The Six Week Old Baby
Now, back to the beginning. The ‘colic syndrome’ starts at four to six weeks of age. Before this, the boundaries of his attention do not stray much beyond his mother’s body and breasts, of its warmth and smell. But now his eyes can focus further and hishorizons expand and he starts to take in his surroundings. It is about a week before he smiles.
Once he starts smiling, so people around him respond. They gaze at him and he gazes back. He watches the curtains flapping by the window. Then grandma visits and she can’t take her eyes off him. With this new attention, his excitement rises to a level that makes him uncomfortable but, alas, he has not yet developed the ability to self-sooth. As the stimulation and stress levels rise he starts to get distressed. He becomes tense and begins to strain and groan, especially late in the day.
His parents become anxious, “Is he constipated? Why does he writhe and arch his back?” Soon his distress level makes him cry and scream. He is picked up and passed hand-to-hand around the family who gaze at him, trying to fathom the cause of his
discomfort. The parents ask advice from neighbours to Emergency Departments and the cascade of advice starts.
Sucking To Calm
What’s a baby to do? Upset babies find sucking calms them down. So our baby starts to feed frequently, sucking, sucking, sucking in an effort to calm himself down. Despite having a full stomach after a good feed the sucking and milk intake continues and in combination with the straining, soon becomes reflux vomiting. He is taken to the hospital, given a barium meal, an oesophageal pH probe study and treated with Zantac, Losec, Prepulsid and taken off the breast because “the flow is too fast”.
In addition, the increased intake of lactose (the sugar in milk) overloads the absorptive ability of the small intestine, so it moves on and spills into the large intestine. There bacteria ferment the sugar to form lactic acid and lots of hydrogen gas. So our baby develops a swollen tummy, twenty gassy explosive stools a day and farts like a trooper. Medical advice decides he has ‘lactose intolerance’ and breast-feeding should be stopped and lactose-free formula started.
Even the baby who isn’t fed tends to suck his tongue in his cot. So he swallows air. Hence when the distressed baby is picked up, he burps..”Ah, that’s why he’s crying, he needed to be burped!” Alas no, He’s burping because he’s crying, he’s not crying because he needs burping.
The “burping babies” story is a bit of a myth. The valve betwen the oesophagus (gullet) and the stomach is actually so weak it can bearly trap a feed let alone trap an air bubble. So regarding burping the baby after a nice feed… don’t bother.
There was a recent editorial in the Australian Paediatric and Child Health Journal titled
“Medicalising Normality” aptly describing what is happening here. All the medical diagnoses
inevitably flow from a series of vicious cycles, all downstream from the true cause of the baby’s distress. There is a condition I call “Christmas Colic” when babies do this in spades.
Too many relatives, too many parties, too much excitement leading to lots of screaming babies in Emergency Departments in late December.
How do we fix the problem? It is simple in principle and tough in practice. We have to reduce the level of stimulation in the babies environment to a level he can cope with, and do it for long enough to calm his active stress response.
In a phrase we have to “Bore Him to Sleep”.
CALMING THE BABY REGIME
- Send his grandparents home. If you have a toddler, send him with them.
- Stick a note on the front door saying that you are out
- Go into his room, draw the blinds and make the light in the room dim. Put on some quiet, restful music; that’s for you, but babies do like a background of ‘family sounds’ rather than silence.
Get the baby and take him into the room with you. Do NOT leave him on his own. He has no ‘off’ switch!
Feed him on demand in the dim light, avoiding long periods of eye contact with him (Do not however do as one mother did, who said to me “I did as you said, Doctor, I haven’t looked at him all week…). Common sense here.
Put him on your chest with his ear against your heartbeat and cuddle him until he settles. This reminds him of the sounds and feel of the womb. It may take some time. Be patient. Calm him.
Then, wrap him firmly in a sheet. Wrap him with his back rounded and his limbs contained – this will also remind him of the containment of the womb and help him feel secure. He may want to have his arms free, but it is preferable to contain them.
Place him in his cot. Pat him gently on the bottom at about 70 pats to the minute (mother’s heart rate) and just …
BORE HIM TO SLEEP
If it helps, give him a dummy.
If he gets upset (and he will), rewrap him and continue cuddling, patting or feeding. If you’re both going crazy, pick him up get someone else to cuddle him, and you take a break. Then put him in the cot again and pat him again.
Continue this (hour after hour) until he settles. Do not leave the baby to cry, but you can leave the room when he finally sleeps.
Generally the first 24 hours can be hell on wheels, but if you persevere, things will improve. He will eventually start to, as the psychologists say, ‘return to base’.
By the second day he will be calmer. Do not take him out of the room, even though he appears improved. Give it another day, to be sure he loses some of his fatigue and stress.
The more he sleeps, the less opportunity there is for him to be stimulated, and the more he will sleep. This is a good cycle, not a vicious one. When he’s calm and sleepy, you can return him to the living room.
You then need to keep the activity and stimulation in his environment down to a level that he can handle.
How much stimulation your baby can cope with depends on his basic temperament. All babies are different.
There are a few babies who self-soothe from the moment they’re born. These babies can be taken to work and meet a hundred people and not get upset. Most babies have a limit, though – you need to find out where your baby’s limit is and keep the level under that.
Some super-sensitive babies need to be in and out of their calming room for the first three months of their life. Don’t worry; they won’t suffer from sensory deprivation. Their most important lesson is learning how to calm themselves. If you have to go out, cover the pram to avoid prying eyes and flashing lights. Alternatively buy your groceries on-line!