The fourth trimester

Colic may be a stage of development—and it’s not your fault


Judith A. Weinstein

Ten years ago, my daughter, Abigail, was born screaming into this world. My husband and I brought her home on a crisp, clear morning in December, and she continued to cry vigorously hour after hour, day after day.

We called the hospital.

"We can’t get her to stop crying," we shouted to the nurse over Abigail’s screams. We felt helpless and unprepared. Photos from those early weeks show my daughter’s beet-red face and my hand in a splint for skier’s thumb from picking Abigail up so many times every day.

Abigail had colic. And nothing seemed to help.

The word colic comes from the ancient Greek word, kolikos, meaning "pertaining to the intestine." This reflects early theories that gastrointestinal disorders cause colic. Other theories blamed mothers’ anxiety, infants’ difficult temperament or newborn brain immaturity. But none of this holds up in the face of extensive research.

About 20 percent of infants are colicky. It doesn’t matter whether you’re a single mom in Copenhagen, a couple in Chicago or a hunter-gatherer of the !Kung San tribe of southern Africa.

But there is still no universal agreement on what causes colic. Some experts, including pediatrician Dr. Harvey Karp, call colic the "missing fourth trimester" because some signs indicate the baby should still be in utero.

"As odd as it may sound, our babies cry because in some important ways, they are born three months too soon," Karp wrote in the February 2004 issue of Contemporary Pediatrics.

Six reasons

Karp believes colic should be considered the fourth trimester because:

 Colicky babies act as though they have tummy troubles, possibly an overreaction of an immature neurologic system to normal intestinal sensations.

 Crying peaks in the evening. This "witching hour" may be caused by a day full of stimulation.

 Colic’s onset is delayed in premature babies. Preemies are not often alert, and not subject to the stimulation that can cause colic.

 Relaxing and shushing mimic the womb and calm colicky babies.

 Research suggests a reduction of colic in cultures where parents simulate the womb by wearing babies in a wrap.

 Colic ceases after three months—the end of the fourth trimester.

Tracking the cause

Colic is a diagnosis of exclusion, says Dr. Rachel Goodman, a pediatrician at Evanston Northwestern Hospital. So the first step is to rule out other causes, such as reflux. Reflux is characterized by arching of the back and irritability—also colic signs—but is due to milk rising from the stomach into the esophagus. Reflux can be treated medically or by changing feeding positions. But often, reflux is diagnosed as colic, says Dr. Marc Weissbluth, a North Side Chicago pediatrician who studies baby crying and sleeping.

Linda Gilkerson, director of the Erikson Institute's Fussy Baby Network, agrees. She and Dr. Larry Gray studied 12 months of crying baby visits to the University of Chicago Hospitals' emergency room. They found no medical reason for one-third of the crying cases.

So is colic simply unexplained crying? Perhaps. True colic follows the rule of threes: Crying for more than three hours a day, for more than three days or nights per week, for more than three weeks.

That’s it. No medical or gastrointestinal cause, no fault. Once you rule out medical issues and confirm crying follows that pattern, you can call it colic.

Offer relief, not advice

So tell all the neighbors, grandmothers, mothers-in-law and well-intentioned friends—you don’t need their advice. You need a sympathetic person to babysit and give you a break.

Lakeview mom Mimi Wallman’s son, Silas, now 2, had colic. "I would just feel bad for him. I felt powerless," she says. Friends were supportive to a point. "I have a friend to this day who thinks there’s something wrong with him."

Since colic is not a medical problem, most doctors don’t want to deal with it, says Weissbluth. Once medical causes have been ruled out and it is diagnosed as colic, parents may be offered methicone drops or pain relievers, but they aren’t necessary since there is nothing wrong with the digestive tract. Instead, Weissbluth looks for nonmedical strategies that center on the caregivers.

"First-time parents worry what’s wrong with their baby. The physician’s responsibility is to get rid of that feeling of guilt and responsibility, and to coach them through this difficult time," he says. Weissbluth helps parents develop coping strategies and prevent colic from becoming an enduring sleep problem.

