The Crying Game

by Alicia Brooks Waltman

The Crying Game

When Talia Boutis was about 3 weeks old, she started to cry and make a fuss around six o’clock each evening. "She’d clench her fists, pull up her legs, and shriek at the top of her lungs," says her mom, Kathleen Boutis, of Takoma Park, MD. "She’d cry so much I thought she was dying."

Not knowing what triggered the wailing, or how to stop it, Boutis took her daughter to the doctor, who assured her that the fits would pass in a few months. It was probably colic, the pediatrician said. The treatment: to wait out Talia’s wails and to make her feel as comfortable as possible.

Boutis tried every remedy that friends and doctors suggested: swings, rockers, car rides, gas-relief drops, baths, massages. She even gave up chocolate, dairy products, and wheat when she found out these foods could upset a breastfed baby’s belly. Her husband, Nick, must have walked Talia up and down their street at least a hundred times. But nothing brought lasting relief. "I don’t know who cried more during that period, the baby or me," says Boutis. "I felt so helpless. I kept thinking, ‘My God, I must be a terrible mother.’"

Such feelings of guilt and incompetence are all too common among parents who deal with colic. It can be a tough experience when you’re trying to bond with your baby, says Robert H. Squires Jr., M.D., associate professor of pediatrics at the University of Texas Southwestern Medical School, in Dallas. In fact, research shows a higher incidence of postpartum depression among mothers of colicky infants. "Not knowing how to console a crying baby can make you feel rejected," says Dr. Squires. Parents may also feel less confident in their parenting skills, as they wonder if they’re holding their baby the wrong way, singing to him off-key, burping him enough. "They’re constantly second-guessing themselves," he says.

What makes colic even more frustrating: No one knows what causes it  — or how to cure it. "Researchers have a tough time just trying to define it," says Steven P. Shelov, M.D., chairman of pediatrics at Maimonides Medical Center, in Brooklyn. Traditionally, a doctor will "diagnose" colic if a baby cries at least three hours a day, three times a week, starting at 3 weeks old. And if a cause can be identified, says Dr. Shelov, the problem isn’t colic. (According to this definition, up to 20 percent of infants have colic.) Some experts even question whether babies with colic feel real pain, preferring to describe those who cry a lot as "high strung" or "extremely fussy."

Luckily, a growing number of experts are coming closer to understanding just what colic is, and isn’t, and how to treat it.

ALICIA BROOKS WALTMAN has written about health and nutrition for Glamour, Woman’s Day, and other magazines. This is her first feature article for Parenting.

Why Babies cry

All infants cry to get their parents’ attention  — to alert them that they’re tired, wet, hungry, or in need of a cuddle. But colicky babies are different: They’ll cry loudly and inconsolably, for no apparent reason. "They don’t necessarily cry more often than other babies," says Ronald Barr, M.D., professor of pediatrics and psychiatry at McGill University, in Montreal, Canada. "They just cry longer once they get started."

Even so, it’s not unusual for a colicky infant to spend half her waking hours in tears. Lori Hamilton, of Hot Springs, AR, says her daughter cried up to eight hours a day as a baby. "Sarah calmed down only when I nursed her," Hamilton recalls. "That would keep her quiet for about a half hour or so, but then she’d start screaming again."

Crying bouts most often occur in the late afternoon and early evening, but some colicky babies cry their way through the wee hours of the morning. Martha and Mike O’Connor, of Pennington, NJ, took turns walking their baby, Kelly, around the first floor of their house when she had colic. "She’d cry if you stopped moving her," says Martha. "I remember looking at the clock and noticing it took exactly one minute to walk her through all the rooms. I remember watching those minutes tick by, at one, two, three o’clock in the morning. Those late-night hours were the worst."

Defining matters

The first English-language pediatrics textbook, published in 1544, labels colic as "a rumbling in the gut," and even now doctors think there’s something to that definition. Colic tends to strike before a baby’s nervous and digestive systems are fully developed, says Marc Weissbluth, M.D., associate professor of pediatrics at Northwestern Medical School, in Chicago. So perhaps it’s not surprising that during this period, some infants have more powerful intestinal contractions than others and act like their tummies hurt. Their legs stiffen, their bellies swell, and they tend to pass a lot of gas when they cry.

According to Dr. Weissbluth, some tests show that babies with colic have elevated levels of serotonin, a brain chemical that can trigger these intestinal muscle spasms. The colic cry is also very similar to a cry caused by pain, notes Barry Lester, Ph.D., director of the Infant Development Center at the Women and Infants Hospital at Brown University School of Medicine. "Both cries are sudden, loud, high-pitched, and involve lots of breath holding."

