Clinical Reference Systems: Pediatric Advisor 10.0
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DESCRIPTION OF FUSSY CRYING (COLIC)

• Unexplained crying
• Intermittent crying one or two times per day
• Healthy child (no sickness or source of pain)
• Well-fed child (not hungry)
• Bouts of crying usually last 1 to 2 hours
• Child acts fine between bouts of crying
• Child is usually consolable when held
• Onset usually under 2 weeks of age (crying that begins after 1 month of age is not colic)
• Usually stops by 3 months of age

CAUSE

Normally infants do some crying during the first months of life. When babies cry without being hungry, overheated, or in pain, we call it colic. About 10% of babies have colic. While no one is certain about what causes colic, these babies seem to want to be cuddled or to go to sleep. Colic tends to occur in high-need babies with a sensitive temperament. 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. Cow's milk allergy may cause 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.

EXPECTED COURSE

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 with treatment.

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

HOME CARE

1. Hold and soothe your baby whenever he cries without a reason.

   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:

   • cuddling your child in a rocking chair
   • rocking your child in a cradle
   • placing your child in a frontpack or pouch, which frees your hands for housework
   • placing your child in a windup swing or vibrating chair
   • going for a stroller (buggy) ride, outdoors or indoors
   • anything else you think may be helpful (for example, a pacifier, massage, or warm bath).

   If all else fails, you might want to buy a device named Sleep Tight. This new device attaches under the crib and simulates the motion and sound of a moving car. This gadget has lessened colicky behavior in over 90% of babies. It costs about $70. For more information call Sleep Tight at 1-800-662-6542.

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

   If none of these measures quiets your baby after 30 minutes of trying and he has been fed recently, your baby is probably trying to go to sleep. He needs you to minimize outside stimuli while he tries to find his own way into sleep. Wrap him up and place him on his back or side in his crib. (As of 1992, this is the sleep position recommended by the American Academy of Pediatrics for healthy infants.) He will probably be somewhat restless until he falls asleep. Close the door, go into a different room, turn up the radio and do something you want to do. Even consider earplugs or earphones. Save your strength for when your baby definitely needs you. But if he cries for over 15 minutes, pick him up and try the soothing activities again.

3. 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 process. Your baby's colic 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.

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

   Try to keep your child from sleeping excessively during the daytime. If your baby has napped 3 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.

5. Try these feeding strategies:

   Don't feed your baby every time he cries. Being hungry is only one of the reasons babies cry. It takes more than 2 hours for the stomach to empty, so wait at least that long between feedings or you may cause cramps from bloating. If you are breast-feeding, avoid taking or drinking coffee, tea, colas, and other stimulants.

   If your child also has diarrhea, vomiting, eczema, wheezing, or a family history of milk allergy, he may be allergic to cow's milk in your diet. If you are breast-feeding, avoid drinking or eating any forms of cow's milk for 1 week to see if your baby's condition improves.

   If you are feeding your baby formula, and he also has symptoms of allergy, try a soy formula for 1 week. Soy formulas are nutritionally complete and no more expensive than regular formula. If your baby's condition dramatically improves when he is on the soy formula, call your baby's physician for additional advice about keeping him on the formula. Also, if you think your child is allergic, but soy formula doesn't seem to help him feel better, call your baby's physician about the elemental formulas.

6. 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.

7. 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 are ineffective and many (especially those containing phenobarbital) 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 according to recent studies, but they are harmless.

   Don't place your baby face down on a waterbed, sheepskin rug, bead-filled pillow, 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) for best results.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• Your baby cries constantly for more than 2 hours.
• Your baby is less than 1 month old AND acts sick.
• You are afraid you might hurt your baby.
• Your baby is acting very sick.

CALL YOUR CHILD'S PHYSICIAN 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.