I’ve been a newborn baby doctor for the last 30 years. After about two of them I lost count of the number of babies I was seeing with so-called ‘colic’. So many endless nights, so many tears, so much screaming…and that was just the parents.
Because of these tired, sad families, I ended up developing an obsession to tell the truth about this disorder. You see, for decades the cause has been known and there is overwhelming evidence on its cause in the medical literature, but few are listening. Frankly it is driving me crazy. Sometimes I think that if I hear another nurse or doctor telling a parent that their screaming baby has ‘abdominal pain’ or ‘heartburn’ I think I’ll scream louder than the baby!
It’s not pain…
Colic has never been about pain in the abdomen or anywhere else for that matter; it’s not about heartburn or ‘wind’. It certainly isn’t about the baby’s stomach. Neither is it anything to do with mother’s mental state, nor the food she eats while is breast-feeding, nor the brand of formula if she’s not breastfeeding.
The reason it’s so hard for parents to figure it out for themselves is the cause is counter-intuitive and, no question, the baby looks like he or she is in excruciating pain. The baby doubles up, knees in chest, and screams like there’s a knife twisting in his gut. But it’s not about pain, it’s about overstimulation of the poor baby’s sensory nervous system.
Before we proceed however, please do not think that this is some crackpot notion dreamed up by some theoretical psychologist or the sound of a particular bee buzzing in my personal bonnet. Every nurse working in a mothercraft hospital, everyone who chooses to read the literature and every neonatologist that spends time observing his babies, knows this is so.
“Six O’Clock Colic”
The situation of babies screaming in distress primarily in the evening (“six o’clock” or “evening” colic) has been around for hundreds of years. It usually starts when babies get to around four to six weeks of age (though for some particularly sensitive babies, it can start from birth), rises gradually to a maximum over the next couple of weeks then often abruptly ceases about three months of age (happily it is also called “three-month colic”).
Premature babies have it earlier and more intensely. It was through the study of just this group of babies that developmental psychologists started to unravel the problem in the fullterm. As premature babies near term they can become very distressed when their environment presents them with even minimal increases in stimulation. If you pick up such a baby, look at him and talk to him, he will often start straining, crying and arching as his nervous system overloads with your input on his senses. With such as him, you can either pick up, or you can look at him, or you can speak to him. You just can’t do all of them at once.
The full-term baby psyche is much more resilient than that. But they still have their limits. If you give a 1000 families a diary in which they are to note when, and how much, their baby cries (this type of study has been reported many times in the medical literature) you find that all babies, to some degree, get upset in this time profile. They’re good for the first couple of weeks, then develop increasing unsettledness which peaks at 6 weeks of age (with an average baby crying/fussing for about 3 hours a day), then the baby population settles gradually over the next few weeks, until the amount falls rapidly at three months of age.
So, let’s start at this end, and work backwards.
The Self-Soothing Baby
At and beyond three months of age babies usually develop the ability to ‘self-sooth’. You can see this at work in a four to five month-old baby who is fed and happy and sitting in a little prop-up chair. He wants to play with his mother so he gazes at her across the room, chuckles and waves his arms to attract her. She can’t resist and approaches him, their eyes lock and soon they are talking nonsense, looking deeply into each others eyes and are totally engrossed in one another. The intensity of their interaction rises. The stimulation then increases to a level that makes the baby uncomfortable. There’s just too much stress in the interaction for him. So he suddenly he looks away, switches off and totally ignores his mother.
He looks at the ceiling or at his hands in his lap as his mother wanders off. The baby sits propped up in his chair, his shoulders tense, his eyes downcast. Then over the next few minutes he calms and relaxes and starts to throw glances at his mum.
His gazes last longer and longer as he relaxes more. Then the cycle starts again. He laughs and waves his hands to attract her and back she comes.
The baby has learnt that when he gets over-stimulated, stressed and uncomfortable, if he looks away and shuts it out, he can calm himself down. This is an invaluable lesson, the first element of a regulatory system that gives him control over the inoput from his environment. It is the start of the ability to concentrate undistracted on a task.
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 his horizons 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.
Diagnoses from “wind”, through lactose intolerance, food sensitivity and stomach spasms to gastro-oesophageal reflux. To fix it, everything from stopping breast-feeding, giving chamomile tea, “winding him properly” through to massaging his stomach (in a clockwise direction) with warm olive oil. And the worst piece of advice: “Just you let him cry it out”!
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!