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This Month's Feature Article hush little baby THE CAUSES OF COLIC ARE STILL NOT COMPLETELY UNDERSTOOD BUT WE DO KNOW PARENTS AND BABY ARE LEFT FEELING ANXIOUS AND EXHAUSTED. HERE WE TAKE A LOOK AT THE ISSUE AND OFFER SOME SOLUTIONS. WORDS Louise Conville

My best friends Jane and Daniel have just survived seven weeks of colic with their first child, Lulu. It has been a gruelling and frustrating time, as they couldn’t figure out why she was so upset when they were doing everything they could to make her feel comfortable, nourished and loved.

It was particularly confusing and worrying for Jane and Daniel because Lulu was a dream child for the first two weeks of her life. She slept when she was tired, cried when she was hungry and stopped crying when she was fed.
Then the symptoms of colic began. Lulu became so upset she appeared to be in agony. Her body would tense up with her legs drawn towards her chest or stretched out stiffly, and her screams made Jane and Daniel wonder if these were signs of something more serious. Jane read books and articles written by doctors with different theories on colic but admits nothing could have prepared her for the exhaustion, the sense of failure and the heartbreak of letting her daughter down, not to mention the anger and frustration she felt towards herself, Daniel and, sometimes, towards Lulu.

WHAT IS COLIC?
The truth is, there isn’t a straight answer to this question. The term is given to babies who cry a lot even though there doesn’t appear to be anything more they could possibly need. Parents with a colicky child can feed, bathe, hold, rock, soothe and change their baby over and over again and still the crying won’t ease. Sometimes this can continue non-stop, often in the evenings for up to three hours or more. The word “colic” means spasm, or painful muscle tightening, but it has also been referred to as “Cause Obscure Lengthy Infant Crying” to deter people from the idea that the cause is abdominal pain. The baby is usually perfectly healthy, with a good diet and a relatively relaxed nature at other times of the day. Even if you are almost certain your baby has colic, you should always get a diagnosis from your doctor rather than presume anything.

WHAT ARE THE SYMPTOMS?
Typical symptoms include loud, high-pitched crying and a tense, scrunched up body and face. The baby’s complexion can redden and moaning noises may appear similar to constipation groans. Arms and legs are often squeezed towards the chest or stretched out and stiff. As sucking is very soothing for babies, they might want to feed more or find temporary relief sucking a dummy.
Dr Judy Barbour, from the Children, Youth and Women’s Health Service (CYWHS) in Adelaide, explains that colic refers to excessive crying for two to three hours a day, although it can go on longer. ‘Most babies do a lot of crying from three to 12 weeks of age. With colic, the baby is unresponsive to normal measures such as changing and feeding. Trying to pacify the baby can sometimes make it worse,’ she says.
‘The difficulty is you do absolutely everything that’s right and the baby cries, so you repeat it and still the crying won’t stop. A baby’s cry is designed to upset people and parents especially are really tuned into this. They have an overwhelming need to stop the baby crying and become upset when they can’t. In many cases colic symptoms appear during the evening meal so it’s hard to eat or even prepare it in the first place. Parents can become angry and I think it’s important for them to know that feeling angry is not unreasonable when they’ve done everything right and are frustrated with the situation.’

WHY DO BABIES DEVELOP COLIC?
Sometimes an increased amount of crying can just mean a baby is hungry because he might not be gaining enough weight. Most babies should gain between 160 and 200 grams every week.
In more serious cases babies with major neurological problems also cry a lot, but this is
usually obvious when a doctor examines them.
Dr Joanne Cox is the Director of the Primary Care Centre at the Children’s Hospital in Boston, US. She believes some babies are naturally more susceptible to colic if exposed to stressful experiences. ‘There is no one cause, but some babies are more excitable and reactive to stimulation,’ she says. ‘Sometimes, a cycle can develop between the child and parents in which the child senses the parents’ mounting anxiety and fatigue, and cries all the more as a result.’
Dr Cox explains that there are a number of theories surrounding colic among the medical community. ‘One theory is that over-stimulation leads to an increased startle or Moro reflex that instigates the crying cycle. Another is that, while in the womb, the baby is accustomed to regular muffled sounds and movements and then has difficulty dealing with the transition into the real world and its louder noises.’
Some colicky babies can also suffer from gastro-oesophageal reflux that causes milk to bubble out of the stomach into the oesophagus. Lactose intolerance, caused by excess hydrogen gas and lactic acid in the large bowel, sometimes develops at the same time as colic but it is difficult to understand which problem comes first. Many doctors now believe these kinds of ailments are a result of colic and not the cause.

