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| '''Colic''' is a form of pain in the ] which starts and stops abruptly.<ref name="titleeMedicine/Stedman Medical Dictionary Lookup!">{{cite web |url=http://www.emedicine.com/asp/dictionary.asp?keyword=Colic |title=eMedicine/Stedman Medical Dictionary Lookup! |accessdate=2008-03-27 |format= |work=}}</ref> | |||
| <br/><br/>'''Colic''' (also known as infant colic, three month colic, and Infantile colic) is a condition in which an otherwise healthy baby cries or screams frequently and for extended periods without any discernible reason. The condition typically appears within the first two weeks of life and almost invariably disappears, often very suddenly, before the baby is three to four months old.<ref>Barr RG. Changing our understanding of infant colic. Arch Pediatr Adolesc Med. 2002; 156 (12):1172-74. </ref> It is equally common in bottle-fed and breastfed babies.<ref>Paradise JL, Maternal and Other Factors in the Etiology of Infantile Colic. JAMA 1966; 197:191-199</ref> | |||
| <br/><br/>The crying often increases during a specific period of the day, frequently this happens in the early evening (the so-called “witching hour”).<br/><br/> | |||
| '''The medical definition of colic''' is ''a healthy baby with periods of intense, unexplained fussing/crying lasting more than 3 hours a day, more than 3 days a week for more than 3 weeks.<ref>Wessel MA, et al. Paroxismal fussing in infancy, sometimes called "colic." Pediatrics. 1954; 14:421-435</ref>'' However, many doctors consider that definition, first described by Dr. Morris Wessel, to be overly narrow and would consider babies with sudden, severe, unexplained crying lasting less than 3 hours/day as having “colic” (so-called “non-Wessel’s” colic).<ref>Barr RG, Rotman A, et al, The Crying of Infants With Colic: A Controlled Empirical Description. Pediatrics 1992; 90:14-21 </ref> | |||
| <br/><br/>Persistent infant crying is much more than a parenting nuisance. Crying and the exhaustion associated with it can trigger serious and even fatal problems, such as marital stress,<ref>Levitzky S, Cooper R. Infant colic syndrome: maternal fantasies of aggression and infanticide. Clin Pediatr 2000;39:395 –400</ref> breastfeeding failure,<ref>Li, R, et al, Why Mothers Stop Breastfeeding: Mothers' Self-reported Reasons for Stopping During the 1st Year, Pediatrics 2008; 122:s69-76</ref><ref>Li, R, et al, Why Mothers Stop Breastfeeding: Mothers' Self-reported Reasons for Stopping During the 1st Year, Pediatrics 2008; 122:s69-76</ref> shaken baby syndrome (also known as abusive head trauma - the leading cause of child abuse fatalities),<ref>Catherine N, Ko J, Barr RG. Should we do more to get the word out? Causes of, responses to and consequences of crying and colic in popular parenting magazines. J Dev Behav Pediatrics 2005;26:14-23</ref><ref>Barr RG, Trent RB, Cross J, Age-related incidence curve of hospitalized Shaken Baby Syndrome cases: Convergent evidence for crying as a trigger to shaking, Child Abuse & Neglect 2006;30:7–16</ref><ref>van der Wal, MF, et al. Mothers' reports of infant crying and soothing in a multicultural population. Arch Dis Child. 1998;79:312-317 </ref><ref>Theodore AD, et al. Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas. Pediatrics 2005;115:331-7 www.pediatrics.org/cgi/content/full/115/3/e33</ref> postpartum depression (affecting 10-15% of new mothers and many new dads), <ref>Murray L, Cooper P. The impact of irritable infant behavior on maternal mental state: a longitudinal study and a treatment trial. In: Barr R, St James-Roberts I, Keefe M, eds. New Evidence on Unexplained Early Infant Crying: Its Origins, Nature and Management. Skillman, NJ: Johnson & Johnson Pediatric Institute; 2001:149 –164</ref><ref>Maxted AE, et al. Infant colic and maternal depression. Infant Ment Health J. 2005;26:56-68 </ref><ref>Howell EA, et al. Correlates of early postpartum depressive symptoms. Matern Child Health J 2006;10:149-157</ref> <ref>Areias ME, et al. Correlates of postnatal depression in mothers and fathers. Br J Psychiatry 1996;169:36-41.</ref><ref>Ramchandani P, et al. Paternal depression in the postnatal period and child development: a prospective population study. Lancet 2005;365:2201-5.</ref><ref>Matthey S, et al. Paternal and maternal depressed mood during the transition to parenthood. J Affect Dis 2000;60:75-85</ref><ref>Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression A Meta-analysis James F. Paulson, PhD; Sharnail D. Bazemore, MS JAMA. 2010;303(19):1961-1969</ref> excess visits to the doctor/emergency room (1 in 6 children are brought to the doctor/emergency rooms for evaluation of persistent crying),<ref>St James-Roberts I, Halil T. Infant crying patterns in the first year: normal community and clinical findings. J Child Psychol Psychiat 1991;32:951-968.</ref> unnecessary treatment for acid reflux<ref>Heine R et al.The role of gastro-oesophageal reflux in infant irritability, Arch Dis Ch 1995; 73:12</ref><ref>Moore DJ, et al. Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. J Pediatrics 2003;143:219-23 CrossRef</ref><ref>Jordan B, et al. Effect of antireflux medication, placebo and infant mental health intervention on persistent crying: a randomized clinical trial. J Paed Ch Health 2006;42:49-58</ref><ref>Jordan B, et al. Effect of antireflux medication, placebo and infant mental health intervention on persistent crying: a randomized clinical trial. J Paed Ch Health 2006;42:49-58</ref><ref>Heine RG, et al: Clinical predictors of pathological gastro-esophageal reflux in infants with persistent distress. J Paed Ch Health 2006; 42: 134-9</ref><ref>Putnam P. Stop the PPI Express: They Don't Keep Babies Quiet! J Pediatrics 2009:154: 475-6</ref><ref>Orenstein SR, et al Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor Lansprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatrics 2009; 154: 514-20</ref> and maternal smoking.