Screaming Through the Centuries

The earliest pediatric textbook, published in 1553 as (before the age of formalized spelling), called a baby’s non-stop screaming “colicke,” a “rumbling in the gut.” “Colic” is derived from the Greek kolon — large intestine — since many early practitioners believed colic was a gastrointestinal problem. It took another 400 years before a British pediatrician, Dr. Ronald Stanley Illingworth, conducted one of the first major studies of colic in the early 1950s. At the time, “cures” for colic included goat’s milk, opium derivatives, and banana powder. For six months Dr. Illingworth closely studied 100 babies, half of whom were colicky. Based on the extensive data, he discovered that colic usually began at around two weeks, babies had their fussiest episodes in the evening/night hours (although they could fuss at other times), and all of the babies were over this painful stage by four months.Since then, researchers have studied colic in different countries and various cultures, ranging from suburban America to the Kung San tribesmen in southern Africa. The colicky baby is a universal problem, from the United States to China, Nigeria to the Netherlands, Korea to Canada.Parents will go to almost any lengths to cure the crying. “In one extreme case, I had a father who would drive his baby across the border from Illinois into Iowa every night to get him to calm down. He did this for three months, until the baby outgrew his colic. It was worth it for the father not to hear the constant crying,” Dr. Borenstein reminisces.

“The most important thing,” he continues, “is to reassure parents that their baby doesn’t have some horrible disease. It’s a developmental stage that they will outgrow.” While this may be reassuring, the question remains: Why are babies colicky and what can we do about it?

Researchers and doctors have various theories and solutions for colic — but which one is correct? Dr. Gwen Dewar explains that there’s no precise cause of colic because different symptoms can be due to varied causes in different babies. With those “clear” guidelines in place, let’s explore some options.

Intestinal Issues

One of colic’s greatest myths is that it’s simply an intestinal disorder. Meir is a six-week-old who shrieks constantly, but mainly in the evening. His fists are clenched, his knees drawn up, and he passes a lot of gas. Meir’s stomach looks swollen, and his constant crying is putting his whole family on edge.

According to Dr. Borenstein, a baby with Meir’s symptoms but no poor weight gain, vomiting, constipation, or loose diapers, is often suffering gas pains because of all the air he swallows when he screams.

Studying hundreds of colicky babies, Dr. Weissbluth explains that the pain might be related to hormone levels of serotonin and melatonin. Serotonin makes the intestines contract, which is necessary for digestion, while melatonin causes our muscles to relax while we sleep. Children and adults usually have peak levels of these hormones in the evening. Little babies, on the other hand, have higher levels of serotonin in the evening, but their melatonin levels stay low. This can cause evening cramps and lack of sleepiness. The solution? Wait! At around three to four months, melatonin levels rise, and babies develop more regular sleep-wake cycles. While some doctors prescribe simethicone, a medication that combines small internal air bubbles into a bigger, easier-to-eliminate bubble, this doesn’t solve the issue.

“Simethicone is safe,” reassures Dr. Eugene Shubin of Community Pediatrics in Mishawaka, Indiana. “You probably won’t see any results, though.”

GERD (Gastroesophageal Reflux Disease)

“All babies have reflux,” declares Dr. Vartabedian. This is where the sphincter muscle at the bottom of the esophagus is too relaxed, allowing acidic stomach contents to come up into the throat. For many babies, the level of reflux is mild. In other babies, the acidic contents of the stomach cause tremendous pain that makes feeding, lying down, and swallowing difficult. A 2004 study of 60 irritable infants found that 66 percent showed internal signs of acid reflux. While the researchers admitted that they could not prove the irritability was caused by reflux, it’s something to think about.“The fussy baby is fussy for a reason,” says Dr. Vartabedian. Not every screaming baby has reflux, but the doctor strongly supports the idea that this is a major component in ceaseless crying.

