Chapter 6: Colic

THE MYTH OF COLIC

I am painfully aware that some babies spend almost all their waking hours crying and screaming. I have known parents to be suicidal at worst and depressed at best with babies such as these. But to label their babies as having “colic,” a meaningless phrase to describe an unhappy, distressed baby, merely lets the doctor off the hook and allows the parent to have a “diagnosis.” We might as well say “baby crying!” The diagnosis of colic should be relegated to the garbage pile. We know something is bothering the baby, and it’s the job of the doctor to try to figure it out.

Where in the world did you hear?

Colicky babies have cramps in their tummy.

Sound Advice

“Colicky” babies are the recipients of countless remedies for “cramps” such as herbal teas, gripe water, antispasmodics, simethicone, antacids, pain killers, heating pads and even sedatives, almost all inappropriate and many potentially harmful. Before any therapy is given, it’s important to look at the evidence.

Cramps don’t occur if stools are normal. However, if the movements are loose, bloody, mucusy or hard then the baby’s tummy might well be the source of the problem. Since milk intolerance or protein allergy can make the baby sick, changing the formula to a specialized hypoallergenic formula or modifying mom’s diet when nursing might solve the problem. But these changes will only be effective if the baby’s digestive system is the true source of the crankiness. If the stools are normal, usually soft, yellow to light brown, and if the baby is gaining weight, it’s time to look elsewhere.

The Conclusion

If the stools are normal in appearance, parents will be frustrated to find that cramp remedies or changes in diet usually don’t solve the problem. It’s important to look elsewhere.

Where in the world did you hear?

Colicky babies have too much acid in their stomachs.

Sound Advice

Cranky babies are often given simethicone drops or antacids in the hope of neutralizing excess gastric acid. But in the absence of symptoms such as spitting up, these measures usually don’t work. Babies who do spit up a lot, however, may be suffering from GERD, gastroesophageal reflux disorder, a cause of painful heartburn. GERD babies sometimes display peculiar behavior, Sandifering, when nursing or taking a bottle: pulling away in pain, extending the neck or arching the back, as though swallowing a razor blade. Those babies with GERD can be turned into angels when their gastric acid is tamed with thickened feeds and antacids such as Zantac or Mylanta. Simethicone is not an antacid and, except for eliminating a few air bubbles in the upper stomach, is quite worthless.

The Conclusion

It helps to observe your baby’s behavior when feeding, especially if she is unusually cranky. If spitting up or pulling back occurs, antacid treatment should help. Otherwise, look for another explanation for the crying.

Where in the world did you hear?

Colicky babies are very hungry. You’ve got to feed them more often.

Sound Advice

What a mistake! A common but rarely recognized cause of distress is overfeeding. Most parents and some doctors mistakenly attribute almost all crying to hunger: when the baby cries a lot, she gets fed a lot. Many “colicky” infants find themselves getting fed every one to two hours in response to crying. Mom has no life! Sticking a nipple in her infant’s mouth usually reduces the crying, but only for a short time. Then the cycle begins all over again. These “hungry” babies may spit up a lot and have frequent stools despite prodigious weight gain. Hungry babies? Not a chance. These poor creatures are miserable from intestinal overload or bloating: overeating. Remember how you felt the last time you ate or drank a lot more than you should have? Not surprisingly, these babies usually stop their excessive crying (and sleep better) when their feeding schedule is stretched to every four hours, giving them time to empty their stomachs and digest their last meal. What a relief for everyone!

The Conclusion

Unless your baby is failing to gain weight, it is a mistake to respond to cranky behavior with increased feeding. This usually makes the problem worse.

Where in the world did you hear?

The baby is cranky because she’s constipated. She’ll feel better if she can relieve herself more often.