<ref>Gaffney KF, Henry LL. Identifying risk factors for postpartum tobacco use. J Nurs Scholarsh. 2007;39:126-132</ref> Crying and exhaustion may also contribute to SIDS and suffocation (from agitated babies flipping onto their stomachs, concerned parents placing fussy babies on the stomach to sleep, tired parents falling asleep with their baby in unsafe places - like couches or beds with bulky covers),<ref>Willinger M, et al. Factors Associated With Caregivers' Choice of Infant Sleep Position, 1994-1998. The National Infant Sleep Position Study. JAMA. 2000;283:2135-42</ref><ref>Colson ER, et al. Trends and Factors Associated With Infant Sleeping Position, The National Infant Sleep Position Study, 1993-2007. Arch Pediatr Adolesc Med. 2009;163:1122-8</ref><ref>Ponsonby AL, et al. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med. 1993;329:377-382 </ref> infant obesity,<ref> Paul IM, Birch L. Pediatric Ambulatory Society (PAS) Meeting The Relationship between Infant Feeding, Sleeping, and Weight Gain Baltimore, MD May 4, 2009</ref> maternal obesity<ref>Taheri S, et al. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index (BMI). Sleep. 2004;27:A146-7.</ref> and even automobile accidents.<ref>2004 Sleep in America Poll Final Report, National Sleep Foundation, March 2004, p 165 http://www.sleepfoundation.org/sites/default/files/2004SleepPollFinalReport.pdf</ref> | |||
| <br/><br/>The total financial burden (medical costs, lost productivity, legal/penal, adverse long term health effects, etc) of the 500,000 infants/year in the United States with colic may exceed $1 billion dollars/year, paralleled by even greater human and emotional costs. | |||
| ==Causes== | |||
| Over the decades, researchers have offered various hypotheses for colic including the exposure to cigarette smoke,<ref>Stroud LR, et al. Maternal Smoking During Pregnancy and Neonatal Behavior: A Large-Scale Community Study. Pediatrics 2009:123; e842-8</ref><ref>Canivet CA, et al. Infantile colic, maternal smoking and infant feeding at 5 weeks of age. Scand J Public Health. 2008;36: 284 –291</ref> insufficient melatonin production (until 12 weeks of age, the time colic usually ends),<ref>Sivan Y, et al. Melatonin production in healthy infants: evidence for seasonal variations. Pediatr. Res. 2001;49: 63–8. doi:10.1203/00006450-200101000-00015. PMID 11134493.</ref> <ref>Weissbluth M, Weissbluth L. Colic, sleep inertia, melatonin and circannual rhythms. Med. Hypotheses 1994;38: 224–8. doi:10.1016/0306-9877(92)90099-X. PMID 1513278.</ref> circadian rhythms,<ref>Weissbluth M, Weissbluth L. Colic, sleep inertia, melatonin and circannual rhythms. Med. Hypotheses 1994;38: 224–8. doi:10.1016/0306-9877(92)90099-X. PMID 1513278.</ref> and stress of the mother in the third trimester.<ref>St James-Roberts I, Conroy S. Do pregnancy and childbirth adversities predict infant crying and colic? Findings and recommendations. Neurosci Biobehav Rev 2005; 29: 313–20. doi:10.1016/j.neubiorev.2005.01.001. PMID 15811501.</ref> <br/><br/> | |||
| Some have said that babies cry because they sense their mother’s anxiety.<ref>Infant crying: Theoretical and research perspectives BM Lester and CFZ Boudykis eds, NY Plenum Press 1985, pp.334</ref> but this is highly unlikely. After all, new babies even need help to burp! They simply don’t have the ability to distinguish a mother’s anxiety from depression, frustration, etc. In fact, even though parental anxiety is markedly reduced with successive children, it has been shown that a couple’s later children are as likely to be colicky as their first.<ref>Hubbard FOA, van IJzendoorn MH. Maternal unresponsiveness and infant crying across the first 9 months: A longitudinal study. Infant Behav and Dev 1991. 14:299-312</ref> It is plausible, however, that anxiety may have some relationship to crying through a more circuitous route. Anxious parents are often so unsure of themselves that they jump from one calming intervention to another without doing any technique long enough for it to be effective. For thousands of years, the number one belief of worried parents, grandparents and doctors has been that colicky crying was a sign of abdominal pain (e.g. intestinal spasm, overfeeding, trapped gas).<ref>Cirgin Ellett ML. What is known about infant colic? Gastroenterol Nurs. 2003;26:60-5.</ref> In fact, even the word “colic” is derived from the ancient Greek word for intestine (sharing the same root as the word “colon”). | |||
| <br/><br/>At first glance, a gastrointestinal (GI) theory of colic seems logical because fussy babies often: grunt/pass gas/double-up/cry after eating; have noisy stomachs; improve with tummy pressure, warmth or massage; may improve with pain medication (e.g. paregoric, also referred to as tincture of opium)<ref>Sanghavi D. “Bleary parents crave colic cure.” Boston Globe, Mar 29, 2005 http://www.darshaksanghavi.com/columns/colic.htm</ref> or sips of herbal teas used for stomach upset (e.g. mint, fennel).<ref>Weizman Z, et al. Efficacy of herbal tea preparation in infantile colic. J Pediatr 1993;122:650-652.</ref> However, 85-90% of colicky babies have no evidence of GI abnormality.<ref>Lucassen P, et al, Effectiveness of treatments for infantile colic: systematic review. BMJ 1998;16:1563-69 </ref> Today, few doctors believe colic is related to gas, cramps, or overfeeding. The prevailing medical view is that colic is just the extreme range of normal. In other words, the 10-15% loudest, most persistent, “shriekiest” of all healthy babies are diagnosed with “colic.”<ref>1 Barr RG. Changing our understanding of infant colic. Arch Pediatr Adolesc Med. 2002;156 (12):1172-74. </ref> | |||