Holding a reflux baby vertical for 20 minutes after a feeding, avoiding positions that put pressure on the abdomen, and elevating the head of a baby’s crib are all ways to use gravity to fight reflux — even though the evidence is not solidly behind the crib elevation (don’t you love these conflicting studies?). Constant burping and smaller, more frequent feedings also help. While rice-thickened formulas don’t seem to do much good, the proper bottle nipple can minimize air-swallowing and help ease a baby’s painful feedings.

Cutting down on stomach acid production with medication sounds like the answer, but treatments take patience and time to work properly. It’s worth noting that some doctors, while they will prescribe these acid- inhibiting medications, don’t believe they’re effective. Dr. Eric Hassel claims that clinical trials show these drugs work no better than placebos. Obviously, the babies weren’t able to offer their opinions (although that would have been helpful), but parents of babies on drugs and parents of babies on placebos reported roughly the same amount of crying. Surprised?

Milk Protein Allergy

“As many as five percent of all babies have some degree of milk protein allergy,” notes Dr. Vartabedian. Milk is made up of protein, fat, and sugar, and some babies are allergic to the protein. Even among nursing infants, trace elements of milk protein from a mother’s diet can cause a reaction.

“Amino acids are the building blocks of protein,” Dr. Borenstein explains. “Think of protein chains as necklaces, made up of amino acid pearls. With a milk allergy, babies are often switched to hydrolyzed or hypoallergenic formula, where the protein chains are broken up into the individual ‘pearls’ that babies can digest.” He cautions that it takes a few days to see improvement, so jumping from formula to formula is not recommended. Babies allergic to milk protein are often also sensitive to soy, so that route should be taken very cautiously.

Should nursing mothers change their diet? One study showed little difference when mothers eliminated milk products, while a second study found positive results – but only when the mothers also eliminated other allergens from their diet (wheat, peanuts, etc.). Either way, results will take time.

“I don’t usually tell mothers to make drastic changes in their diets,” Dr. Borenstein says. “New mothers are dealing with so much stress that a difficult diet is often not realistic.”

Transient Lactose Intolerance

“Some babies may actually be lactose intolerant,” says Dr. Gwen Dewar. Babies with milk protein allergy are sensitive to the protein in milk, while these babies suffer from a temporary inability to digest lactose, the sugar in milk. This happens when the lining of the intestine is damaged, either by acute diarrhea, malnutrition, or a gastrointestinal illness.

In cases like this, doctors try to treat the diarrhea in order to heal the lining of the intestine. Lactose-free formulas, or a prescription of infant drops containing lactase may help these babies digest lactose properly. Going on a lactose-free diet is not recommended — so no worries about that tempting milchig ice cream.

Bacterial Imbalance

Many fussy, excessively gassy babies seem to have more gas-producing bacteria in their digestive tracts. Researchers examining the intestinal contents of colicky babies versus normal infants found a higher concentration of E. coli bacteria, which can cause infections in the digestive tract and other parts of the body.

“Babies like this benefit from probiotics — ‘friendly’ microorganisms that colonize the digestive tract and reduce inflammation,” explains Dr. Dewar.

In one study, colicky babies were given probiotics for 28 days, after which 95 percent of them showed a reduction of crying from 159 minutes to around 51 minutes. These numbers look like the light at the end of the tunnel for parents of colicky babies, but always consult with a pediatrician, who will know which probiotics to prescribe for maximum effectiveness.

Food Allergy

Esty is a nine-week-old who simply won’t stop screaming. Her mother’s morning cups of coffee are invariably followed by an hour-long marathon of piercing shrieks. Her mother finally decides to cut out the daily “cup of joe,” and Esty’s screaming stops. Whether Esty’s mother can handle her caffeine-free morning remains to be seen….

According to some studies, there are babies who seem to be sensitive to certain things nursing mothers eat.

