Newborn Crying and Colic

Why do babies cry?

• They are hungry.
• They are tired.
• They have a dirty diaper or a diaper rash.
• They are too hot or too cold.
• They have gas, reflux, or other tummy issues.
• They want to be held.
• They want more stimulation.
• They want less stimulation.
• They are sick.
• They are teething.
• They are picking up your anxious or depressed mood.
• They are responding to a random occurrence: this tag on my shirt is scratchy, someone’s hair is wrapped tightly around my finger or penis (this is common), or something is pinching me.

What is normal crying?

Crying is a baby’s way of communicating that she needs something, or she needs you. Nearly all babies go through a fussy period of normal crying.

What is colic?

Colic occurs in about one-fifth of all babies. Colic is defined as crying that lasts for more than three hours per day, more than three days per week, and more than three weeks. Remember 3-3-3. There is no single cause of colic.

Common characteristics of colic

• Crying associated with colic generally starts between two and four weeks, peaks at four to six weeks, and subsides by twelve weeks.
• Colic screams often begin during or shortly after a feeding.
• Babies with colic may grunt, strain, or seem relieved by passing gas or pooping.
• Colic is normally worse in the evening hours.
• Colic can occur with a fifth child just as easily as with a first child.

Possible colic triggers you can control

• Mom’s diet. Foods passed through breast milk can affect baby, typically two to six hours after exposure. The worst trigger foods are dairy products, coffee, tea, soda, soy products, peanuts, shellfish, chocolate, gas-producing vegetables (peppers, onions, broccoli, cabbage, and cauliflower), acidic foods (tomatoes, citrus, berries), and spices (garlic, chili pepper, curry).
• Formula. Talk to your doctor. The AAP does not recommend switching to soy formula for colicky infants, but some babies may be sensitive to certain proteins in standard milk-based formulas.
• Over-feeding with a bottle. Feedings should be at least two to two-and-a-half hours apart. If feeding takes less than twenty minutes, the hole in the nipple may be too large.
• Too much foremilk. If you are breastfeeding a colicky baby, let baby finish the first breast before offering the second. Foremilk at the beginning of each feeding is more pressurized and gassier and lower in calories and fat. Hind milk at the end of each feeding is richer in fat and under less pressure. Hind milk is typically more soothing to baby’s stomach, and it can be healthier as well, since fat is necessary to metabolize many vitamins.
• Medicine. Medicines passed through breast milk can also upset your baby’s digestive system.
• Hypersensitivity to stimulation in the environment. Avoid bright lights and loud or abrupt sounds while feeding.

Possible colic triggers you can’t control

• An intense temperament
• An immature nervous system
• An immature digestive system
• Acid reflux
• Increased hormone levels that make people fussy
• Embryonic and post-natal experiences that altered the enteric nervous system, or the “second brain” in the gut⁹

If your baby won’t stop crying, what can you do?

• Take a few deep breaths and calm yourself first.
• Take baby outside.
• Hold and cuddle baby in an upright position. This helps move gas out of the body and reduces heartburn.
• Rock baby. Rocking is particularly calming and comforting because every step Mom took in utero caused a swinging motion. Rocking also helps baby pass gas.
• Sing lullabies or make calm “shushing” noises.
• Give baby a massage with lotion.
• Bicycle baby’s legs to help release gas.
• Offer baby a pacifier or your pinkie finger for sucking.
• Swaddle baby in a thin blanket. Make her feel secure and warm.
• Put baby on her side to move the gas around, then put her on her back to sleep.
• Try a colic hold or “super baby hold”: hold your arm in front of you, palm facing up, and place baby stomach-down on your forearm, with your hand cupping the upper chest. Walk baby around the house, flying him up and down like super baby.
• Put baby on his stomach across your knees while rubbing or patting his back.
• Wear baby in a sling or front carrier. Sometimes the more baby is held during the day, the less baby will fuss at night.
• Take baby for a car ride.
• Turn on white noise for baby. You can buy a small, portable white noise machine, download white noise online, or turn on a fan, hair dryer, or vacuum cleaner to help soothe baby.
• If painful gas is suspected and you’ve exhausted this list, try a few drops of over-the-counter anti-gas simethicone. Simethicone is generally considered safe for infants because it is not absorbed into the bloodstream. It decreases the surface tension of gas bubbles to promote flatulence.¹⁰ However, at $8-10 per ounce, parents should carefully assess results. Some studies show that simethicone may produce nothing more than a placebo effect for infants and infant colic.¹¹

Safety Alert!