| <br/><br/>The main reason experts no longer believe colic is caused by stomach upset are: | |||
| <br/><br/>1) Fussiness peaks at about 6 weeks and reliably ends by 3-4 months, yet infants continue to experience plenty of burps, flatus, BMs, etc. well beyond 4 months of age <ref>Brazelton TB, Crying in infancy. Pediatrics. 1962; 29:579-588</ref> | |||
| <br></br>2) Premature babies - with very immature intestines – have no more colic than full term-ers (despite the fact that their intestines are much more immature). And, when they do get colic it doesn’t start until they reach their due date. (In other words, a baby born three months early has the same 10-15% chance of developing colic as a full term baby. Despite eating, pooping, burping and “tooting” every day, he/she will have almost no fussing during the first three months.<ref>Barr RG, et al. Crying Patterns in Preterm infants. Dev Med and Child Neuro 1996; 38: 345-355</ref> | |||
| <br></br>3) Contrary to the belief that babies cry from swallowed air, X-ray studies reveal that when babies start wailing, they have much less air trapped in their stomachs than they do after the colic is over and they are calm and relaxed.<ref>Illingworth RS. Three months colic. Arch Dis Child. 1954;29:165-74. MEDLINE | CrossRef</ref> (Babies gulp air while crying. So they have more air in the stomach after crying, but it is totally innocuous.) | |||
| <br></br>4) “Burp” drops (simethicone) are no better at reducing crying than drops of distilled water.<ref> Danielsson B, Hwang CP. Treatment of infantile colic with surface active substance (simethicone), ACTA Ped Scan 1985 74:446-450</ref><ref>Metcalf T, et al. Simethicone in the treatment of infantile colic, Pediatrics, 1994 94:29-34</ref> | |||
| <br></br>5) Car rides and vacuum cleaner sounds may calm fussing, yet have no power to lessen GI pain (just as adults never use a car ride or vacuum to sooth a stomachache). | |||
| <br/><br/>In 90% of cases, colic is unrelated a baby’s diet.<ref>Taubman B. Parental counseling compared with elimination of cow's milk or soy milk protein for the treatment of infant colic syndrome: a randomized trail. Pediatrics 1988;81:756-761</ref><ref> Thomas DW, et al. Infantile colic and type of milk feeding. Am J Dis Child. 1987;141:451-453</ref> However, in 10% of cases colic is triggered by stomach discomfort from food allergy and requires altering the diet of a breastfeeding mom or switching a baby to a hypoallergenic formula (e.g. Pregestimil).<ref>Lothe L, Lindberg T, Jakobsson I. Cow's milk formula as a cause of infantile colic: A double-blind study. Pediatrics. 1982;70:7-10</ref><ref>Lothe L, Lindberg T, Jakobsson I. Cow's milk formula as a cause of infantile colic: A double-blind study. Pediatrics. 1982;70:7-10</ref> The most problematic foods for fussy babies seem to be cow’s milk based formula and, for breastfeeding babies, dairy products in the mother’s diet. Other, less common allergens are wheat, soy and nuts. Breastfed babies may also become fussy from stimulants in the mother’s diet (see section on treatment).<ref>Jakobsson I, Lindberg T. Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics 1983;71:268-271.</ref><ref> Evans RW, et al. Maternal diet and infantile colic in breast-fed infants. Lancet. 1981;1:1340-2.</ref><ref> Forsythe BW, Colic and the effect of changing formulas: A double-blind, multiple-crossover study . J Pediatrics 1989; 115:521-6</ref> Parents and doctors commonly switch fussy babies to a soy forumla - however, it is not clear that soy reduces colic.<ref> Bhatia J, et al. Use of Soy Protein-Based Formulas in Infant Feeding. Pediatrics, 2008;121:1062-8</ref> | |||
| <br/><br/>Also, unlike older children and adults who have GI discomfort from lactose intolerance, there is little evidence that this causes crying among infants.<ref>Barr RG, et al. Carbohydrate change has no effect on infant crying behavior: A randomized controlled study. Am J Dis Child 1987; 141:391</ref><ref>Liebman WM. Infantile colic association with lactose and milk intolerance. JAMA 1981; 245: 732-3</ref><ref>Heyman, MB, et al. Lactose Intolerance in Infants, Children, and Adolescents. Pediatrics, 2006;118:1279-86</ref> | |||
| <br/><br/>Some reports have associated colic to changes in the bacterial balance in a baby’s intestine. They suggest treating the crying with daily doses of probiotics, or “good bacteria” (such as Lactobacillus acidophilus or Lactobacillus reuteri). In one study,<ref>Pelle SF, et al. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: A prospective randomized study. Pediatrics 2007:119; e124–30 </ref> 83 colicky babies given probiotics had reduced crying. After one week, treated babies had a mere 10% less crying (159 min/day vs. 177 min/day). By 4 weeks, treated babies had 65% less crying (51min/day vs. 145 min/day). However, a more recent study found no reduced colic in over 1000 babies who were given probiotics from birth.<ref>Kukkonen K, et al. Long-Term Safety and Impact on Infection Rates of Postnatal Probiotic and Prebiotic (Synbiotic) Treatment: Randomized, Double-Blind, Placebo-Controlled Trial. Pediatrics 2008;122;8-12</ref> | |||
