Colic Cry or Reflux Cry?
When your baby is crying, all of your energy is focused on finding a way to calm her. You might try rocking her or walking with her over your shoulder. If that doesn't work, you might feed her or change her. On and on you go until she is calm again. But what if you cannot calm her? What if the crying escalates into shrieking and her little body is stiff and her fists are clenched? You might start to feel tense and upset, even angry. Anyway, why is she so upset?
Is it a Colic Cry or Reflux Cry?
Whether your baby has colic or gastroesophageal reflux disease, it is likely you will deal with a lot of crying. Some babies will cry for hours at a time or all night long. When a baby is inconsolable and seems to be in pain, it is likely you will quickly get yourself to a doctor's office or the emergency room. Unfortunately a baby's communication is limited to crying so parents and doctors are left guessing what is wrong. Since gastroesophageal reflux or GER is a common condition in infancy, a doctor may look for other clues such as spit up or vomiting, poor sleep and poor eating that may indicate a diagnosis of GER. A few babies who cry in pain will even have Gastroesophageal Reflux Disease or GERD. The doctor will also look for other causes of crying such as illness, constipation or an infection. However, if the baby is otherwise healthy, gaining weight and doesn't have outward signs of a digestive problem, a diagnosis of colic may be made.
What is colic anyway? It used to be that colic was defined by the "rule of three's" or crying that lasted 3 hours or more per day, 3 days or more per week for 3 months. Now it is more often defined as inconsolable crying in a young infant that is high pitched, loud and sudden. When you look at a baby with colic, it appears that she is in terrible pain. Sometimes the pain and discomfort are from a digestive problem such as GER. According to a study at the Colic Clinic at Brown University, approximately 50% of the babies with colic have mild GER symptoms. Some babies diagnosed with colic may also have milk/soy protein intolerance. Other theories about the causes of colic include: an immature nervous system, poor self regulation for sleep, an immature digestive system, gas and too much serotonin in the brain. Recent studies have looked at the flora in the gut and found differences in babies with colic vs. babies who do not have colic. Exposure to cigarette smoke and family/maternal stress may also be risk factors for colic. The bottom line is-we still don't really know what causes colic.
The good news is, doctors are moving away from the old school method of treating colic. In the past, parents were told that their babies were "normal" and "healthy" and they just had to endure colic until it ran its course. But when your baby is so upset that you cannot take a shower or answer the phone, you feel like putting her in a basket and leaving her on the steps of the fire station...or worse.
Some doctors treat colic with medication although there isn't a great deal of evidence that these treatments are effective. Anti-gas medication such as simethicone or an antispasmodic medication may be tried. There is some evidence that probiotics reduces colic symptoms. Your doctor may also suggest changing your diet if you are breastfeeding or changing the formula. Infant massage, infant carriers and vibrating seats or swings may offer temporary relief for some babies. If you live near Brown University in Rhode Island, you and your baby would have access to the Colic Clinic and receive a holistic approach including medical treatment for your baby, support and parent strategies for calming your baby. Most of the time, doctors have limited time and tools for teaching parents how to realistically manage a baby with colic or GER who cries. I feel really sad about this because it is so important for parents to have tools for coping with a crying baby. Some parents I know have found success with Dr. Harvey Karp's Happiest Baby book and video. Others have moved grandma into the spare bedroom or hired a nanny. HealthCentral and other sites get plenty of messages from parents seeking support, mostly mothers using screen names such as, "Sleepless in Detroit" or "At my Wits End".
Most families have just endured colic and GER until it went away. I am not sure this is the best method since researchers at the Colic Clinic have found a high level of maternal stress and depression in caregivers. I wish there was a more organized approach to helping parents and especially mothers find support and tools they can use to console their babies during the longs days and nights when colic and GER take over and cause pain and sadness to all. Until then, I am sending hugs to all of the caretakers who must deal with an inconsolable infant. If I lived closer to you, I would come right over and hold your baby so you could take a shower. I would also tell you over and over again that it isn't your fault that your baby is crying and she really does love you. In the coming weeks, I will discuss home care for your fussy/inconsolable baby and coping so you will have the strength to get out of bed and face the day.