“Are you eating cabbage or broccoli?” Dr. Shubin will ask mothers of fussy newborns. In his experience, these foods can cause gas and discomfort. Other doctors are vehemently opposed (of course) to this idea. Dr. Weissbluth puts it bluntly: “This [theory] makes about as much sense as the argument that when a nursing mother eats chocolate, she produces chocolate milk.” Regardless of which side of the food fence you (and your pediatrician) are on, there are definitely mothers who see a drastic improvement in their babies when they remove certain foods from their diets. If you decide to go the elimination-diet route, do so under a doctor’s supervision. This will involve eliminating certain foods for a few weeks, and then reintroducing them to see if your baby’s symptoms improve and then return when you go back to the offending food. Identifying the digestive culprit will hopefully result in a happier mother and baby.

Interestingly, the gemara (Kesubos 60b) says if a woman has a nursing child, she shouldn’t eat anything that could affect her milk, and thus the child. Some things can cause the milk supply to diminish, and other substances can affect the child. The list is as follows: hops, a certain type of small fish, dirt, the soft part of a palm tree, a certain type of dairy dip they ate in those days, and fish hash. Rashi in parshas Behaalosecha says that the mahn couldn’t taste like certain foods since this was bad for pregnant and nursing mothers, although we don’t know what would happen to those who ate these things. This includes cucumbers, melons, leeks, onions, and garlic. (The Bais Efraim says these aren’t a real safeik sakanah, but of very slight concern, and there is no halachic obligation to refrain from eating them.)

Temperament

In a fascinating breakthrough, doctors are beginning to realize that some babies have more difficult temperaments. These babies react more strongly to outside stimuli, and colicky screaming is their way of dealing with what their brains see as stressful events.

“Temperament” — how different children respond to their environment —can be tracked within days of birth. Everyday activities like diaper changes upset babies with difficult temperaments more. For instance, in 2021 a group of 21 babies was monitored while being exposed to the smell of rotten cabbage (the lengths to which these researchers go…). Babies who responded with elevated brain activity were far more likely to develop colic.

In a sweeter experiment, researchers gave both colicky and normal infants a sugar solution to calm them. However, the soothing effect lasted for only about two minutes among the colicky infants. These babies are simply less tolerant of the world around them.

Surprisingly, Dr. Dewar explains that less stimulation might be the key. Always holding and responding to these babies doesn’t reduce their crying. This is where swaddling, white noise, gentle rocking, or riding in the car might work. A dark, quiet room is essential. There is no one-size-fits-all cure for the temperamental baby (You knew this was coming, right?).

Sleep Disorder

It’s a revolutionary idea: Can colic be a form of sleep disorder? Sleep guru Dr. Weissbluth, the author of Healthy Sleep Habits, Happy Child, thinks there might be some connection. Sleep can be divided into two states: the REM (rapid eye movement) stage, where our eyes move, we are more restless, and breathe less regularly; and the deeper, calmer non-REM sleep. Both types of sleep are important, with REM sleep restoring emotional equilibrium and non-REM sleep restoring the body physically. Newborns spend much of their time in REM sleep, and their sleep patterns only become more like those of adults at four months. True restorative non-REM sleep is associated with deep, even breathing, but this is a relationship that develops over time, although doctors don’t know how this happens. In colicky babies, sleep organization seems to take longer to progress, and their breathing when asleep is often quick and shallow. Dr. Weissbluth speculates that intense crying at night might be a colicky baby’s way of inhaling the oxygen he isn’t getting from his abnormally light sleep breathing. This sleep-breathing-crying connection might have something to do with SIDS (Sudden Infant Death Syndrome), since colicky and fussy babies are almost never victims.Regular soothing techniques should be used until four months of age, and then Dr. Weissbluth recommends putting these babies on a sleep schedule. While his sleep philosophy is an entire article (book) in and of itself, the basic premise is to put children to bed before the overtired stage hits (most mothers can relate to that one), with a sleep pattern tailored to each age and stage.

Colicky Conclusions

Every parent wants a baby who sleeps, doesn’t cry too much, and is a smiling, peaceful delight. Every parent wants to use their vacuum cleaner only for carpets. Not all parents are so fortunate. Night and day can merge into a lonely, miserable series of sobs — not all of them baby’s.

