“My baby cries all evening and night! What could be wrong with her? What can we do?” I have heard these words often as a practicing general pediatrician. After the excitement and challenges of pregnancy and the immediate newborn period in the weeks after birth, one out of five families faces the frustration of a baby who cries excessively despite their best efforts. No matter how much the parents hold, carry, or feed these babies, the crying continues.
What is Colic?
Infant colic has many definitions. One of these is unexplained, sudden fussing and crying lasting more than three hours a day, for more than three days a week, for more than three weeks duration. More simply stated, colic may be described as prolonged or excessive crying. Colic occurs more often in the late afternoon and evening, especially from 5 p.m. to midnight, but may last through most of the night.
Colic is not really an illness. It is a frequent variation of infant behavior, and occurs in about 20 percent of all babies. It usually happens between two weeks and three months of age. There is sudden onset of loud, continuous crying, lasting several hours at a time. The baby’s face may be flushed, and the area just around his mouth may appear pale. His abdomen may be swollen and tense. Often, the baby’s legs are drawn up to the abdomen, and his hands are clenched.
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The baby may appear hungry, but feeding does not quiet her. There may be temporary relief with passing feces or gas, but this break usually does not last long. Many parents believe that colic is caused by gas, but often, the gas may be an effect of excessive crying and swallowed air. The colic episode typically ends when the baby is completely exhausted.
How Much Should a Normal Baby Cry?
Many parents are not familiar with the normal amount of crying that babies do in the course of a day. At two weeks of age, the average baby cries two hours per day. This increases to three hours per day at three weeks, and reduces to one hour per day at three months. But not every normal baby is average: up to 25 percent of infants will cry three and one-half hours or more at six weeks of age. Normal babies differ in how much they cry, how loud the crying is, how sensitive they are to stimulation, and how easily they are comforted. Babies also cry more when they are tired.
Babies are Different from One Another
Infants are born with different temperaments, and their environments from the moment of birth influence these personalities. While one baby may have colic—his or her sibling may not, even at the same age. Premature babies may be especially prone to fussiness and excessive crying. And some parents are more disturbed by prolonged crying than others.
Sensitivity to Stimulation
Many babies with a tendency to prolonged crying have an increased sensitivity to extreme or inappropriate stimulation, such as bright lights, loud sounds or too much touching. Often, parents of these sensitive infants may reach to pick them up, rock them, and talk to them when they are crying. This may backfire and make the crying worse, since the stimulation may be too much for them.
Most babies with colic will reduce their duration of crying when their parents or caretakers modify the babies’ environments and change their response to the crying. A quiet room with dim lighting is often helpful. Soft, soothing music is OK, but loud jarring music or other noise may make the crying worse. Parents should reduce stimulation, although close physical contact is often helpful. If these guidelines are followed, most colicky infants will reduce the duration of their symptoms, although they still will have periods of crying. Remember: comfort more—stimulate less!
How Else Can Parents Cope?
Crying babies are very frustrating. It is often helpful to trade off between caretakers, to take a break away from the infant. And, remember, never shake a baby!
If reducing stimulation doesn’t help, some remedies that may possibly be effective in managing colic are:
- In breastfeeding mothers, a low allergen diet (free of milk, egg, wheat, and nut products) has sometimes helped. Also, breastfeeding moms should look at whether other items in their diets influence their babies’ discomfort, such as caffeine, spicy or gas-producing foods.
- In formula-fed infants, hypoallergenic or soy formulas have helped some infants.
- Herbal tea containing chamomile, vervain, licorice, fennel, and balm-mint showed some benefit in one study—but watch the quantities, since young babies can get water-overloaded very easily!
Make sure to let your pediatrician know before trying any of these remedies. Some commonly used medications, including simethicone and “gripe water,” which is a mixture of dill with water, have not shown any real effectiveness in treating colic. Beware of unsolicited advice from relatives and friends. Above all, realize that colic is not your fault and that it will go away!
When Should I Call My Pediatrician?
Whenever you are frustrated in managing your baby’s crying, you should call her doctor. Before calling, it is often helpful to keep a diary. Note the time of crying, when the baby was fed, and what you did to try and comfort her. Also note any stresses going on in the family. If the crying is out of the ordinary, take the baby’s temperature.
When you bring your baby to see the pediatrician, the doctor will make sure there is nothing physically wrong that would explain the colicky crying. Medical disorders that may masquerade as colic include ear and urinary infections, intestinal blockage, injuries to the surface of the eye, incarcerated hernia, and other causes of pain. Food allergy or intolerance may also cause excessive crying.
For further information on infant colic, call your pediatrician.