| <br/><br/>In 2009, a University of Texas study observed that colicky babies had a higher incidence of mild intestinal inflammation and a specific intestinal bacteria, Klebsiella.<ref>Rhoads, MJ, et al. Altered Fecal Microflora and Increased Fecal Calprotectin in Infants with Colic. J Pediatrics 2009;155: 823-8</ref> But, a commentary in the same journal, noted that the inflammation and bacteria were most likely just an exaggerated variation of normal.<ref>Moore DJ, Inflaming the Debate on Infant Colic. J Pediatrics 2009;155:772-3</ref> | |||
| <br/><br/>Over the past 15 years, many thousands of fussy babies have been given medicine in the belief that their colic was caused by painful acid reflux, so-called gastro-esophageal reflux disease (GERD). From 1999-2004, the use of a popular class of liquid antacid (proton pump inhibitor, or PPI) in young children increased 16 fold.<ref>Barron JJ, et al. Proton pump inhibitor utilization patterns in infants. J Pediatr Gastroenterol Nutr. 2007;45:421-7 CrossRef</ref> And, from 2000-2003 there was a 400% increase in the number of babies treated with anti-reflux medicines. By all accounts this rate of increase has continued - or accelerated - from 2003 to the present. | |||
| <br/><br/>In truth, most babies have mild reflux, but we simply call it “spitting up.” Over the past 5 years, several studies have proven that GERD rarely causes infant crying. Even crying during feeding and crying accompanied by writhing and back arching is rarely related to acid reflux, unless the baby also has: 1) poor weight gain (less than ½ ounce/day), 2) vomiting more than 5 times/day or 3) other significant feeding problems. | |||
| <br>A multicenter study, organized by researchers at Pittsburgh Children’s Hospital, concluded that GERD medicine is no better than plain water at reducing infant crying. Surprisingly, 50% of fussy babies improved on medicine…but so did 50% of fussy babies given the placebo. | |||
| <br/><br/>If your baby cries during feeding, the most logical reason is not acid pain, but rather that he/she is overreacting to a totally normal intestinal process, the gastro-colic (GC) reflex.<ref>Karp H, The “fourth trimester”: A framework and strategy for understanding and resolving colic, Contemporary Peds 2001; 21:92-114</ref> When your stomach fills with food it sends a message to the colon to start tightening (to squeeze out the poop and make room for the coming new food). | |||
| <br/><br/>All of us have a GC reflex. In adults, it gets switched on about an hour after eating, but in babies it revs up within minutes of the start of a meal (often leading to a BM before the baby has even finished eating). Most of us have little or no awareness when the GC reflex is working, however some overly sensitive infants do feel it…and don’t like it. They often arch and cry as waves of intestinal squeezing move the partially digested food through the intestines. These cries are often misdiagnosed as acid reflux, gas cramps or overfeeding. But babies who cry from the GC reflex are usually just overreacting to a normal sensation. They’re the same sensitive infants who shriek after a sudden loud laugh or telephone ring. In fact, it’s easy to prove these cries are not from pain, simply by stopping them with correctly performed calming techniques (see the “5 S’s” described below). | |||
| <br/><br/>The fact that many hyperirritable babies calm with simple soothing maneuvers has given birth to an engaging new theory of colic, the “missing 4th trimester.” This theory, described by California pediatrician, Dr. Harvey Karp<ref>Karp HN, DVD - The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer, 2002 www.happiestbaby.com</ref><ref>Karp HN, The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer, New York, NY: Bantam Dell, 2002 </ref><ref>Pady C. What is Colic? Dr. Harvey Karp's Theory and the Ten Universal Truths of Colic Mar 23, 2009, Suite 101</ref> is the most logical scientific explanation of colic ever and is recommended by leading pediatricians and parenting books.<ref>Jana LA, Shu J. Heading Home With Your Newborn. New York, NY: American Academy of Pediatrics, 2005</ref><ref>Schmitt BD, Your Child's Health, New York, NY, Bantam, 2005</ref> | |||
| <br/><br/>The “missing 4th trimester” is based on the fact that our newborns are very immature at birth.<ref>Bluestone CD. Humans are born too soon: impact on pediatric otolaryngology. Int J of Ped Otorhinolarygol 2005;69:1-8</ref> Baby horses, by comparison, can walk and even run on the very first day of life. However, since human fetuses have such large brains, they must be born before they are mature enough to stand, run, or even smile. Babies held inside longer would never get through the birth canal and they (and their mothers) would die in childbirth. (The head of a newborn chimpanzee is only 80-90% of the mother chimp’s pelvic opening. On the other hand, a human baby’s head totally fills the pelvic outlet and has to “mold” - squish into a cone or banana-shaped head – to slip out!) | |||
| <br/><br/>Contrary to unscientific theories that babies cry from gas pains or from being over-stimulated, Karp’s theory suggests that infant crying is actually related to under-stimulation. In other words, he believes babies cry because the rich symphony of womb sensations has been replaced by the profound stillness of our homes. | |||
