Understanding Infant Colic
There are few things that cause such stress to new parents as the sound of their baby crying. There are few things more satisfying to a new parent than soothing their baby’s cries. It is not surprising then that infant colic (excessive infant crying) is one of the most common reasons for visits to the pediatrician in the first few months of a baby’s life outside of the well-child visits. Parents of infants with colic feel helpless. They see their baby red-faced in apparent pain and they feel unable to do anything about it. For some parents, it is a major contributor to household stress at a time that is already stressful. Some parents of infants with colic feel despair (“I must not be a good parent”) and frustration (“I must be doing something wrong”), and others fear (“will it strike today?”) or even anger (“why won’t he just stop crying?”). These are all normal feelings in response to infant colic. While much is known about infant colic (it goes away), much is also still a mystery (what causes it).
Despite the absence of a specific test, x-ray or physical finding to make the diagnosis of infant colic, there are some characteristic patterns described. Babies usually slowly increase the amount of crying they do between two and four weeks of age. Parents commonly report that at four to six weeks their baby “changed”. Parents of infants with colic usually report that the crying clusters in the evening time; there is often a “witching hour”. Their baby seems to be in pain; legs drawn up to their belly, face red, hands clenched. Often their baby will pass some gas. The parents often report that their baby will like being held or rocked and will cry immediately when placed down. Many families will place their baby in a car seat and drive them in the car. Common criteria used by pediatricians to diagnose colic are if the infant cries more than three hours in a day, for more than three days in a week, or greater than three weeks (“the rule of threes”)
Infant colic is quite common. It affects between 10 and 20% of all babies and thus, most pediatricians have developed their own styles in handling babies with colic (and their parents!). The most important first step in thinking about a child with extreme crying is to make sure that there is no recognizable underlying cause for their crying. If you think that your baby may have colic, it is crucial to have them evaluated by their pediatrician. Serious causes are rare, but need to be excluded.
One of the most common recommendations made to parents is dietary change. For babies who are formula fed, an alternate formula may be recommended. For babies who are breast fed, the pediatrician may suggest some dietary changes for the mother. While diet is often blamed, it is uncommon that dietary changes make any noticeable difference in infant crying. Other common tricks include: using a white noise source (vacuum or dishwasher), infant rockers or swings, and parental backpacks (for prolonged carrying). Some pediatricians will prescribe medications for colic. This should be discouraged. No medications help infants with colic and some may have dangerous side effects. The most important thing your pediatrician can do is to address any parental frustration or sadness. Parents should have “crying holidays”; given a break by another adult for a period of time. It is important that a parent never, ever shake their baby for any reason. There is a light at the end of the tunnel. Colic is should seen as a short, but noisy, detour on the road of parenthood.
Editorial provided by Christopher S. Greeley, MD, FAAP, Associate Professor of Pediatrics at the Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Sciences Center at Houston and founder of a specialty clinic for parents of infants with colic.