Even with all the theories and soothing techniques, some babies still cry, and no one knows why. That’s the nature of colic.

But it will end. Life will once more include sleep. The sound of the vacuum cleaner will cease — unless the carpets need cleaning. And you will be left with your beautiful, miraculous baby. Thank you, Hashem.

Colicky Parenting 101

Colic is complicated. Parents are unwillingly thrust into the Sherlockian role of detective as they try to figure out what can be causing their darling’s exhausting behavior. Meanwhile, there is a long list of techniques to try; what works for your friend’s colicky baby might not work for yours. Even Sherlock Holmes might give up with such convoluted clues, but since parents don’t have that luxury, here are some strategies to try when you’re watching the sun rise for the seventh time this week….

Try one, try them all (after speaking to your pediatrician). Hopefully, something will bring peace and quiet to your home:

• Gripe Water: A British-created compound, over 100 years old, to reduce gas. Many versions contain ginger or fennel. “I don’t generally find it useful. Gripe water used to contain alcohol — maybe that’s what really helped,” Dr. Borenstein conjectures. Regardless, some parents love it.
• The Colic Hold: Gravity applies pressure to baby’s abdomen to help with gassiness; baby should be face down, his tummy on your forearm and his legs straddling your elbow. Baby’s chin will be in your hand. Any position putting pressure on the stomach is effective.
• Herbal Tea: Lukewarm herbal teas (chamomile and fennel) are an old folk remedy for colic.
• Sound: White noise drowns out background noise and lulls children to sleep. Sound machines, hair dryers, radio static, or shushing can all work.
• Music: Music or singing may be effective. At the very least, they can distract the baby from discomfort. Don’t worry if you can’t carry a tune — baby doesn’t care!
• Motion: This is usually effective. Rhythmic motion in your arms, a cradle, rocking chair, baby swing, sling, or car rides all seem to bring relief.
• Massage: A gentle stomach massage can relieve discomfort.
• Cuddling, Swaddling, and Holding: Gentle pressure from being hugged or held feels good. Sleeping in a car seat or soft baby carrier gives babies a similar sensation.
• A Warm Bath: May be relaxing.
• Pacifiers: Can trigger the sucking reflex, which automatically calms baby.
• Feeding: Many babies are soothed while they are feeding (and sucking).
• Fathers: Mothers need breaks, and fathers can be excellent at taking over.

Colic needs to be taken seriously. Sleepless nights, stress, frustration, and anger, all put parents’ mental health and relationships at risk. Shockingly, the National Center on Shaken Baby Syndrome estimates that 90 percent of head trauma occurs in babies due to inconsolable crying. While waiting for colic to subside, “Keep up your health, good cheer, and loving relationships,” advises Dr. Weissbluth. “I paid a neighbor to hold my firstborn so I could take a shower without hearing her screaming,” says one mother, Miriam. Neglecting your mental and physical health won’t help anyone, including your colicky baby.

Here are some tips to keep in mind:

Take turns soothing the baby. Friends and relatives can help.

Mini breaks are essential.

Accept offers of help.

Tend to your own needs.

If you’re at your breaking point, put the baby down in a safe place and step away for a few minutes to recharge.

5 Things NOT to Say to Parents of a Colicky Baby:

1. Can you please get him to quiet down? (What do you think I’m trying to DO?)
2. Cherish this stage— it goes by so fast. (Not fast enough….)
3. I think she’s hungry. (I just fed her! AGAIN!)
4. You’ll get through it. (That’s certainly encouraging.)
5. All babies are like this. (I hope not.)

Instead:

1. What night can I send over supper?
2. My daughter would love to babysit. What time works best?
3. Can I take your baby for a short time?
4. Here’s a small (insert gift here). I can’t stop the colic, but I want you to know I care.
5. I made you a potato kugel/challah/dessert for Shabbos. Enjoy!

Causes and Symptoms of Colic

(Originally featured in Family First, Issue 879)