Self-Control and Colic

The noise stress from colic, in addition to sleep deprivation, social isolation, and frustration over not knowing what to do, can be unexpectedly intense when compounded over several colicky hours. Know when it’s time to take a break.

• Call in back-up help. Ask a friend or family member to help with the baby for a few hours.
• If you are feeling out of control, put baby down in a crib, close the door, and let him cry in a safe place (for no more than a few minutes), while you gather perspective in another room.
• Never shake your baby. Inconsolable crying or colic is a primary trigger for shaken baby syndrome (SBS), a leading cause of child abuse deaths in the U.S. It is estimated that 65-90% of SBS offenders are male.¹²

If baby is four months old, and the colic is not subsiding, consider these possible medical causes:

• Gastroesophageal reflux (GER): This is baby heartburn, or stomach acid floating up into the esophagus. If baby spits up after feedings, shrieks like he is in pain, cries mostly after feedings, draws up his legs in pain, and seems better when he is upright, he may have reflux.
• Food sensitivities: Keep a log of the foods that may be triggering your baby’s colic.
• Cow’s milk sensitivity: The potentially allergenic protein in cow’s milk, beta-lactoglobulin, may affect a breastfed baby when Mom drinks cow’s milk
• Transient Lactase Deficiency (TLD): This is a temporary insufficiency in the intestinal enzyme that digests lactose sugar in breast milk or formula. TLD may improve by adding drops of the enzyme to an infant’s breast milk or formula.
• Formula allergies: Talk to your doctor. Cow’s milk allergy (CMA) is estimated to affect two to three percent of young children. The diagnosis of CMA can be based on a supervised oral food challenge (OFC), or a convincing clinical history, skin-prick test, and measurement of certain antibodies when baby drinks milk-based formula.¹³ Following proper testing, a hypo-allergenic or lactose-free formula may help.¹⁴

Practical tips from real parents: Colic

• Try your best to keep colic in perspective. This, too, shall pass.
• This is how colic played out in our house: After a long day of caring for our firstborn solo, by 8:00 p.m. or so I would lash out at my husband, “Do something! Why do you never help with the baby?” He would yell back, “Because you won’t even let me touch the baby without your permission!” Baby would cry louder. Then we would try a swaddle, a pacifier, a hair dryer, a vacuum, and white noise from an iPod. Hours would pass and baby was still crying. Looking back, yelling at my husband was not particularly helpful. Colic is just something that you have to get through together.
• Colic can affect your marriage months after the crying stops.
• Do not allow anyone in the family, especially from an older generation, target your wife as the cause of baby’s colic. There is an old wives tale blaming colic on a new Mom’s anxiety that has no scientific base.
• Vacuuming with baby in a sling was our colic cure.
• I held our baby upright, danced around the house, and sang repetitive songs. I think it helped my baby weight come off, too.
• Hold a colicky baby in front of a mirror and let him watch his own dramatic performance. Touch his foot or hand to his reflection and watch him go silent.
• Many friends say their worst colicky babies turned out to be their most motivated kids—a frustrated temperament as an infant may signal a child with extra “get-up-and-go” later.

Sources

7.         Dube, R. Mom survey says: three is the most stressful number of kids. Today Moms 2014; Available from: http://www.today.com/moms/mom-survey-says-three-most-stressful-number-kids-6C9774150.

8.         Bureau of Labor Statistics. Employment Characteristics of Families 2013. 2014; Available from: http://www.bls.gov/news.release/famee.nr0.htm.

9.         Shamir, R., et al., Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms. J Pediatr Gastroenterol Nutr, 2013. 57 Suppl 1: p. S1-45.

10.       Medical Letter on Drugs and Therapeutics, Simethicone for gastrointestinal gas. Med Lett Drugs Ther, 1996. 38(977): p. 57-8.

11.       Metcalf, T.J., et al., Simethicone in the treatment of infant colic: a randomized, placebo-controlled, multicenter trial. Pediatrics, 1994. 94(1): p. 29-34.

12.       Shelov, S.P. and American Academy of Pediatrics, Caring for your baby and young child: birth to age 5. New & rev. 5th ed. 2009, New York: Bantam xxxvi, 892 p.

13.       Kattan, J., R. Cocco, and K. Jarvinen, Milk and soy allergy. Pediatr Clin North Am, 2011. 58(2): p. 407-426.

14.       Karp, H., “Happy baby doctor” calms colic crying, M. Falcon, Editor. 2002: USA Today.