Colic (The Crying Baby)

What is colic?

Colic is unexplained crying (not due to pain or hunger) in young babies. The bouts of crying/fussing add up to more than 3 hours per day. The child acts happy and content between bouts of crying. The crying usually stops when the baby is held and comforted. Colic usually begins at about 2 weeks of age.

What is the cause?

Normally babies do some crying during the first months of life. When babies cry excessively for more than 3 hours per day without an obvious cause, we call it colic. While no one is certain about what causes colic, it tends to occur in babies with a sensitive or spirited temperament. Another current idea about the cause of colic is that our world is too still and quiet for these fussy babies and they need us to imitate the sensations they experienced constantly inside the womb.

There are some misconceptions about what causes colic. 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. Colic is not due to inadequate breast-feeding. Cow's milk allergy may cause excessive crying in a few babies, but it is a possible cause of crying 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 uses these muscles to cry. Drawing up the legs is also a normal posture for a crying baby, as is flexing the arms.

How long does it last?

The hard crying starts to improve at the age of 2 months and is gone by 3 to 4 months of age. In the long run, these children tend to remain more sensitive and alert to their surroundings.

This fussy crying is harmless for your baby. Although the crying can't be eliminated, the minutes of crying per day can be dramatically reduced by following the suggestions below.

How can I take care of my child?

1. Hold and soothe your baby whenever he cries.

   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 4 months. Consider using the following to calm your baby:

   • Rocking your child in a rocking chair, in a cradle or while standing (most babies calm best with rapid tiny movements like vibrations)
   • NEVER shake your baby, it can cause brain damage
   • Placing your child in a windup swing or vibrating chair
   • Going for a stroller ride, outdoors or indoors (instead of a ride in the car)
   • Running a vacuum cleaner, or playing a CD of monotonous sounds. Avoid very loud volumes due to the risk of hearing damage.
   • Anything else you think may be helpful (for example, a pacifier, massage, or warm bath)

   (Probably the best resource for helping parents calm fussy babies is The Happiest Baby on the Block DVD by Dr. Harvey Karp)

2. Swaddle your baby in a blanket.

   Snug swaddling is the most helpful technique for calming crying babies. It also reduces awakenings caused by the startle reflex and increases the length of sleep. Some babies cry more right after swaddling, but they usually relax (and even fall asleep) when you add some other calming measures, like strong white noise and rocking. Be sure to do the swaddle correctly:

   • Use a big square blanket.
   • Use the 3-step "burrito-wrap technique. Have the arms straight at the sides, but the hips a little bent. Safe swaddling keeps the legs in a straddle position. Pull the left side of the blanket over the upper body and tuck. Second, fold the bottom up. Third, pull the right side over the upper body and tuck snugly.
   • Don’t cover your baby's head or overheat your baby.

   Swaddling is useful for at least the first 4 months especially when paired with a loud but soothing CD. Keep the white noise on any time your baby is crying or should be sleeping (that means all night). When your baby is awake and not crying, keep your baby unwrapped and turn off the white noise so she can get used to the normal sounds of your house. (For details, view Dr. Karp's DVD.)

3. A last resort: Let your baby cry himself to sleep.

   If none of these measures quiets your baby after 20 minutes of trying and he has been fed recently, your baby is probably trying to go to sleep. Swaddle your baby snugly, place him on his back in his crib, turn on some white noise, and leave the room. (On the back is the sleep position recommended by the American Academy of Pediatrics for protecting babies from crib deaths). He will probably be somewhat restless until he finds his own way into sleep. Close the door, go into a different room and turn up the radio or use earplugs or earphones. Save your strength for when your baby definitely needs you. If you’re frustrated, it’s always smart to walk away. If he cries for over 20 minutes, pick him up and try the soothing activities again or ask someone for help.

   Caution: NEVER, ever shake your baby. It can cause serious brain damage. If you are frustrated by your baby’s crying, call your healthcare provider or other resource now.

4. 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 rock your baby every time he goes to sleep, you will become indispensable to your baby's sleep transition process. Your baby's crying during the night won't stop at 3 months of age. To prevent this from occurring, when your baby is drowsy but not crying place him in the crib and let him learn to comfort himself and go to sleep by himself. Don't rock or nurse him to sleep at these times. Colic can't be prevented, but sleep problems can be prevented.

5. Promote nighttime sleep (rather than daytime sleep).

   Try to keep your child from sleeping excessively during the daytime. If your baby has napped 2 hours, gently awaken and play with or feed your baby, depending on his needs. This will help to cut down the amount of time your baby is awake at night.

6. Try these feeding strategies:

   Don't feed your baby every time he cries. Being hungry is only one of the reasons babies cry. However, if the calming measures listed above don’t soothe your baby in a minute or two, try giving a little more to eat. During the first month of life, some babies need just a bit more, even right after eating! If you are breast-feeding, avoid eating excessive chocolate or drinking excessive coffee, tea, and colas (1 or 2 servings a day is usually fine.) Also avoid other stimulants such as decongestants.

   If your child continues to cry, ask your doctor if your child might be suffering from a cow’s milk allergy or acid reflux. Your doctor may recommend trying a different formula for a week or, if you are breast-feeding, to avoid drinking or eating any forms of cow's milk for 1 week to see if your baby's condition improves.

7. Get rest and help for yourself.

   Avoid fatigue and exhaustion. Get at least one nap a 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 baby sitter 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.

8. Avoid these common mistakes.

   If you are breast-feeding, don't stop. If your baby needs extra calories, talk with a lactation nurse or specialist about ways to increase your milk supply.

   The available medicines for colic are ineffective and some are dangerous for children of this age. The medicines that slow intestinal motion (the anticholinergics) can cause fever or constipation. The ones that remove gas bubbles are not helpful, but they are harmless.

   Don't place your baby on a waterbed, sheepskin rug, bead-filled pillow, memory foam mattress or other soft pillow. While these surfaces can be soothing, they also run the risk of suffocation and crib death. A young infant may not be able to lift his or her head adequately to breathe.

   Inserting a thermometer or suppository into the rectum to "release gas" does nothing except irritate the anal sphincter.

   Stay with TLC (tender loving care) and swaddling for best results.

When should I call my child's healthcare provider?

Call IMMEDIATELY if:

• Your baby cries constantly for more than 2 hours.
• You are afraid you might hurt your baby.
• Your baby is acting sick or like he may be in pain.

Call during office 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 be hungry.
• You have other concerns or questions.