Sound Advice

Constipation as a cause of crankiness? True constipation, the presence of hard, formed stool is not common in young infants. Although some babies wait several days before relieving themselves, especially when nursing, the stool produced is usually soft. These babies are usually relaxed and happy, despite having passed their last stool some time ago. This is not constipation! Parents often fear their infant is constipated when they observe straining, grunting and purple faces when defecation is attempted. Another surprise awaits the anxious parent: the stool finally produced is usually soft, not the granite boulder anticipated after all that labor. Is this constipation? No. It’s just that these babies haven’t yet learned to relax their rectal sphincter muscles when pushing normal stool out. It’s like trying to force a door open that’s still latched shut. This temporary discomfort can be relieved by gently stimulating the anus with a glycerin suppository when the baby is straining. After a few weeks, virtually all babies catch on and the purple faced bowel movement is a thing of the past.

Babies are truly constipated when infrequently passed stool is large and formed, looking more like the stool of an older child or an adult. True constipation can, indeed, result in cramps, excessive gas, fullness and discomfort while feeding. Usually increasing fluid intake, changing the formula or adding prune juice (usually one or two ounces daily) to a bottle should solve this dilemma. When these simple remedies fail to work, the baby needs to be evaluated for other conditions such as Hirschprung’s Disease and hypothyroidism, among others. Often, the cause is genetic. Just ask mom about her bowel habits.

The Conclusion

Although it’s common to blame constipation for almost everything, must cranky babies are not constipated even when their movements are infrequent. If your cranky baby doesn’t pass large, hard stools, look for another answer.

Where in the world did you hear?

Colicky babies have too much gas.

Sound Advice

Here’s another “condition” which supports the drug manufacturers. Favored by most grandmothers and caretakers around the world, gas is our most popular scapegoat. Does gas cause pain? Usually not! Gas, a normal byproduct of intestinal bacteria, passes painlessly through the colon and out the rectum, albeit with some fanfare. Sometimes excessive gas is a sign of dysfunction, such as retained stool or formula intolerance but those conditions are unlikely if stools are normal and the baby is gaining weight. Babies always pass more gas when crying due to abdominal muscle contractions. Crying produces flatulence, not vice versa. Think of it, do you ever cry when you pass gas?

The Conclusion

Every human being produces gas. Babies are shameless and expel gas at will, especially when they’re crying. However, there is no evidence that normal gas produces pain, nor is it a sign of illness. Be happy that your baby passes gas, it means that he is alive and well.

Where in the world did you hear?

Babies who are always cranky must have something wrong with them.

Sound Advice

Despite exhaustive efforts by parents, some infants are just plain miserable! Don’t blame the frustrated parents. Some babies who are cranky with no apparent reason may have inherited an irritable temperament. Every baby is born with a different threshold for crankiness. Have you ever noticed that some babies always seem relaxed while others jump out of their skin when you look at them? Nothing appears to soothe some infants, neither singing, cuddling nor rocking seems to work. These babies are a source of great frustration, parents feeling guilty and inadequate. Nothing could be further from the truth since these parents usually expend much more energy in the care of their babies than those whose babies are “laid back.” These cranky babies eventually become mellower and parents learn to deal with a slightly whiney personality as the child matures.

And then there are those infants who are happy most of the day until they enter the “witching” hours, usually between 6 P.M. and midnight. This group can drive parents to drink. For no apparent reason, witching hour babies cry inconsolably for several hours during the evening. Nothing soothes them and yet nothing is wrong with them. They merely cry at the top of their lungs until the period of “witching” passes, reverting to their former peaceful, happy state. Most pediatricians feel that this merely represents an immature arousal cycle in the infant’s developing central nervous system. The good news is that this irritable condition, usually inherited from one or both parents, is short lived, a few weeks at the most. Questioning the grandparents almost always reveals that one of the parents was a “difficult” baby. The cure for this type of “colic” comes with time since, by six to eight weeks most babies learn to enjoy life a little more. So do the parents.

The Conclusion

It’s important to rule out all organic causes of discomfort in your baby. If he is healthy but continues to be cranky, don’t despair. Time is on your side and even the most miserable baby, after a few weeks, should become much happier. So should you.

Have any questions? Please contact Dr. Mesibov

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