| <br/><br/>In the womb, fetuses experience non-stop hypnotic rhythms (e.g. stroking against the soft uterus walls; frequent tiny, jiggly movements; constant warmth; and continual sound - louder than a vacuum cleaner - created by the whooshing of blood through the placental arteries).<ref>Smith C, et al: Intrauterine sound levels: Intrapartum assessment with an intrauterine microphone. Am J Perinat 1990;7:312-5 </ref><ref>Walker D, et al. Intrauterine noise: A component of the fetal environment. Am J of Obgyn 1971;109: 91-5 </ref> No wonder babies can fall asleep at crowded parties and noisy basketball games better than adults. | |||
| <br/><br/>Karp postulates that all babies are born with a “calming reflex” that is a relative “off-switch” for crying and “on-switch” for sleep. This unique response is activated when parents perform 5 techniques (the “5 S’s”), which closely mimic the rhythmic sensations in the uterus. Duplicating the baby’s womb experience and turning on the “calming reflex” is probably how traditional calming methods (for example, car rides, vacuum cleaners, bouncy dancing, warm baths, carrying babies in slings, etc) work to reduce fussing. | |||
| <br/><br/>The“calming reflex” is like the knee reflex. Knee reflexes are extremely predictable; one can activate it hundreds of times in a row, but only if it is done correctly. However, hit the knee 1 inch too high - or low - or too softly - and you will totally fail to trigger it! Similarly, only parents who have been trained to do the "S's" correctly (see below - section on treatment) can turn on the “calming reflex.” | |||
| <br/><br/>Babies who continue crying despite the “5 S’s” being done correctly may be hungry, uncomfortable or ill. Parents who are unable to soothe their baby’s crying must call their healthcare provider to make sure the baby is not sick. Fortunately, only 5% of colic cases are caused by illness (most commonly by intestinal allergy, described above).<ref>Barr RG, Management of Clinical Problems and Emotional Care: Colic and crying syndromes in infants. Pediatrics 1998:102 (5) Supplement;1282-6</ref> | |||
| <br/><br/>Parents should be especially suspicious of illness or pain as the cause of their baby’s fussing if the cry is accompanied by at least one of the following ten “red flag” symptoms: <ref> Karp HN, The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer, New York, NY: Bantam Dell, 2002</ref> | |||
| <br>1) Persistent moaning or weak crying | |||
| <br>2) High-pitched, shrill cry (sharp and more dramatic than usual) | |||
| <br>3) Vomiting (vomit that is green or yellow, bloody or occurring more than 5/day) | |||
| <br>4) Change in stool (constipation or diarrhea, especially with blood or mucous) | |||
| <br>5) Fussing during eating (twisting, arching, or crying that begins during or just after a feed) | |||
| <br>6) Abnormal temperature (a rectal temperature less than 97.0°F or over 100.2°F) | |||
| <br>7) Irritability (crying all day with few calm periods in between) | |||
| <br>8) Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over 6 hours) | |||
| <br>9) Bulging soft spot on the head (even when the baby is sitting up) | |||
| <br>10) Poor weight gain (gaining less than ½ ounce a day) | |||
| <br/><br/>Babies with persistent crying or any “red flag” symptoms should be checked by a healthcare professional to rule out illness. The top ten medical problems to consider in irritable babies with “red flag” symptoms are:<ref> Karp HN, The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer, New York, NY: Bantam Dell, 2002</ref> | |||
| <br>1) Infections (e.g. ear infection, urine infection, meningitis, appendicitis) | |||
| <br>2) Intestinal pain (e.g. food allergy, acid reflux, constipation, intestinal blockage) | |||
| <br>3) Trouble breathing (e.g from a cold, excessive dust, congenital nasal blockage, oversized tongue) | |||
| <br>4) Increased brain pressure (e.g., hematoma, hydrocephalus) | |||
| <br>5) Skin pain (e.g. a loose diaper pin, irritated rash, a hair wrapped around a toe) | |||
| <br>6) Mouth pain (e.g. yeast infection) | |||
| <br>7) Kidney pain (e.g. blockage of the urinary system) | |||
| <br>8) Eye pain (e.g. scratched cornea, glaucoma) | |||
| <br>9) Overdose (e.g. excessive Vitamin D, excessive sodium) | |||
| <br>10) Others (e.g. migraine headache, heart failure, hyperthyroidism) | |||
| ==Effect on the family== | |||
| Infant crying can have a prominent effect on the stability of the family. Crying and the fatigue that typically accompanies it can inflict enormous emotional strain causing parents to feel they are providing inadequate care, triggering anxiety, stress, resentment and low self-esteem.<ref>Kirkland J. CrySOS, Cry Research Letter, 5:9-14, 1983</ref> | |||
| <br/><br/> Persistent infant crying has been associated with severe marital discord, postpartum depression, Shaken Baby Syndrome, SIDS/suffocation, early termination of breastfeeding, frequent visits to doctors, maternal smoking and over a quadrupling of excessive laboratory tests and prescription of medication for acid reflux. | |||
| <br/><br/>Parents at especially high risk of experiencing a serious reaction to their infant’s crying, include teens, drug addicts, military families, foster parents, parents of premies and parents of multiples. Families living in dense housing projects, such as apartment blocks, may also suffer strained relationships with neighbors and landlords if their babies cry loudly for extended periods of time each day. | |||
| == |
==Types== | ||
| Types include: | |||
| In past decades, doctors recommended treating colicky babies with sedative medications (e.g. Phenobarbital, Valium, ethanol), analgesics (e.g. opium) or anti-spasm drugs (e.g. scopolamine, Donnatal, dicyclomine), but all of these have been stopped because of potential serious side-effect, including death. | |||
