The Crying Baby and Colic

By Dr Megan Yap - PaediatricianBabies14 Aug 2017

Ahhhh  babies.

They are so cute.  So cuddly.  So angelic.  And their little heads smell so nice…

But what do you do when they cry?   Like,   ALL.  THE.  TIME.

Screaming till they are red in the face, screaming till they are hoarse, screaming till you think their head might explode (and feel like your head is going to as well)…

Well if you are my husband Troy, you get your orange, noise-cancelling lawn mower ear muffs and you wear them around the house.  Apparently they work pretty well, but are not very comfortable.  Ba ha ha ha ha!! No seriously… he actually did do that (sorry babe – but you actually did ?  ).  In his defense though, both our kids were REALLY loud (and still are).

Babies cry.  Most of it is a normal behaviour.  Some cry a lot, some not so much – and there is a wide range of normal.  But WHY do they cry?  And WHAT can we do about it?  Paediatricians, GPs, emergency doctors, house-call doctors, community nurses and midwives see a LOT of crying babies… and not surprisingly a LOT of tired, stressed parents.  When you are a new parent (and sometimes even if you are not, but you are getting to know your new baby), it can be hard to distinguish a “I’m hungry” cry, from a “I have a dirty bottom” cry, from a “I have a cracking belly pain that is distressing me” cry.

Hopefully this post can help to relieve SOME of your stress about your screamy little mini-monster, and give you some strategies to deal with them, as well as figure out when you need to get medical attention.

 

Crying is usually periodic and related to discomfort, stress or temperament.  If the baby has periods in between of being completely well and happy, it is MUCH less likely something serious is going on.

Usually need to consider:

  • Wet/dirty nappy
  • Too hot/too cold
  • Hungry
  • Wind/Colic or discomfort of some other sort (eg positioning)
  • Bored
  • Environmental stress (eg loud noise/bright light)
  • Reflux
  • Teething

Every parent should run through this CHECKLIST of things to try when trying to calm a crying baby:

  • Check/change their nappy
  • Do they feel hot/cold?  Then unwrap them, or rug them up depending on this
  • Try a feed
  • Burp them or change their position (pretty much every position gets uncomfortable if you stay in the same one long enough!)
  • Interact with them (yes, babies get bored too!  They like being talked/sung to and entertained) or cuddle them
  • Remove environmental stressors where possible
  • Consider simple pain relief (eg baby paracetamol) if they appear to be in pain

There ARE of course times (and these are FAR less common than the above situations) where seeking medical attention for a crying baby will be warranted.

The biggest red flags are:

  • Fever in your baby who is less than 8 weeks of age AND/OR any baby (of any age) who is unimmunised
  • Sudden onset or severe crying
  • Crying associated with a change in colour (eg baby suddenly looking pale), gut distension or bilious vomiting
  • If your “gut feeling” is that there is something really wrong with your baby – seek medical attention, NO self-respecting doctor will turn away a worried parent with a screaming child without a history and examination to exclude serious causes

If sudden onset or severe crying some things the doctor might consider might be:

  • Any acute illness (eg a respiratory tract infection, a urinary tract infection)
  • Otitis media (middle ear infection and inflammation)
  • Intussusception (where the bowel telescopes upon itself)
  • Strangulated inguinal hernia (where there is a hernia, but something happens (eg like a twist in the bowel) and the blood supply is cut off to that part of bowel)
  • History of trauma (eg an older baby rolled off a change table)

 

So then, WHAT IS COLIC?

The terms is used commonly, because it is a common problem.  Basically colic is a term used to describe periodic crying affecting infants in the first 3 months of life

Features:

  • Crying is paroxysmal (ie it comes and goes suddenly)
  • It may be associated with hunger, swallowed air or discomfort from over-feeding
  • Often occurs in evenings  – ever heard of the term “The Witching Hour” (or in my family we call it “Arsenic Hour”)?  Well this is the tendency for babies to cry for an hour (or several) around the 4-6pm mark for no particular reason.  It is totally fun for parents.  NOT.  If you are really lucky (like Troy and I were with both our sweet little cherubs), you will be rewarded at the end of the 2 hours of delightful fighting, screaming and thrashing with a massive chunky vomit all over the freshly changed cot sheets/blankets, pajamas, carpet and on special occasions, in your hair
  • Can last several hours – flushed face, distended tense abdomen, drawn-up legs
  • In between attacks child is happy and well**  This point is absolutely key.
  • Episodes usually start abruptly and end with passage of flatus/faeces
  • Usually resolves spontaneously by 3 months of age

Management:

  • Reassurance to parents – non-serious problem, self-limiting
  • It is not a reason to stop breast feeding
  • Occasionally mother going on dairy free diet can help – but beware of this.  Some mums come back to me after eliminating dairy, gluten, nuts et cetera, and all they are consuming is water and potato crisps.  Not cool.  If you are going to try it, do it with the guidance of your GP/doctor, and only eliminate ONE thing at a time, for a FINITE period of time (eg 2-3 weeks).  If you don’t notice a SIGNIFICANT difference (ie “Oh my goodness I have a different child”  vs  “Hmmm… I’m not really sure if it has made a difference… maybe?”) then re-introduce the food.
  • There are a lot of products on the market sold for colic.  These include products like,
    • Infacol (simethicone)
    • Marina wind drops
    • Infant Gripe Water
    • Colica
  • There is NO EVIDENCE TO SHOW THAT ANY OF THESE PRODUCTS REDUCE THE SYMPTOMS OF COLIC ANY MORE THAN PLACEBO.
  • Most recently there has been some very WEAK evidence (ie really tiny trials) that showed a very small improvement with some strains of probiotic – but not enough that I would hang my hat on it.
  • The only thing shown beyond a doubt to work to cure colic is “Tincture of time” – that is, in time, they will grow out of it

So I hope you have found this post helpful.

 

Thanks for your support so far and until next time – may your babies sleep soundly and cry less!!

xx Dr Megs

For more from Dr Megan Yap visit her blog – Kids Health Guru

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