How to tell if your child is suffering from colic

Imagine this scenario.

Your baby is her bouncy self during the day. She just completed two weeks in this world. She is content, feeds properly and gives an occasional smile. But when the clock strikes six, she is an entirely different person! She starts to cry A LOT! Nothing you do soothes her. You start wondering where you are going wrong… Is she getting enough milk? Is she tired? Are you holding her correctly? She keeps on crying and your self-doubt deepens.

Does this sound familiar?

“Yes,” you may say, “she is suffering from colic.”

Well, new evidence has come to the surface and it changes the way experts think about crying. In most of such cases, the crying is a normal phenomenon. The use of the word ‘colic’ is gradually becoming redundant. Dr Ronald Barr, the Canada Research Chair in Community Child Health Research at the University of British Columbia describes it as the period of PURPLE crying.

What is the Period of PURPLE crying?

PURPLE is an acronym that explains the crying pattern during this phase. The baby’s crying gradually increases and Peaks around two months and then starts to wane. It is often without any triggering factor, thus Unexpected. The crying is Resistant to soothing and the baby often makes a Pain-like face, even though she is not in pain. The crying is Long-lasting and it generally happens during late afternoons and Evenings.

From this, you can be sure of three things:

• All babies cry, some more others less.
• It is a period: there is a start and more importantly, an end to it.
• It is not your fault: you are not doing anything wrong.

You may be wondering, is this just a fancy way of describing colic? Let us see what colic is and how this is a better way of understanding the crying for parents.

How is this different from colic?

In 1954, a brilliant paediatrician, Dr Wessel, proposed a definition for colic. Colic is defined by the Wessel’s rule of 3:

‘A healthy baby with periods of intense, unexplained fussing and crying lasting more than three hours a day, more than three days a week, for more than three weeks.’

At that time, this was a game-changer as very little research was available about crying. So it is not surprising that he was the doctor not just for children but for the whole family. A baby’s cry makes everyone doubt where they are going wrong. Dr Wessel helped parents understand that they were not at fault.

However, this definition poses two main issues. To start with, it would let someone believe that some babies have colic whereas others do not. The second issue and the most important of all is that it makes us believe that it is a ‘condition’ and thus, warrants treatment. A recent study shows that there is no ‘effective treatment’ for colic. Another study, albeit a slightly older one, states that the contemporary ‘treatments’ did not perform better than placebos. At the best, if the babies are allergic to certain proteins found in the food, the mother would have to make some dietary modifications.

I am sure Dr Wessel did not intend us to reach this interpretation, but the way colic is described and discussed, it often ends up being that way. That is why defining it using Wessel’s rule of 3 makes us want to get the baby treated.

PURPLE, on the other hand, is more helpful for parents. It is described in such a way that it helps us appreciate that it is natural, like say, teething. Clubbing all the crying babies together would not solve any purpose, and as the study shows, only about 5% of the babies diagnosed with colic have some organic underlying cause.

The biggest problem in calling the crying as colic is that it is often treated. Not all medicines are safe for the babies and unnecessary ones should be avoided.

How much crying is normal?

Babies cry. It is the only way of expression for them. The cause behind the crying is unknown. However, Dr Ronald Barr describes the importance of crying in the psychosocial development in children.  Here, he states that ‘Similar “distress curves” have been found in all mammalian species in whom it has been looked for, including guinea pigs, rat pups, chimpanzees, and Rhesus macaques, suggesting that this distress pattern is not unique to human infants’. He later concludes that the research that has happened in the past 30 years has shifted the understanding of crying from being a ‘pathology’ to being just normal.

So, as long as the baby is content during the non-crying periods, is feeding well and exhibiting all the symptoms of being a ‘happy baby’, you should not be worried. Infants have been known to cry for even five hours in a day! Imagine the frustration of the caregivers. But that is normal. So unless the crying is associated with any other illness, you can safely consider it as normal.

How to handle the baby during this phase

This is the most important part. Dr Barr goes on to explain that the emotional distress seen in the caregiver can cause often grave injuries to the baby. The incidence of Shaken Baby Syndrome: a disastrous outcome of the incessant crying is highest at 12 weeks when the crying is at the peak. Shaken baby syndrome is when a caregiver, in an attempt to soothe the baby, or to stop her from crying, shakes the baby vigorously. It can cause severe brain injury to the child, and can also result in death.

So, it is very important to understand how to handle the baby during this fussy period. As the definition goes, the baby is inconsolable. Nothing you do is going to make her ‘stop’ from crying. But soothing the baby will reduce the intensity of crying. Infants respond to touch. So give your baby all the cuddling she can possibly have, even when she is crying.

Follow these seven steps to soothe the baby even if she does not stop crying:

1. Ensure that the baby is comfortable. Add/subtract layers of clothing.
2. Use a thin swaddle cloth to swaddle the baby.
3. Hold the baby in such a way that she is on her side. Cry and hold her as close to you as possible. Many times, your scent can reduce the intensity or cut short the duration of crying.
4. When it is evening, switch on the lights, taking particular care that the lights are not harsh.
5. Avoid going to malls or other places in the evening where your baby will see bright lights.
6. Sing and repeat. Human voices soothe the babies much better than electronic voices. Repetition works wonders with babies.
7. If you are feeling frustrated, switch places. The rule of thumb is switch every 20 minutes. Don’t keep on carrying the baby in a frustrated state. It is instances like these that lead to Shaken Baby Syndrome.

 DO’s and DON’Ts

Here is a quick list of do’s and don’t when it comes to taking care of a crying infant:

Do’s

• Rule out the cause of cry due to illness, hunger, soiled diaper, burp, clothing or flatulence.
• Anticipate a cry. Try what worked last time.
• Try latching her once or twice after burping her. Maybe, this particular episode might be just a hunger cry.
• Keep a tab on the growth of the baby. PURPLE is applicable only when the baby is growing normally.
• Try different holds.
• Distract the baby by singing, walking or plain talking. The baby is in a developmental phase where she is discovering the world around her. You can get temporary breaks between bouts of crying when you successfully distract the baby.
• A change of hands can also do the trick.

Don’ts

• Don’t vent out your frustration on the baby.
• NEVER EVER shake the baby.
• Don’t get caught in self-doubt.
• You are not a bad mum/dad if you just want a break. Don’t feel guilty about taking a few minutes off.
• Don’t feel bad if the baby stops crying in someone else’s hand. The baby is too small to understand the mother-daughter relationship.

Remember, this is just a phase. It will soon pass. In just a couple of months, your baby would be her bouncy self and start giving you that million-dollar smile of recognition. Till then, just hand in there mums! Read more about PURPLE crying here.

References

1. Wessel MA, et al.Paroxismal fussing in infancy, sometimes called “colic.” Pediatrics. 1954; 14:421-435
2. What Is Colic?
3. Crying Behaviour and Its Importance for Psychosocial Development in Children
4. Why This Crying Is Normal
5. Infantile Colic. ROBERTS D M, OSTAPCHUK, M, Am Fam Physician. 2004 Aug 15;70(4):735-740.