| *], a condition, usually in infants, characterized by incessant crying | |||
| <br/><br/>Currently, the first approach most commonly recommended in healthy babies (without any “red flag” symptoms) is to use non-medicinal, noninvasive treatments like emotional support<ref>Wolke D, et al. Excessive Infant Crying: A Controlled Study of Mothers Helping Mothers.. Pediatrics 1994; 94:322-32</ref><ref>MR, et al. Effectiveness of an Intervention for Colic. Clinical Pediatrics 2006;45:123-33</ref> or the rhythmic calming of the “5 S’s.” | |||
| *], a pain in the flank, characteristic of kidney stones | |||
| <br/><br/>There is a broad body of evidence showing that soothing measures, such as pacifiers,<ref>Woodson R, et al. Effects of non-nutritive sucking on state and activity: Term-preterm comparisons. Infant Behav and Dev 1985; 8:435-41 </ref><ref>Campos RG. Soothing pain-elicited distress in infants with swaddling and pacifiers. Child Dev. 1989; 60: 781-792 </ref> strong white noise<ref>Brackbill Y, et al. Arousal level in neonates and preschool children under continuous auditory stimulation. J Exp Child Psychol 1966;4:178-88.</ref><ref>Brackbill Y, Continuous Stimulation And Arousal Levels in Infancy: Effects of Stimulus Intensity and Stress. Child Dev 1975; 46: 364-9</ref><ref>Birns B, et al. Behavioral inhibition in neonates produced by auditory stimulation. Child Dev 1965; 36: 639-645</ref><ref>Smith C, Steinschneider A. Differential effects of prenatal rhythmic stimulation on neonatal arousal states. Child Dev 1975; 46:574-8</ref><ref>Spencer JAD, et al. White noise and sleep induction. Arch Dis Child 1990, 65:135-7 </ref> and jiggly rocking<ref>Koner A, et al. The relative efficacy of contact and vestibulo-proprioceptive stimulation in soothing neonates. Ch Dev 1972; 43:443-53</ref><ref>Pederson DR. The soothing effect of rocking as determined by direction and frequency of movement. CanJBehav Sci 1975;7:237-43</ref><ref>Hunziker U, Barr R. Increased carrying reduces infant crying: A randomized controlled trial. Pediatrics 1986; 77:641-8 http://pediatrics.aappublications.org/cgi/content/abstract/77/5/641?ijkey=718ecc3ab3b25018bca2d0b4aacca3cc97259b80&keytype2=tf_ipsecsha</ref><ref>Elliott MR, et al. Effects of rocking on the state and respiration of normal and excessive criers. Can J of Psych 1988, 42: 163-172</ref> are effective in calming babies during crying bouts. These techniques form the core of the “5 S’s” approach: 1st S - Swaddling<ref>van Sleuwen BE, et al. Swaddling: a systematic review. Pediatrics. 2007;120 (4). Available at: www.pediatrics.org/cgi/content/full/120/4/e1097</ref><ref>Gerard CM, et al. Physiologic studies on swaddling: an ancient child care practice, which may promote the supine position for infant sleep. J Pediatrics 2002;141:398-403 </ref><ref>Gerard CM, et al. Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics 2002;110 (6) Available at: www.pediatrics.org/cgi/content/full /110/6/e70</ref><ref>Franco P, et al. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 2005;115:1307-11</ref><ref>Lipton EL, et al. Swaddling, a child care practice: Historical, cultural and experimental observations. Pediatrics 1965;35(suppl):521-567</ref><ref>Karp HK Safe Swaddling and Healthy Hips: Don't Toss the Baby out With the Bathwater. Pediatrics 2008; 121: 1075-6. http://pediatrics.aappublications.org/cgi/content/full/121/5/1075-a?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=karp&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT</ref><ref>Mahan ST, et al, Safe Swaddling and Healthy Hips: Don't Toss the Baby out With the Bathwater: In Reply. Pediatrics, 2008; 121: 1077. http://pediatrics.aappublications.org/cgi/content/full/121/5/1077-a?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=mahan&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT</ref>); 2nd S - Side or stomach (holding a baby on the back is the only safe position for sleep, but it is the worst position for calming a fussy baby); 3rd S - Shhh sound (making a strong shush sound near the baby's ear or using a CD of womb sound/white noise)<ref> Brackbill Y, Adams SG, Crowell DH, et al. Arousal level in neonates and preschool children under continuous auditory stimulation. J of Exp Child Psychol 1966; 4: 178-188</ref><ref> Brackbill Y, Cumulative effects of continuous stimulation on arousal levels in infants. Child Dev 1971; 42: 17-26</ref><ref> Brackbill Y, Continuous Stimulation And Arousal Levels in Infancy: Effects of Stimulus Intensity and Stress. Child Dev 1975; 46: 364-69</ref><ref> Birns B, Blank, M, Bridger WH, et al. Behavioral inhibition in neonates produced by auditory stimulation. Child Dev 1965; 36: 639-645</ref><ref> Spencer JAD, Moran DJ, Lee A, et al. White noise and sleep induction. Arch Dis Child 1990, 65:135-137</ref>; 4th S - Swinging the baby with tiny jiggly movements (no more than 1” back and forth) always supporting the head and neck<ref> van den Daele l. Modification of infant state by treatment in a rockerbox. J of Psychol 1970, 74:161-165</ref><ref>Brackbill Y, Cumulative effects of continuous stimulation on arousal levels in infants. Child Dev 1971; 42: 17-26</ref><ref>Brackbill Y, Continuous Stimulation Reduces Arousal Level: Stability of the Effect over Time. Child Dev 1973; 44: 43-46</ref><ref>Koner A, et al. The relative efficacy of contact and vestibulo-proprioceptive stimulation in soothing neonates. Ch Dev 1972; 43:443-53</ref><ref>Pederson DR, et al Ter Vrught D, The influence of amplitude and frequency of vestibular stimulation on the activity of two-month-old infants. Child Dev 1973, 44: 122-128</ref><ref>Pederson DR. The soothing effect of rocking as determined by direction and frequency of movement. CanJBehav Sci 1975;7:237-43</ref><ref>Kramer LI, Pierpont ME. Rocking waterbeds and auditory stimuli to enhance growth of preterm infants. J Peds 1976; 88:297-299</ref><ref>Elliott MR, et al. Effects of rocking on the state and respiration of normal and excessive criers. Can J of Psych 1988, 42: 163-172</ref><ref>Korner, AF, et al. Sleep enhanced and irritability reduced in preterm infants: Differential efficacy of three types of waterbeds. Dev and Behav Peds; 1990; 11:240-246.