Get help

Weissbluth also helps parents prepare before the baby is born. He encourages moms-to-be to read about the first six weeks of a baby’s life. He gets fathers and partners—or a friend—involved early because mom will need support.

Wallman agrees. "The best thing going through this was when family members were not afraid to take the baby off your hands for a while. ... But then you’re gone and you’re thinking, ‘Oh God, poor Grandma.’ You’re still not having fun. You walk out the door, and you’re like, ‘Phew,’ for about five minutes, then you’re worrying if he’s OK. Is Grandma pulling her hair out? And you’re watching the clock."

During my year in North Carolina, my husband and I had little respite. One weekend, my friend Alyce flew in from New Jersey to meet our newborn and give us an evening together. "I promise I won’t let her cry," said Alyce. Her words were kind, but I knew nothing would stop Abigail from crying.

Help for fussy babies

If only I had had access to a program such as the Erikson Institute’s Fussy Baby Network, the only program of its kind in Chicago (see story on page 11). It offers many support services on a sliding-fee scale to families worried about their baby’s crying, feeding or sleeping.

But programs such as Erikson’s are rare, and many parents feel they have nowhere to turn. Worse, some parents or caregivers may snap, leading to violence, such as shaken baby syndrome.

Indeed, every mother of a colicky baby I’ve ever spoken to has said to me, barely joking, "I can now understand child abuse." Weissbluth confirms tragedies can occur when babies cry for "no apparent reason" and parents lose it. He says most infant deaths occur in the first few days of life. The next peak in the U.S. infant mortality rate is at 6 weeks—the height of colic.

While colic happens all over world, caregiving styles may make a difference in the intensity and duration of crying. Which brings us back to the !Kung San tribe of Africa.

In 1991, Dr. Ronald Barr, a professor of pediatrics and psychiatry at McGill University in Montreal and a colic authority, studied crying in !Kung San infants. The study, published in Developmental Medicine and Child Neurology, examined whether infants in less industrialized societies cry less.

The researchers found !Kung San infants cried as often as babies in industrialized countries—but for half as long. In fact, !Kung San caregivers were able to calm their crying babies in as little as 30 seconds. The suggested reason—Africans were more likely to respond immediately and carry their infants continuously. "In contrast, rates of deliberate nonresponse in Western samples approach 40 to 50 percent," the researchers wrote.

In short, the researchers found caregiving styles affect the duration of crying, but not the frequency.

Surviving the colic

While colic does end by the third month, you still have to get through it. Here are some survival strategies:

 Less stimulation. I’m certain the constant stimulation I gave Abigail contributed to her colic. Did she really need the flash cards strapped to her car seat? On the other hand, playing the soundtrack to "Priscilla, Queen of the Desert" loudly enough to rock the house seemed to help.

 More comforting. Relaxing and shushing actions that mimic the womb can help. Our doctor gave us a prescription for Sleep Tight, a device that attaches to the crib and simulates the motion of a car going 55 mph with the wind rushing past. Insurance denied the claim, so we took to the real wheels. In retrospect, it was probably dangerous for a sleep-deprived mom to be out cruising. And while Weissbluth says there is no evidence that infant massage cures colic, it can help calm them as well.

 Wear your baby. My friend Cécile claims her trusty Baby Bjorn carrier got her through colic. Another friend taught me how to swaddle my baby on my back with a cloth, but I was a little nervous about her safety.

 Have a plan. Weissbluth says research suggests you don’t have to waste time on gimmicks—what you need is empathy and a plan.

March 15, 1995, three months after Abigail was born, she stopped crying. She woke up with a smile. By no means did she become an "easy" baby. She was still intense and had trouble sleeping.

When my husband and I finally got the courage to plan another pregnancy, we vowed we would be different if we had another colicky baby. We aimed for a spring birth date and got it. Our identical twins were born in April 1999. They were not colicky.

Judith A. Weinstein, who lives in Chicago, is a public health educator, writer and the mother of three.

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