Parenting is a joyful and rewarding experience and the appearance of a concern in the newborn can be very distressing. We frequently encounter parental concerns themed on crying and suspicions of colic in newborns. This post on Infantile colic is the first of two addressing this concern commonly seen in about 1:5 newborns. The most widely used definition of colic is set in the rule of threes. These seriously fussy babies cried for more than 3 hours a day, more than 3 days a week, and for longer than 3 weeks. This cascade of events is Illustrated below.
Baby’s been home for more than 2 weeks already and everyone’s settling into the routine of caring and nurturing the newest member of the family, then here comes along these crying bouts, with a higher pitch than mom or dad ever recalled before. These crying episodes now occur more frequently and baby is only about 3 weeks old, and oh yes- they go on for hours, sometimes for as long as 3hours! It happens up to three times weekly! Even more perplexing to everyone is the fact that baby is dry, was fed recently, and doesn’t appear ill or unwell. The crying goes on and on, despite efforts to soothe and calm the baby and this is all happening in the evening – just when everybody is getting tired and getting ready for bed! Did the doctor also say this can go on for up to 3 or 4 months?
Crying is a welcome response to stimulation especially right after the newborn is removed from the birth canal during the birthing process and pretty much a normal feature of infancy. When it occurs in the context described above, Infantile Colic becomes a strong possibility in the affected infant. Physician notification and evaluation is necessary in these situations to exclude other potentially serious conditions that may be amenable to medical and occasionally surgical intervention that can also present with prolonged crying bouts.
The mnemonic PURPLE, developed by the National Center on Shaken Baby Syndrome, is designed to reinforce parental education which as we discuss in this post is the cornerstone of treatment and to help reduce the incidence of shaken baby syndrome, which sadly still happens. Never shake a baby. This mnemonic PURPLE helps to remind parents of the characteristics of infant crying: P for the peak pattern occurring around the third week of life to about 3 months, U for the unexpected timing of episodes, R for resistance to soothing, P for pain-like look or drawing up of knees, L for long bouts lasting for 3hours are not uncommon, and E for the evening pattern of occurrence of these symptoms.
What Can I do to help my baby with colic? “Anticipation is more potent than surprise”, once quipped a very successful military commander. Anticipating colic and having a plan in place during these fussy periods can be a particularly potent intervention. In our practice, parents are encouraged to first ensure that the baby is dry and fed. Soothe the baby by swaddling, or gentle rocking motions. Certain distracting sounds, not subjected to scientific scrutiny at any level yet, but commonly generated in the home e.g., from a kitchen blender or vacuum cleaner or the static noise from a poorly tuned TV or radio have oddly worked sometimes too. A short car ride with the gentle din of the engines etc. have anecdotally worked too. These interventions take the infant’s attention away from the discomfort central to colic. When crying continues despite these interventions, parents should allow the infant to cry for a short period and observe. This approach allows parents to reassess the situation and is a cautious reminder that crying is a feature of infancy. This can assuage parental concerns however momentarily. The rule remains, never shake a baby. Calling your pediatric office to review the situation offers much needed support and a follow up plan on the infant's symptoms usually follows. Parents should not neglect themselves, their overall health and well being directly affects their ability to care adequately for the infant. Good amounts of rest, and enlisting the help of family members or friends to take over from time to time to reduce stress on themselves.