</ref><ref>Gatts JD, Fernbach SA, Wallace DH, et al. Reducing crying and irritability in neonates using a continuously controlled early environment. Journal of Perinatology, 1995; 15:215-221</ref>; 5th S - Sucking (Letting the baby suckle on the breast, your clean finger or a pacifier) | |||
| *], blockage by a gallstone of the common bile duct or the duct leading into it from the gallbladder | |||
| <br><br/>Numerous studies mentioned above have shown that when key components of the “5 S’s” (e.g. swaddling, shushing, swinging) are used all night they can improve sleep or reduce crying; and, when the “5 S’s” are done correctly and in combination, they offer significant potential to promptly reducing infant crying and promote sleep. | |||
| *], a potentially fatal condition experienced by horses, caused by intestinal displacement or blockage | |||
| <br/><br/>In a study conducted by the Boulder Colorado Department of Public Health home visiting nurses taught the “5S’s“ to 42 at-risk families (teen parents, addicts, parents of premature babies, etc) with fussy babies. After a single, one-hour visit to teach parents this approach (plus giving parents The Happiest Baby DVD, CD of womb sounds and a large swaddling blanket) 41/ 42 (98%) families reported a dramatic improvement in their ability to calm the fussing, even in babies with acid reflux and those whose mothers abused methadone or methamphetamine. Many parents also reported that their babies slept longer.<ref>Adler M. Promoting maternal child health by teaching parents to calm fussy infants at the Boulder Colorado Department of Health. Presented at: the CDC CityMatCH Urban MCH Leadership Conference; Aug 28, 2007; Denver, CO</ref> | |||
| *], an affliction caused by lead poisoning | |||
| In an NIH funded pilot project by researchers at Penn State University, 80 new mothers were taught the “5 S’s." Breastfeeding mothers taught The Happiest Baby reported that their babies had significantly increased sleep (30-45 min/avg) and significantly reduced trend to obesity at 1 year of age (when combined with simple dietary advice).<ref>Paul IM, Birch L. Pediatric Ambulatory Society (PAS) Meeting The Relationship between Infant Feeding, Sleeping, and Weight Gain Baltimore, MD May 4, 2009</ref> | |||
| *Painter's colic or ] | |||
| <br/><br/>A small Ohio study was unable to reveal any difference in sleep/ crying behavior between moms given a Happiest Baby video and those given a standard child care video.<ref>McRury,JM and Zolotor, AM , A Randomized, Controlled Trial of a Behavioral Intervention to Reduce Crying among Infants J Am Board Fam Med 2010;23:315–322.)</ref> | |||
| <br/><br/>However, the authors noted that there were many reasons why they may have failed to show Happiest Baby benefits. The study suffered from a low number of subjects and a high drop out rate. Also, it was not clear that parents ever tried the “5 S’s” or used them correctly. | |||
| <br/>Crying from an overreaction to the gastro-colic reflex (described above) is usually easy to resolve with the “5 S’s.” And, since pain does not disappear with simple calming measures, the rapid reduction in crying when using the “5 S’s” makes it unlikely that the fussy baby is in pain. | |||
| <br/><br/>Many communities, clinics and support groups have been set up for parents of children with colic. Such groups include the colic clinic at Woman’s and Infant’s Hospital, Providence, RI; several fussy baby clinics organized by the Erikson Institute of Chicago, IL and hundreds of Happiest Baby classes across North America.<ref>Karp HN. “The Secret to Getting Your Baby to Sleep.” Huffington Post Jan 12, 2010 huff po 1/15 2010 http://www.huffingtonpost.com/harvey-karp/baby-sleep-the-secret-to_b_419308.html</ref><ref>Carpenter M. “Clashing data bombards new parents as old-school ideas fall by the wayside. Pittsburgh Post-Gazette, Dec 6, 2009 | |||
| http://74.125.155.132/search?q=cache:xSNpQIRTqTMJ:www.post-gazette.com/pg/09340/1018799-51.stm+washington+post+harvey+karp+carpenter&cd=8&hl=en&ct=clnk&gl=us#ixzz0i10bCvBG | |||
| Smeltzer MB. “Fussy babies soothed with Cuddle Cure.” Fairbanks Daily News-Miner, Mar 28, 2006</ref> | |||
| <br/><br/>Over the past 5 years, thousands of professionals have begun teaching Happiest Baby classes across the US - and in 6 other countries, including: hospitals (e.g. University of Michigan, Northwestern, St. Luke's Children's Hospital, Boise, ID)<ref>National Association of Children's Hospitals and Related Institutions. Children's Hospitals at the Frontlines: The Prevention of Child Abuse and Neglect. Alexandria, VA: National Association of Children's Hospitals and Related Institutions; 2007:9-10 http://www.childrenshospitals.net/AM/Template.cfm?Section=Site_Map3&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=48418</ref>, military bases<ref>Evans, S. “Crying, Tantrums and Mini-Cavemen.” US Navy Nurse Corps News, Vol 1 Issue 20 pg 2 Apr. 27, 2007</ref><ref>Todd DR. “US Marines in Japan Class helps parents learn how to calm their baby.” Feb 