Overview of Colic
What is colic?
Colic is when babies cry more than they should be crying. Babies cry for different kinds of reasons. Some of it is just biology. It’s just the way they’re wired. They go through a certain period where they cry too much. Sometimes the colic is because of other problems like feeding. Sometimes the colic is really secondary to reflux and if you treat the reflux, the crying gets diminished. Other times, babies cry too much because maybe they’re not sleeping enough and they’re sleep deprived and they’re like all of us — we get cranky and fussy and irritable when we don’t sleep.
When does colic usually begin? How long does it last?
There are many myths about colic, an easy answer to say some time between three and six weeks and it happens often at night. But, the fact of the matter is, it doesn’t always happen that way. There are some babies who enter the world screaming and they have colic from day one. Some babies don’t show it until a little bit later. For some babies, again like in this baby, she cried during the day. Now the sort of typical myth is that colic is an evening thing, but this was not an evening thing, so some babies are just persistently cranky and irritable and cry during the day as was the case with this baby.
Is there an average time that it subsides? Is it four to eight months, or is there an average?
Well, if you look at the normal development of crying, if you forget colic for a moment, but if you just follow developmentally how often babies cry and when they cry, crying in normal development peaks around four to six weeks. About 20 percent of babies will cry more than two or three hours a day and those babies often get labeled colic. But, if that’s all that’s going on, you’re probably looking at temperament. You’re probably looking at a temperamentally difficult baby who’s cranky and irritable and crying more than 80 percent of the babies. So, four to six weeks is when normal crying peaks and if it gets to be too much, it’s often called colic.
What are some of the do’s and don’ts? Let’s start with the don’ts. What are some tips for parents to not do, to try to avoid?
It’s important to try and understand, if at all possible, what it is that is making the baby cry and to look for potential solutions. Babies intrinsically have, very often, preferences. We know things newborns like and things they don’t like. So, its important to try and figure out what are the kinds of things your baby likes.
Some babies like to be held upright. Some babies like to be held horizontally. Some babies like to be walked around with. So, trying to find out what is most attractive to your baby is a very important thing to do.
The flip side of it is to try and not be too rigid. Sometimes parents get stuck in a particular regime of just doing one thing over and over again. It might not work, but they get sometimes afraid to try new things because if they try something new and it doesn’t work, they try something else that doesn’t work again, that’s not very satisfactory.
Another thing not to do is to blame yourself. Probably the most difficult thing that we see in the colic clinic, and again we saw to some extent with this patient, here’s a mom who’s breastfeeding and she naturally assumes on day 12, she has a gorgeous baby and on day 13 the baby starts screaming. She naturally assumes a, that there’s something wrong with the baby and b, that she did it. So she changes her diet. She goes through all the typical things that one would do, and often what happens is it makes you feel like its your fault, you did it, you’re responsible for the colic, you blame yourself and that really drives a wedge into the mother/child relationship so that blaming yourself and undermining your self confidence as a mother is something that can really get in the way.
What are some of the recommendations for treating colic?
Some of the recommendations might be things like in terms of helping to soothe the baby, putting the baby face down if they like it, sometimes rubbing the belly helps. But you have to see what your baby likes and what your baby doesn’t like. Experiment with different kinds of soothing techniques and strategies. Get out of the house, walking around. Those are just sort of traditional things that people would do with any crying baby. If we do figure out that there is a feeding-related issue, then we might think about different kinds of formulas or nipples or once in a while medication, but it really depends on in a sense what the baby is bringing to the table.
In terms of the overall status of the baby, we like to know more than whether or not the baby is just crying a lot, so we administer something called the ‘colic symptom checklist,’ which enables us to in a sense quantify the severity of the colic. Some babies just cry a lot, but other babies, in addition to crying a lot, will show other signs and symptoms. The baby’s face gets red, they clench their fists, their arms and legs go stiff, the belly gets tight, they arch their back, so that’s kind of more extreme and usually tells us that maybe there’s more of a feeding or some other kinds of issues that are going on.
Maternal depression is probably the most common psychological comorbidity that we see. We see about 40 percent to 45 percent of the mothers have post-partum depression and that’s one of the more difficult scenarios that we see is the combination of having a colicky baby and being depressed. Its very, very difficult because it compromises the mother’s ability to parent, to be able to effectively read her baby’s signals and cues and really try and understand what’s going on. If you say that you have a colicky baby and you really get angry at the baby and sometimes you hate the baby. You know, that’s OK, its OK to have those feelings. Those are legitimate, normal feelings. It’s not OK to act on them, but it is OK to have them. So legitimizing those feelings and to some extent normalizing those feelings is a way of helping parents get on track with their relationship with the baby.
Some of the treatment involves helping psychologically the mother deal with her issues in the family but also helping to get her life back, get in touch with that person you were before you had the baby. Get out of the house, do the things that are going to make you whole again and make you rediscover who you are so that you have a life and an identity apart from being the mother of a screaming kid. That restores self-esteem and self-confidence.
Does the diary help the mother to see if she’s feeding the baby too little or too much?
Nursing mothers feed much more than mothers who are bottle feeding, so you have to take that into account, but it tells us when the feedings are occurring and if they are feeding too much or too little. It also tells us how much the baby is sleeping. If the baby is sleeping at night or sleeping too much during the day or sporadically, so sometimes the crying is really secondary to a sleep problem and that usually shows up on here because we might see little catnaps throughout the day and no sustained period of sleeping. This is very useful and this is something that parents can do on their own.
The colic symptom checklist does a couple of things but mostly it enables us to look at the severity of the colic and see what other symptoms are going on. Many colic episodes start suddenly. You can be sitting there holding this baby who’s looking at you and appearing absolutely normal and the next minute, it’s literally like a spell. Its like it just comes out of nowhere and that’s a characteristic of this true colic where it just seems to be a spell or an episode that comes out of the blue. Second is the sound of the cry and you heard that today. The baby sounds like he or she is in pain. A pain cry is different from a non-pain cry. Every mother knows what a pain cry sounds like and in babies who have this severe colic, when they’re crying like that, the cry is high-pitched, it has this sudden quality, its very loud, and the mothers will say he sounds like he’s in pain. When the baby is sitting there and pulling the legs up and the stomach is tight, you can see the baby is in pain, so that’s the third dimension we look at is these other physical signs of do the legs come up, do the arms and legs get stiff, which is stiff muscle tone, does the face get red? Sometimes babies stop breathing. So, there are 8 or 10 of these characteristics that we look at. Then the last set of characteristics is consolabilty. What have you tried to help the baby stop crying or does anything work? That’s the bottom line, have you found anything that works and very often, you’ll find not.