THE THEORY OF SELF-SOOTHING
Dr Howard Chilton, from the Prince of Wales Private Hospital and Children’s Hospital in Sydney, explains his theory about colic in his book, Baby On Board. A neonatologist for nearly 30 years, Dr Chilton believes the cause of colic is over-stimulation coupled with a newborn’s inability to self-soothe.
A baby aged less than three or four months may not yet be able to turn away from something stressful or over-exciting that might upset him, he explains, and until he learns to do this he is susceptible to colic. Self-soothing happens when ‘the baby gets more and more excited and more and more stimulated, until he can bear it no more. Then he shuts out the cause of stimulation and self-soothes. A baby can’t learn to do this until he’s ready,’ he adds.
To explain why babies can suddenly develop this excessive, fretful crying, Dr Chilton says the focal distance of a baby’s eyes begins to improve at about four or five weeks, enabling him to look around and take in his close environment. If this is too stimulating because of bright colours, loud noises or excited visitors, the baby can feel uncomfortable and may simply become upset.
Dr Chilton says the answer to soothing colic, and its secondary upsets such as reflux vomiting, is to do the soothing for the baby by creating peaceful, secure surroundings that will calm him. He suggests keeping his environment boring, neutral and quiet, sending visitors home, feeding on demand and staying with him in a dimly-lit bedroom until he falls asleep. A few days of this repeated pattern can make the baby calm enough to be back among normal family life, with noises around him, if the atmosphere remains relatively relaxed.

DOES MEDICATION HELP?
Some people believe that colic can lead to other ailments such as lactose intolerance, vomiting, wind and gastro-oesophageal reflux. They feel that by concentrating on fixing these secondary problems, they are missing the genuine cause of a colicky baby’s distress. Others believe that, as problems such as reflux and lactose intolerance can cause crying in a similar pattern to colic, they may be misdiagnosed as colic, so that babies do not get the help they may need.
Dr Barbour believes it’s difficult to study colic because a healthy baby shouldn’t be subjected to intrusive tests. ‘Babies get better from colic whether they’re treated or not so it’s hard to tell if medications work or are even necessary.’ Many available medications come with the warning that they should only be used for babies under six months on medical advice so always consult your doctor before trying any treatment.

ARE ANY NATURAL OR ALTERNATIVE TREATMENTS RECOMMENDED?
Every baby is different and you may need to try various ways to help your baby settle to discover what will work best. Some breastfeeding mothers find avoiding caffeine can help by preventing its effects being passed on to the baby. Others avoid spicy foods or garlic, but sometimes just enjoying everything in moderation can be enough.
In recent years the market has been flooded with dairy produce containing good bacteria, such as lactobacillus acidophilus, and some baby formulas now include a probiotic. Again, these can work for some babies when used correctly but not for others. Special feeding bottles designed to help relieve the symptoms of colic by reducing vacuum and air bubbles mixing with the milk are also readily available.

WHAT IS THE MOST EFFECTIVE WAY TO CALM MY BABY?
Again, it’s really a case of discovering what works best for your own little one. The most important thing to remember is, as Dr Chilton says, to create a quiet, dim and peaceful environment for your distressed baby. Make sure you provide a physical connection by patting his back but avoid eye contact as this can be too much stimulation all at once for a baby who already feels over-excited and over-tired.
Dr Cox recommends a number of methods that have proved successful before. ‘Swaddling the baby tightly in a wrap so they cannot move their arms and legs decreases the startle reflex. Remember that babies at this age cannot be spoiled,’ she says. ‘Hold the baby and gently sway, or try a baby swing if you get too tired. Sing to the baby and play soft music.’

WHAT CAN PARENTS DO TO TAKE A BREAK FROM THE STRESS?
Stress, depression and sleep deprivation are three of the most common side effects parents have to deal with as a result of looking after a child with colic. At times, the stress and noise becomes so much that parents feel they must leave their child even for 10 minutes. This is perfectly normal and there are many things that can be done to lessen the tension, to give yourself a break and have some time alone.
Jane found short walks were a good way of relieving her stress. To her amazement, Lulu enjoyed it too, often nodding off to sleep after two or three minutes. She would wrap Lulu up in a papoose and stroll slowly around the block with her. As Dr Cox assures, ‘If all else fails, it is absolutely OK to put the baby in a crib, close the door and give yourself a chance to calm down. This will not hurt the baby at all. Seek the help of friends or family members if you need help, and if you feel depressed, tell your doctor about it. Remind yourself that colic is self-limited. It goes away with time and in no way predicts that the baby will become a difficult child.’

FURTHER READING
• Baby On Board by Dr Howard Chilton
(Finch Publishing, $22.95). Available from www.mothersdirect.com.au.

USEFUL CONTACTS
• www.cyh.sa.gov.au - Provides valuable information on parenting, including coping with colic, lactose intolerance and reflux.
• www.mayoclinic.com - Provides excellent information on colic.
• www.nlm.nih.gov/medlineplus/infantandnewborncare.html - Provides a great summary of many resources on newborn care.
• www.betterhealth.vic.gov.au - Government website for all types of health issues.
• Maternal and Child Health Line Provides 24-hour telephone advice and support to families with children from birth to school age.    Contact 13 22 29.