16, 2007 http://www.okinawa.usmc.mil/public%20affairs%20info/Archive%20News%20pages/2007/070216-baby.html</ref>, teen parenting programs, state and local child abuse prevention programs,<ref>Massachusetts Shaken Baby Prevention Center, Massachusetts Citizens for Children, http://www.masskids.org/downloadable_forms/SBSbrochure.pdf</ref><ref>Child Abuse and Neglect: An introductory manual for professionals and paraprofessionals. Colorado Dept of Public Health and Environment, Oct 2006 pg 5;11 http://www.cdphe.state.co.us/ps/cctf/canmanual/CANManualCover.pdfhttp://www.cdphe.state.co.us/ps/cctf/canmanual/CurrentTopicsinChildMaltx2.pdf</ref> PPD support groups<ref>Johannes B, Menei L. “Calming Techniques Ease Mother’s Minds.” Spectrum Nursing Magazine, Mar 28, 2007</ref>, fatherhood classes and state departments of health and child welfare (PA, WY, MN, CO, MA, CT, etc.).<ref>Zajac FB. “The Happiest Baby program helps soothe crying newborns.” | |||
| Uniontown Herald-Standard, Feb 17, 2008 | |||
| http://www.heraldstandard.com/site/news.cfm?newsid=19304021&BRD=2280&PAG=461&dept_id=480247&rfi=6 | |||
| </ref><ref>Sutter C. “Hush little baby 'Happiest Baby' methods expand their reach in Boulder County.” The Daily Camera, Jan 2, 2006</ref><ref>Pennsylvania Department of Health. Cries to Smiles. Harrisburg, PA: Pennsylvania Department of Health, Breastfeeding Awareness and Support Group; 2007</ref>. | |||
| <br/><br/>The University of Arizona surveyed 225 parents-to-be before and after taking a Happiest Baby class. They showed a dramatic boost in confidence. Pre-class 40% of pregnant couples reported being moderately to very worried about being able to calm their baby's crying/problems, Post-class that dropped to a mere 0.5%.<ref>SEABHS: Data Summary of Happiest Baby on the Block Retrospective Post-Test Surveys: (Southeastern Arizona Behavioral Health Services, Inc.) (study conducted by The UA Evaluation Research and Development Team (ERAD) http://www.happiestbaby.com/wp-content/uploads/files/THBE_Univ_AZ_study_2008.pdf</ref> | |||
| <br/>If simple approaches are not working to reduce the crying, parents should consult their health care provider to ask: 1) are they doing the techniques correctly? or 2) Is there a medical problem requiring treatment? | |||
| <br/><br/>The most common medical causes of colic are food related. In a breastfed baby, the doctor may suggest eliminating all stimulant foods (e.g. coffee, tea, cola, chocolate, decongestants, diet supplements, etc) from a mother’s diet for a few days to evaluate for improvements in the baby's condition. If food allergy is suspected, the doctor may suggest a hypoallergenic formula for a formula fed infant or, if the mother is breastfeeding, a period of elimination of allergenic foods (e.g. dairy, nuts, soy, citrus, etc) from her diet in order to observe changes in the baby's condition.<ref>Jakobsson I, Lindberg T. Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics 1983;71:268-271.</ref><ref>Evans RW, et al. Maternal diet and infantile colic in breast-fed infants. Lancet. 1981;1:1340-2.</ref> If the crying is related to a cow’s milk allergy benefits are usually seen within 2-7 days. Mothers can then choose to add back small amounts of the suspected offending food a little bit at a time as long as persistent crying does not reappear. If crying reappears, the offending foods may need to be avoided for many months.<ref> Lucassen PL, et al. Infantile colic: Crying time reduction with a whey hydrolysate: a double-blind, randomized, placebo-controlled trial. Pediatrics 2000;106 :1349–54</ref><ref>Forsythe BW, Colic and the effect of changing formulas: A double-blind, multiple-crossover study . J Pediatrics 1989; 115:521-6</ref>. | |||
| <br/><br/>Persistently fussy babies with poor weight gain, vomiting more than 5 times a day, or other significant feeding problems should be evaluated by a healthcare professional for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).<ref>Heine RG, et al: Clinical predictors of pathological gastro-esophageal reflux in infants with persistent distress. J Paed Ch Health 2006; 42: 134-9 </ref> | |||
| ==See also== | ==See also== | ||
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Revision as of 20:39, 15 June 2010
"Cholic" redirects here. For cholic acid, see Cholic acid. This page is about the type of pain. For the three arteries supplying parts of the abdomen see Left colic artery, Right colic artery and Middle colic artery.Template:Infobox Disease bigobble
Colic is a form of pain in the abdomen which starts and stops abruptly.
Types
Types include:
- Baby colic, a condition, usually in infants, characterized by incessant crying
- Renal colic, a pain in the flank, characteristic of kidney stones
- Biliary colic, blockage by a gallstone of the common bile duct or the duct leading into it from the gallbladder
- Horse colic, a potentially fatal condition experienced by horses, caused by intestinal displacement or blockage
- Devon colic, an affliction caused by lead poisoning
- Painter's colic or lead poisoning
See also
References
- "eMedicine/Stedman Medical Dictionary Lookup!". Retrieved 2008-03-27.
 | This medical article is a stub. You can help Misplaced Pages by expanding it. |
| Signs and symptoms relating to the human digestive system or abdomen | |||||||||
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| Gastrointestinal tract |
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| Accessory | |||||||||
| Defecation | |||||||||
| Abdomen |
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| Hernia | |||||||||
| Other | |||||||||