Another new theory with researchers: Colicky infants are just poor sleepers. "These babies are more sensitive to noise, light, and other stimuli than other infants," says Maureen Keefe, Ph.D., dean of the College of Nursing at the Medical University of South Carolina, in Charleston. "Our research indicates that they spend more time in ‘active’ sleep, than in ‘deep’ sleep. So they tend to have a tougher time falling and staying asleep." There’s also some evidence that babies who suffer from colic may have low levels of melatonin, a hormone that helps regulate sleep.

Relieving the discomfort

What soothes one infant may not help another. In fact, you may have to combine a few of these time-tested strategies to find what works for your baby.

PICK HIM UP "You can’t spoil a baby with too much cuddling," says Dr. Squires. In fact, research shows that infants who are held a lot now tend to cry less later on in their childhood.

Most babies like to be held close, in a grown-up’s arms or in a body carrier, or swaddled firmly in a tight blanket. But some parents swear by the following colic hold: Lay your baby belly-down along the length of your forearm (with one leg on either side of your arm), and cup his chin in your hand to support his head. Or lay him on his tummy across your lap and gently rub his back; the gentle pressure on his abdomen will help relieve intestinal gas, a suspected source of discomfort.

Jim DeSimone, of Cranford, NJ, experimented with a number of holds until he found one that worked for his baby: "I hold Isabella in the crook of my elbow, the way a quarterback holds a football, with her back to me, and her head and shoulders draped over my forearm."

GET MOVING Some babies are soothed by rhythmic motions, such as a car ride. "If yours insists on being rocked for hours at a time, carry her in a front pack or sling to free up your hands," says Dr. Weissbluth. "Or put her in a baby swing or a bouncy seat."

HUM A LULLABY Infants react to sound’s volume and tone, so play or sing a soft tune. Many are also calmed by "white noise," the constant low sound of a dishwasher or a vacuum cleaner. Another trick: dimming the lights. Babies who are overstimulated are more likely to calm down in a dark room.

WATCH YOUR DIET Some pediatricians recommend that you cut down on gassy foods (such as cabbage, broccoli, and cauliflower) if you nurse, since they could irritate a baby’s stomach and aggravate her colic. Other possible infant-tummy irritants: caffeinated beverages, chocolate, and dairy products.

If your baby is bottle-fed, it might help to switch his formula. Some infants are intolerant of cow’s milk formula, for example, and feel better when they’re given a soy-based one. Bottle-fed infants may get stomach pains from swallowing too much air when they drink; it may help to try bottles designed to minimize air intake during feedings.

Extra nursing or bottle-feeding can quiet and comfort a crying baby, as can letting him suck his thumb or a pacifier.

STICK TO A ROUTINE "Colicky babies are already overstimulated," says Keefe. "Some may get even more upset if you switch soothing techniques too quickly." She advises that you develop a routine of five tactics that usually comfort your baby; do each tactic for at least five minutes when he cries.

GO HERBAL Some parents rely on diluted (and lukewarm) tea made with chamomile to help them get through the night. "Nursing moms may drink it themselves or give it directly to their baby," says Christopher Hobbs, author of Herbal Remedies for Dummies. It’s still important to talk to a pediatrician before trying any herbal concoction; some of them may contain ingredients that are dangerous for infants and older babies.

CONSIDER MEDICATION Over-the-counter anti-gas remedies that contain simethicone (such as Infants’ Mylicon drops) may help relieve gas in some infants and are safe to use. But many pediatricians are wary of prescribing stronger medications to babies because of the potential side effects and the risk of an overdose, according to George Cohen, M.D., a pediatrician at Children’s National Medical Center, in Washington, DC. Muscle relaxants, such as Levsin, for example, are used on occasion, but may cause dry mouth. In rare in-stances, a mild sedative, such as chloral hydrate, may be prescribed.

GIVE YOURSELF A BREAK Spending too much time trying to comfort a crying baby can spark feelings of hostility and resentment, which is why it’s so important to take some time out for yourself. Take a quick break at least once a day, and try a longer one  — to a movie or out to dinner with a friend  — at least once a week.

If you ever feel like you may lose control or harm your baby, leave him in a safe place (like his crib) and walk away from him until you calm down. You might want to call the pediatrician or a local parents’ support group.

Lasting memories

The good news is that colic usually disappears by the time a baby is 4 months old. Many parents even look back on this period in their lives as one with some positive aspects. "Talia’s colic somehow made me feel closer to my husband," says Kathleen Boutis. "Maybe it was because we spent so much time together trying to make her stop crying. Maybe it was the way he was so gentle and patient with her. But the experience made me realize what a great father he is  — and that I wanted another baby."