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Infant Colic: What New Parents Need to Know
'Colic' or excessive crying, is very common among infants—it affects one in five babies, usually starting around 3 weeks of age, becoming most intense around 6 weeks, and resolving by 3 months of age. The crying can occur at any time during the day or night, but is more common in the late afternoon and evening. It can be difficult to figure out what causes the crying and how to console your baby. Even though you know your baby will get better in time, this can be one of the most challenging experiences for new parents.

What causes colic?
Over the years, there has been a lot of research to determine the causes of infant colic. The name 'colic' was given many years ago when it was thought that infant crying was caused by intestinal problems, since the symptoms can include a distended abdomen, pulling up the legs, and passing gas. But recent research shows that less than 10% of babies with excessive crying have intestinal problems or other medical conditions.

Experts currently view infant crying as a normal part of the development of babies' neurological systems in the first few months of life. During the first three months, babies' bodies and nervous systems are undergoing tremendous changes. They double their weight, an incredible growth spurt that is unmatched at any other time in their lives. In addition, they develop attachments to their caregivers, begin to vocalize cooing sounds to communicate, start to reach out to grab objects, and learn to stay awake more during the day and sleep at night. It can be difficult for babies' neurological systems to accommodate all of these changes.

Crying is the primary way that babies communicate their feelings and needs to their caregivers. Most babies cry a total of one to two hours over the course of a day. Colicky babies cry for longer periods of time and more intensely due to increased sensitivity and reactivity to the changes in their bodies and their environment. But most babies with colic are healthy, outgrow their excessive crying by 3 months of age, and continue to grow and develop well in later infancy and childhood.

How can I help my baby through colic?
Every baby is different—what brings on colic episodes for one baby is not necessarily the same as what brings on the episodes for another baby; and what soothes one baby is not necessarily the same as what soothes another baby. The challenge for parents is to observe your baby closely and try to determine what helps and what doesn't help him. Here are some steps to try:
  • Keep a diary for a week to document the periods of time your baby fusses and cries. Try to note what situations cause your baby distress and what responses seem to soothe her.
  • Talk to your pediatrician about your baby's colic. The doctor will listen to your story and examine your baby to determine whether your baby might have a medical problem causing the crying. Although medical problems are a rare cause of colic, they are more likely if your baby has persistent vomiting, diarrhea, failure to grow, or continued colic after 4 months of age. For example:
    • An allergy to cow's milk protein: this is more likely in families with allergies. If you're feeding your baby formula, the doctor might recommend changing to a special hypoallergenic/hydrolyzed casein or soy formula for a week. If your baby has a milk allergy, you'll notice an improvement.
    • For breastfed babies, a reaction to some irritating food in your diet: try eliminating caffeine (coffee, tea, cola, chocolate), milk products, onions, and cabbage from your diet for a week to see if it reduces the crying.
    • Gastroesophageal reflux (excessive vomiting or spitting up): if your baby is diagnosed with this problem, the doctor could prescribe medication to help.
  • Try to develop regular, predictable routines for your baby's feeding, playing, going out, bathing, and sleeping. Try to make the transitions between activities smooth and gentle. This can help your baby anticipate changes and move more comfortably from one activity to the next.
  • Identify the times of day when your baby is quiet and alert. Play with your baby and enjoy your baby fully during these times.
  • Try to avoid over-stimulating and over-tiring your baby, especially in the late afternoon and evening. Avoid many strong stimuli—sights, sounds, and motion—all at once.
  • Recognize your baby's early signs of distress such as frowning, yawning, turning her eyes and head away, turning red, breathing irregularly, squirming, flailing her arms and legs, arching her back, and whimpering. Respond promptly to reduce the stimulation and help your baby calm herself. Try the following to see what might help:
    • Take your baby into a dark, quiet room.
    • Swaddle your baby in a blanket to help her feel warm and secure.
    • Carry your baby in a carrier on your chest, or hold your baby close to your chest with skin-to-skin contact.
    • Gently rock your baby up and down.
    • Lay your baby on her tummy across your knees and gently pat her back.
    • Give your baby a pacifier. If your baby sucks her thumb or fist, help her find it to comfort herself.
    • Hum, sing, or speak softly to your baby.
  • If you've done everything you can to soothe your baby but he keeps crying, he might just need to 'cry it out.' If you're feeling completely exasperated, the safest thing to do is to put your baby on his back in his crib or bassinet and let him cry. Check him frequently, and try some of the comfort techniques later. Don't ever shake your baby—it can cause blindness, brain damage, or death. If you're feeling overly stressed or depressed, ask your family and your doctor for help.
  • Talk with other parents whose babies have colic. Share your experiences, feelings, and coping strategies.
  • Be sure to take some time each day so you can get a break from caring for your baby. Have someone you trust take care of your baby for a while so you can relax.

In all, try to maintain your empathy, patience, and self-confidence as a parent—things will be better within a few months.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician