knowing there are other women who have -- or have survived -- colicky babies can help.
See a Doctor
Talk to your ob-gyn or ask your baby's pediatrician for a referral to a therapist. Moms suffering from postpartum depression may benefit from a prescription antidepressant, and many are safe to take while breastfeeding.
Arming yourself with information can give you peace of mind. Try: Why Is My Baby Crying? by Barry Lester, Ph.D.; Colic Solved: The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult-to-Soothe Baby by Bryan Vartabedian, M.D.; or The Fussy Baby Book: Parenting Your High-Need Child from Birth to Age Five, by Babytalk contributing editor William Sears, M.D.
Probiotics: Miracle Cure?
New research found that colicky babies reduced their crying to about 35 minutes a day after taking probiotic drops containing Lactobacillus for three weeks. Researchers think the live bacteria ease intestinal problems that upset babies.