Crying and Colic
All infants will cry, some more than others. In fact, infants will cry more during the first three months of their lives than at any other time. It is normal for crying to total nearly two hours a day in the first six weeks and to slowly decrease to approximately 70 minutes a day by twelve weeks. Most crying is distressing for families, and even more so when the crying is felt to be excessive or due to colic.
Colic has many definitions and is often used to describe a baby’s fussy period when the level of crying escalates and the baby cannot be comforted. Colic has come to be a diagnosis of exclusion and should used when other more serious causes of excessive or prolonged crying have been ruled out.
Colicky behaviors generally begin around the third week of life and resolve around 3 to 4 months. Approximately one fifth of all infants will be diagnosed with colic. It will occur equally in boys and girls, breast and bottle-fed infants, full term and preterm babies, and first and second children.
Although there is no strict definition for colic, many health care providers define it with a “rule of three;” the crying lasts for more than three hours a day, occurs more than three days in a week, and lasts for more than three weeks. The colicky episodes often have an identifiable beginning and end, typically between 6 and 10pm. The crying of a colicky infant is often different from a normal crying episode, as it is usually louder and higher in pitch. The infants often become flushed and tense. They can either pull their legs up towards their belly or straighten them out with arching of the back. The belly may be full and the baby may pass gas. In general, a colicky baby will be either difficult or impossible to console, no matter what a parent or other caregiver does.
When attempting to treat colic, it is important to remember that no single treatment will work for every infant.
Changing the baby’s diet and method of feeding is one calming technique. If the baby is bottle fed, feeding in an upright position with a curved bottle or bottle with a drop-in liner may be helpful. Some colicky babies will improve when they are switched to a soy or hypoallergenic formula. If an infant is breast fed, mothers can try a hypoallergenic diet for themselves, eliminating milk, eggs, nuts, and wheat. There is also some evidence to say that allowing the baby to fully drain one breast rather than feeding from both breasts may alleviate symptoms.
Changing the baby’s environment and limiting external stimulation may also help to soothe. Offering a pacifier, riding in the car, using a swing or vibrating seat, warm baths, and belly massages have all been shown to reduce colic symptoms. Using some type of white noise can also provide comfort. This can be done with a white noise machine, a fan, a simulated heartbeat, or by placing the infant in a car seat near a running clothes dryer. There may also be some benefit when the baby is carried in the parents’ arms, a sling, or carrier. Swaddling can help those infants that seem hypersensitive to body stimulation and touch, especially if they are younger than two months old.
Two well-done medical studies have shown the probiotic Lactobacillus reuteri to be helpful in the treatment of colic, mainly with a decrease in the total amount of crying in the day. Herbal remedies such as chamomile, fennel, and balm-mint may also provide some relief from colic. Gripe water, which often contains dill, may also be helpful. Always consult a physician before starting any herbal remedy, as some of these preparations have been found to contain dangerous ingredients including alcohol.
Remember that babies cry and an inconsolable infant can be extremely anxiety provoking. It is normal to feel tired, angry, sad, and stressed out. When you feel this way, it is important to take a break, even for a short time. Ask a friend or family member to watch after the baby. If you are alone, put the baby in a safe place like the crib. Crying for a short time without you there will not harm the baby, as long as he or she is safe. Always reach out to your pediatrician if you feel overwhelmed or if you are concerned about the health of your baby.
Leslie Greenberg, MD is a Pediatrician at Princeton Nassau Pediatrics. Princeton Nassau Pediatrics provides state of the art care for children from infancy through college at their four locations in Princeton, Pennington, Monroe and West Windsor, NJ. To schedule an appointment visit www.princetonnassaupediatrics.com