Theories on the cause of colic have shifted from a sort of infant version of irritable bowel syndrome (IBS) or gas, to neurological immaturity and nervous system overload. In my review of the research on colic and ongoing interviews with colic experts, I think one thing is clear, colic has different causes for different babies, but there are universally common characteristics of babyhood that show us what the usual suspects are. Some things, from biological to neurological, just go along with being a baby in those first few tumultuous months. Child psychiatrist and neuroscientist, Bruce Perry, MD, PhD, who I've found has one of the most profound understandings of how our brains develop, describes the extreme discontent babies suffer in the first months as resulting from the various rhythms of the brain not yet being synchronized. Eventually, Perry promises, "your baby's neurological rhythms will become synchronized like an orchestra." That's when the clouds part, the sun pierces your weary soul, and the angels sing. Your baby emerges as a real, responsive, connected person, rather than a crying machine. Until then . . . you gotta get your soothing game on!
Another thing that seems clear, and at the same time enlightening, is that colic isn’t always colic—the diagnosis simply describes a symptom: crying for more than three hours a day, three times a week, for three weeks or more. This symptom can commonly be brought about when a baby's holding-time quota is not being met.This idea sprouted when I first read a blog post by Jay Gordon years ago in which he profoundly suggests that babies thought to be “colicky” simply need to be fed and held more. He describes working with parents on soothing skills in his pediatric practice and suddenly, their baby no longer fits the diagnostic criteria for colic. This dynamic is echoed in my work as well, especially with experienced mothers whose first babies were of a milder temperament. I would add that these babies often need more intensive help getting to sleep! This brings me to my gigantic colic caveat: All babies really are different. Some need far more soothing than others (and this is one of the simplest answers to why prolonged crying happens). Some are extremely more sensitive to being overtired (being awake too long between feeds), and some are actually gassy or have reflux.
The approach I take with my coaching clients it to explore those usual-suspect causes directly. Through process of elimination and taking specific steps, we are able to drastically reduce the crying. Sometimes this improvement happens in just days, when the cause is the need for more soothing, for example, and sometimes it takes up to two weeks, like when there's a problem like reflux, allergies, or a combination of causes in play.
Here is a checklist, step by step, you can go through yourself, if your little one (under four months) is suffering from seemingly inconsolable crying episodes, whether he’s been given a colic diagnosis or not:
1. Bring the crying to the attention of your baby’s doctor, not because your pediatrician will offer much help, unless they are of the rare Harvey Karp, MD, or Jay Gordon, MD variety, but because you want to first eliminate the possibility that there could be something physically, medically wrong that is causing your baby pain. (This is usually not the case, but a logical first step.)
2. Hold and carry your baby more both in general and just before the time the crying spells normally hit. Studies show, as Dr. Gordon observed, holding and carrying can drastically reduce prolonged crying for most, but not all, babies.
3. Reduce novel stimulation and simulate a womb-like environment. This is where Dr. Karp’s “5 Ss” as in The Happiest Baby on the Block, come in. Find a routine by using Karp’s combination of swaddling, shushing, side position, and swinging as a starting point and adding your own techniques if necessary through experimentation. Babies womb-experiences vary slightly, so their “calming reflex,” as Karp terms it, can be somewhat unique as well. Use this routine in a dark room with loud white noise to help your baby tune out the world and go to sleep. I'm also a big fan of Dr. Karp's Snoo Smart sleeper. Some attachment parenting purists worry that it will cause babies to not be held as much, but reality is parents must be able to put baby down to sleep some and for many babies, Snoo is the only thing that makes that possible, therefore it's a solution that protects the family's energy resources and sanity while providing biologically critical movement and sound stimulation.
4. Watch the clock if you have a fussy baby. This component of my approach was inspired by Mark Weissbluth, MD, author of Healthy Sleep Habits, Happy Child, who emphasizes the dramatic effect of "overtired"; he uses the term as a noun as if it's an entity (rightly so). This has lead me to a guiding belief that was later repeatedly validated by numerous clients as well as my own experience with my colicky daughter: these more sensitive babies are difficult if not impossible to read in terms of sleepiness. They will flip a switch on you and start wailing with none of the “sleepy signs” for which the baby sleep books tell you to watch. Take notes, and get ahead of the crying times by starting your soothing routine before the witching hour(s) hits.
5. If breastfeeding, try eliminating dairy (the most likely culprit), eggs, cruciferous vegetables, and wheat for two weeks (or ask your pediatrician for dietary guidelines). Breast milk is rarely the problem, but an allergy could be just the thing for your baby (especially suspect if the soothing and sleep stuff above didn’t make a difference).
6. If formula-feeding, ask your pediatrician for a hypo-allergenic formula and/or probiotic supplementation. Recent research, the latest of which was published just last month (Jan. 13 in the journal JAMA Pediatrics), has shown that colicky babies do have different flora (bacteria) in their intestines than non-colicky babies. In many cases, probiotic supplementation does reduce prolonged crying, reflux, and constipation, according to the study authors. This works presumably because it balances the intestinal flora, bringing just the comfort your little screamer needed. (I'm paraphrasing several studies and interviews here.)
7. With both bottle and breast, feed your baby in a slightly upright position and keep her upright and still for about 15 minutes after each feed. This will reduce acid reflux, which most babies have to some degree (diagnosed or not!). This is an easy thing to implement, but again, not usually the cause of colic. I’ve had clients with babies with diagnosed acid reflux but a funny thing happens after the three-month-mark (when the neurological rhythms calibrate and the need for a womb-like sanctuary dissipates). These babies with reflux still spit up all over the place after every feed, but now they laugh about it—it wasn’t the reflux that had caused their crying.
One of the most useful revelations my research over the past three years has revealed is just how different one baby is from the next in terms of sensitivity. All babies are born immature (human brains are only 25 percent developed at birth). But, some babies are neurologically more sensitive to the discomforts which that underdevelopment can bring. There are universal truths. Most babies do instinctively desire a lot of holding and soothing in the first few months. But if you have a little one who seems to require constant holding, please don’t see it as a negative (even if this means they wail for 2.5 hours a day). It’s a challenge, to be sure, but your little touchy type may turn out to be more curious or more perceptive in later years. It’s just sad that quiet, easy babies are said to be “good babies.” There’s no good or bad in this. Your baby’s crying today is in part tied up in some aspects of her temperament, which is a neutral thing. It may be the very trait that underlies the things you’ll grow to treasure about her emerging personality in the years to come. As trying as this crying phase can be, it’s part of the wondrous journey with your one-of-a-kind little person. And like the challenge of giving birth to her, you’re in it together.
Have more questions? Post them on Facebook and I will try to answer all!