All babies cry—some more than others. Parents I work with whose little ones fall into the "more than others" category would call that an understatement. They worry that something is wrong with their baby or that they're doing something wrong when the crying doesn't stop after a feed or goes on for hours in the evening. Once you've fed, burped, diapered, and checked for a rouge safety pin that must have somehow become lodged into your babies tender skin—even though you don't even use safety pins—the source of the crying can become quite a conundrum. Parents want to know why. 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!
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Parents hate to hear their babies cry. They also need to get some sleep in order to be good parents. These two seemingly conflicting forces butt heads like enraged bulls throughout the parenting books and blogs. With everyone shouting at each other about how it should be done, it's easy to lose sight of the truly relevant questions: What is literally happening in baby’s brain when we leave her in a room to cry herself to sleep? (This is one popular solution to the ubiquitous sleep dilemma). It’s the answer to that question which holds the key to finding our way through the clashing advice and handling sleep challenges in the healthiest way possible for your unique baby. One of the first subjects we tackle as little humans is the ever fascinating, cause and effect—What happens when I drop my food over the highchair? We come to count on cause and effect patterns that we learn, for a lifetime. Every time I go to Whole Foods with my kids, they hop into the “race car” shopping cart and we roll into the elevator. We want to go to the second floor for our snacks and salads. To cause that to happen, we push the elevator button, because we have learned repeatedly this causes the elevator to take us up to where we'll be rewarded with yummy (read: kale!) treats. One day, we push with confidence, but nothing happens. Bewildered, we push again, harder. We really don’t want to be down here in this elevator hungry, so we jab repeatedly at that second-floor button—still nothing. Next, two things happen and they are universal: One, we give up (feeling frustrated, we get out of the race car and take the stairs, and two, we learn that this elevator is unreliable! Pushing that button doesn't work like its supposed to. This little scenario is so universal in human and animal behavior that it has a name in the sciences. It’s termed, “extinction.” It may surprise you that the cry it out (in which baby is left alone to cry to sleep) method is, in fact, called the “total extinction” method by scientists who study such things (“controlled crying” methods are termed “partial extinction.”) The problem is, unlike in the elevator example, young babies are not able to take the stairs; they are stuck in a potential toxic avalanche of emotional “dysregulation.” As this blog post by Darcia Narvaez, PhD, pointedly outlines, this carries a host of legitimate concerns for neurological development. This is because contrary to popular myth, babies are unable to soothe themselves from extreme distress; they don’t have the brain function to do this, so extinction “teaches” them to self-soothe like tossing them in the ocean teaches them to swim. When they are tossed into extreme distress and comfort is withheld, the stress hormone cortisol actually destroys nerve connections in critical portions of an infant’s developing brain. It seems clear that extreme prolonged and repeated distress is cause for concern during the time the brain is growing and wiring exponentially more than it ever will again. But is it really that stressful? I’m just in the next room from little Junior's safe plush, CPSC-approved crib. There really is no cause for intense distress. We have to keep in mind that babies are operating primarily from their base-level survival instincts, which demand he keep his parent close to protect him, he actually doesn’t know he’s safe—he’s very likely afraid for his very life, as illogical as they may be to us, when he's suddenly left alone to sleep. This biological perspective puts the cry-it-out debate in a new light. Stress level vis-à-vis baby’s survival instinct and the neurological damage possible from it is one concern that’s been overlooked by advocates of the total extinction method. Now remember all that desperate jabbing of the button that we did at Whole Foods when the elevator failed to respond as expected? There’s a scientific name for that specific behavior, too: “an extinction burst.” This is when baby increases his cry to a higher, more desperate pitch when his trusted care-giver doesn’t respond to him. As a parent, you can practically hear the blood-pressure and stress hormones skyrocketing (or you can just look at the studies that have measured them). The extinction burst, before the behavior is extinguished, produces a different type of crying, far more severe than normal everyday crying. Mommy’s instinct is correct in feeling this level of distress needs attention. If you don't want extinction, the extinction burst is your cue to step in. This leads to another concern that rears its ugly head when we understand the process of extinction: What exactly are we are extinguishing? Is it the need for soothing, or the communication of that need? Scientists know that infant crying is communication, plain and simple. But researchers at the University of Texas took the understanding of crying communication to a new level when they set out to see what happened to stress levels of infant and their mothers when babies’ cry for help at sleep time went ignored. Inadvertently, this study busted the “teaching to sleep” myth used to prop up the cry it out method. Just as you’d expect, stress levels were extremely high when babies were left to cry, and mothers’ stress levels, of course, mirrored those of their screaming babes’. But after babies’ crying stopped (because their communication was not causing the desired effect) and they were officially "sleep trained," their stress levels remained elevated—they just didn’t express it. Did they learn that it's okay to go to sleep alone? Their little bodies suggest otherwise. But we already knew this communication suppression to be the true effect, because neglected infants found in Romanian orphanages didn’t cry at all, even though their discomfort was undeniable. John Medina, PhD, in his book, Brain Rules For Baby, says, “Indeed, you could walk into some of these hundred-bed orphanages and not hear a sound.” I'm not comparing a few days of crying it out to the orphanages level of neglect, but rather demonstrating what extinction is: stifling, not teaching. Given that building trust (reliability) and establishing communication, which are intertwined, are the hallmarks of healthy infant mental development, it seems unwise to use a method that compromises both. Babies come hard-wired to expect someone to respond to them; the elevator button is supposed to work! Aside from the concern over cortisol levels produced by crying it out, is it a good idea to teach baby that his primary attachment figure is unreliable, like that frustrating elevator? Is it advisable to condition him not to communicate his needs, which are based on powerful survival instincts? When I work with clients on baby sleep issues, we instead use an approach based on a brilliant psychological theory that originated in the 1930s: The Zone of Proximal Development, first asserted by the Russian scientist, Lev Vygotsky and validated and expanded over the following 80 decades. This allows me and the parents to create a sleep plan that pushes baby just enough to encourage real learning, without crossing a stress threshold that may break trust and dampened communication. We put baby in a sweet-spot that challenges him in just the right dose and frequency, based on his unique history, temperament, and age. It’s not cold-turkey; it’s not sink-or-swim; it’s not extinction; it’s actual teaching to sleep more independently. As for those cortisol levels of the mothers, after the babies stopped crying—they plummeted, no longer psychologically mirroring their still-distressed babies. The communication was broken, or as the researchers put it, “They no longer expressed behavioral distress during the sleep transition but their cortisol levels were elevated. The dissociation between infants' behavioral and physiological responses resulted in asynchrony in mothers' and infants' cortisol levels.” Parents need sleep and there are many things we can do to get it short of putting baby down and walking out that nursery door. Isn’t it better to approach sleep-training with respect for parent-infant synchrony, protection of developing communication, and assurance of lower stress levels for both mother and baby? Remember, they can’t walk out of the crib the way we can walk out of the elevator. During whatever period these desperate, intense-type cries are ignored, in their baby-perception, their very survival is at risk. For more on this topic, see my posts on Psychology Today with Dr. Darcia Narvaez. Please post sleep-training questions on my Facebook page and I'll coach you toward better nights without CIO. |
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Angela Braden is a journalist, researcher, and parent educator devoted to early parenting based on baby brain development. This blog explores what science shows we can do as parents to give our little ones the best foundations for life. |