Crying Baby (Colic)
DEFINITION
- Unexplained crying
- Intermittent crying one or two times per day
- Healthy child (not sick or in pain)
- Well-fed child (not hungry)
- Bouts of crying usually last 1 to 2 hours
- Child fine between bouts of crying
- Child usually consolable when held
- Onset under 4 weeks of age
- Resolution by 3 months of age
- This diagnosis must be confirmed by a physician
Cause
Normally infants do some crying during the first months of life. When babies cry without being hungry, overheated, or in pain, we call it "colic." About 10% of babies have colic. Although no one is certain what causes colic, these babies seem to want to be cuddled or to go to sleep. Colic tends to occur in high-needs babies with a sensitive temperament. Colic is not the result of bad parenting, so don't blame yourself. Colic is also not due to excessive gas, so don't bother with extra burping or special nipples. Cow's milk allergy may cause crying in a few babies, but only if your baby also has diarrhea or vomiting.
Colic is not caused by abdominal pain. The reason the belly muscles feel hard is that a baby needs these muscles to cry. Drawing up the legs is also a normal posture for a crying baby, as is flexing the arms.
Expected Course
This fussy crying is harmless for your baby. The hard crying spontaneously starts to improve at 2 months and is gone by 3 months. Although the crying can't be eliminated, the minutes of crying per day can be dramatically reduced with treatment. In the long run, these children tend to remain more sensitive and alert to their surroundings.
COPING WITH COLIC
- Hold and soothe your baby whenever she cries without a reason. A soothing, gentle activity is the best approach to helping a baby relax, settle down, and go to sleep. You can't spoil a baby during the first 3 or 4 months of life. Consider using the following:
- Cuddling your child in a rocking chair
- Rocking your child in a cradle
- Placing your child in a baby carrier or sling (which frees your hands for housework)
- A windup swing or a vibrating chair
- A stroller (or buggy) ride outdoors or indoors
- Anything else you think may be helpful (e.g., a pacifier, a warm bath, or massage)
- A last resort: Let your baby cry herself to sleep. If none of these measures quiets your baby after 30 minutes of trying and she has been fed recently, your baby is probably trying to go to sleep. She needs you to minimize outside stimuli while she tries to find her own way into sleep. Wrap her up and place her stomach down in her crib. She will probably be somewhat restless until she falls asleep. Close the door, go into a different room, turn up the radio, and do something you want to do. Even consider earplugs or earphones. Save your strength for when your baby definitely needs you. If she cries for over 15 minutes, however, pick her up and again try the soothing activities.
- Prevent later sleep problems. Although babies need to be held when they are crying, they don't need to be held all the time. If you overinterpret the advice for colic and rock your baby every time she goes to sleep, you will become indispensable to your baby's sleep process. Your baby's colic won't resolve at 3 months of age. To prevent this from occurring, when your baby is drowsy but not crying, place her in the crib and let her learn to self-comfort and self-induce sleep. Don't rock or nurse her to sleep at these times. Although colic can't be prevented, secondary sleep problems can be.
- Promote nighttime sleep (rather than daytime sleep). Try to keep your infant from sleeping excessively during the daytime. If your baby has napped 3 hours, gently awaken your baby, and entertain or feed her, depending on her needs. In this way the time when your infant sleeps the longest (often 5 hours) will occur during the night.
- Try these feeding strategies. Don't feed your baby every time she cries. Being hungry is only one of the reasons babies cry. It takes about 2 hours for the stomach to empty, so wait that long between feedings or you may cause cramps from bloating. For breast-fed babies, however, nurse them every time they cry until your milk supply is well established and your baby is gaining weight (usually 2 weeks). Babies who feed too frequently during the day become hungry at frequent intervals during the night. If you are breast-feeding, avoid drinking coffee, tea, and colas and avoid taking other stimulants. Suspect a cow's milk allergy if your child also has diarrhea, vomiting, eczema, wheezing, or a strong family history of milk allergy. If any of these factors are present, try a soy formula for 1 week. Soy formulas are nutritionally complete and no more expensive than regular formula. If you are breast-feeding, avoid all forms of cow's milk in your diet for l week. If the crying dramatically improves when your child is on the soy formula, call us for additional advice about keeping her on the formula. Also, if you think your child is allergic, but she doesn't improve with soy formula, call us about the elemental formulas.
- Get rest and help for yourself. Although the crying can be reduced, what's left must be endured and shared. Avoid fatigue and exhaustion. Get at least one nap each day in case the night goes badly. Ask your husband, a friend, or a relative for help with other children and chores. Caring for a colicky baby is a two-person job. Hire a babysitter so you can get out of the house and clear your mind. Talk to someone every day about your mixed feelings. The screaming can drive anyone to desperation.
- Avoid these common mistakes. If you are breastfeeding, don't stop. If your baby needs extra calories, talk with a lactation consultant about ways to increase your milk supply. The available medicines are ineffective and many (especially those containing phenobarbital) are dangerous for children of this age. The medicines that slow intestinal activity (the anticholinergics) can cause fever or constipation. The ones that remove gas bubbles are not helpful according to recent research, but they are harmless. Inserting a thermometer or suppository into the rectum to "release gas" does nothing except irritate the anal sphincter. Don't place your baby face down on a waterbed, sheepskin rug, bead-filled pillow, or other soft pillow. While these surfaces can be soothing, they also increase the risk of suffocation and crib death. A young infant may not be able to lift the head adequately to breathe. Stay with TLC (tender loving care) for best results.
CALL OUR OFFICE
IMMEDIATELY if
- Your baby cries constantly for more than 2 hours.
- You are afraid you might hurt your baby.
- You have shaken your baby.
- Your baby starts acting very sick.
During regular hours if
- You can't find a way to soothe your baby's crying.
- The crying continues after your baby reaches 4 months of age.
- Your baby is not gaining weight and may
- You have other questions of concerns
Instructions for Pediatric Patients, 2nd Edition, ©1999 by WB Saunders Company.
Written by Barton D. Schmitt, MD, pediatrician and author of Your Child’s Health, Bantam Books, a book for parents.
