Every infant cries. It’s a part of being a newborn, yet infant crying still puts many of us on edge. As parents, we want to calm our babies and prevent crying; it’s simply instinctive to want to make it go away. The period of time when our babies cry most (between 1-2 months of age) can be entirely exhausting, unsettling, and unnerving. As we transition into parenthood, one of the most difficult challenges can be learning to soothe our crying newborns. One expert, Dr Ron Barr, refers to this period of crying as the PURPLE period. I’ll explain, but first, let’s talk a bit about colic and news today about using alternative “folk” treatments, and ultimately what it may mean when someone, a doctor or not, tells you that you’ve got a “colicky” baby.
This morning I did an interview for Good Morning America Health about a Pediatrics systematic review evaluating 15 large studies (including nearly 1000 babies) to determine if things like infant massage, probiotics, chiropractor’s manipulation, herbal supplements, and sugary/glucose solutions really helped “colicky” babies stop crying. The results proved unfortunate. No, these interventions don’t tend to help infants who are crying/fussy/screaming their heads off. Two things to think about with the new findings: first, when you’re frustrated with a baby’s fussing/crying, don’t reach for these remedies as solutions or as “cure alls.” As we know it now, there’s not a lot of evidence to use any of these remedies. Secondly, don’t confuse the word “natural” with “harmless” or “safe.” Many of these herbal and complementary remedies come with labels that say “natural.” Natural doesn’t confer safety. Some limitations of interpreting data from the 15 studies reviewed was the reality that little time was spent reporting side effects to interventions and therapeutics. It may simply be because there were few, but researchers are unsure. We only want to use medications in infants that prove effective.
The most important thing to do for a fussy infant is to find ways for you to soothe your baby. But know that you won’t always be successful. If your baby has been fed, burped, changed, is warm and comfortably dressed and they’re still crying, don’t spend all of your energy determining the why behind their cry. Unfortunatley, you likely won’t find the answer! Rather, spend time figuring out what helps: things like rocking, holding, walking outside, taking a stroller ride, taking a car ride, running a faucet of water for white noise, changing your babies position, or putting the baby down for a break in their crib. Breaks are key. This space can provide a break for both of you. What’s most important is that you as a caregiver, find soothing in times of stress, too!
As I prepped for the interview regarding the review of alternative remedies, it brought up a need for clarity of what is normal, and what is not, when it comes to crying in infants. So here’s some answers to general questions:
What is Colic?
Oddly, diagnosing colic can be controversial. Not every pediatrician uses the term. Infantile crying is expected and varies from baby to baby. The key point here is that ALL babies cry. From the moment they are born, infants have their first big important cry to clear fluid from their lungs. Then crying time starts to accelerate from 2 weeks of age with a peak around 6-8 weeks and then ultimately dramatically improves after about 3-4 months of age. By definition, colic goes away simply with time. But not all babies are alike, some cry far more than others.
- Colic has traditionally been defined using “Wessel’s Rule of Threes.” That is, infants who cry more than 3 hours a day, at least 3 days a week, for more than 3 consecutive weeks. However, the cut-off of three hours is entirely arbitrary. Although the rule of 3′s can help families define it, ultimately the label of “colic” doesn’t solve the frustrating crying. As any parent can attest, 2 hours and 59 min of crying versus 3 hours and 10 min of crying a day certainly isn’t very different. So defining colic is only a part of it. Sometimes, though, I think parents feel better having a label to the crying a name to help define it. It gives them scope for their struggles and frustrations. But having a diagnosis of colic doesn’t mean there is something wrong with your baby.
- Infantile crying is common and variable with some studies finding nearly 20% or more of babies demonstrating “excessive” crying every week. It’s hard to define what is normal and what is abnormal, hence the controversy in colic’s definition. Often how we experience our infant’s crying varies from parent to parent, too. Which again confuses the labeling.
- Most parents and pediatricians think of colic as crying that is more intense, difficult/resistant to soothing, and last for long periods of time. Dr Ron Barr, an expert on infant crying, told me that roughly speaking, “unsoothable” crying represents about 5-15% of all crying and fussing that infants do. The rest is made up by “fussing” (about 65%) and “crying” (about 35%).
- Excessive crying can be seen in all babies, no matter if they are breastfed or formula fed, 1st or 2nd born, boy or girl, premature or full term.
Crying can be extremely difficult on caregivers. Particularly because crying peaks in the late afternoon and evening when parents are already exhausted. This is a huge part of the diagnosis and a huge part of the therapy. Recognizing the toll on caregivers is essential for supporting the baby.
Is It Just Infants Who Have “Colic” and Excessive Crying?
Yes, again, crying is a part of every new baby’s life but varies dramatically between one to another and even siblings. Just like weight and height vary, crying varies dramatically between one healthy baby and another.
Tip: Colic and infantile crying generally improves after 3 months of age, with 60% of excessive crying resolving by 3 months!
Do We Know What Causes Colic?
The short answer: No. Now knowing for sure what causes excessive crying and colic is part of the problem with helping families understand that testing (blood work or radiology studies) and medication interventions, are overwhelmingly not needed. However, theories about colic and excessive crying look to food allergies, formula intolerance, gas formation and intestinal cramping. Many researchers believe crying is a normal part of an infants life and that the “painful” look on their face or sound of their cry may not represent a medical problem, but rather a spectrum of normal, infant crying.
Some babies may have high amounts of normal crying that are exacerbated by illness or cause. This could be a sensitivity to cow’s milk protein (dairy), or excessive gas, or an intolerance to formula or other proteins. If you think your baby is fussy in a typical pattern, or acutely changes in the way they cry or cries only with feeding, it’s absolutely something to share with your pediatrician.
We know that lots of other species, mammals and even non-primates who breast feed, have similar trends of rising distress or crying in first few months of life. Some researchers theorize the why behind all this crying lies in evolutionary terms: babies who cry are cared for, form attachements and better bonds with caregivers and parents, and are more likely to be picked up, held, and protected from predators.
What is the Period of PURPLE Crying?
PURPLE is an acronym to help define the normal pattern of crying for newborn infants. It describes the typical crying behaviors. Again, all infants cry with a Peak in the minutes or hours of daily crying around 6-8 weeks of age. Most babies will cry Unpredictably (unprovoked or unexpectedly), and their cries will be Resistant to the best of our efforts to comfort. Many normal, healthy babies will cry and it will look like they are in Pain, and they will cry for Long periods or time (up to an hour or more). And finally, they tend to cry most in the Evening when we’re all exhausted and run down.
Sometimes just knowing the range of normal can help us calm down. The most important thing for our babies is that we take care of ourselves, too, in our frustrations to soothe crying. Taking breaks can be essential and taking turns caring for babies when you get frustrated. Talk with your partners, nannies, or any other caregivers about the PURPLE period so they know, too, what to expect.
What Can You Do To Treat Colic?
Time, support for parents and caregivers, and partnerships with pediatricians are essential. Sometimes, having a baby evaluated for allergies or intolerance is part of the work-up to define additional treatments, but not in the majority of infants. Sometimes modifying a breast-feeding mom’s diet (restricting dairy, usually) can help and is worth a try. When you’re worried about your baby, call the pediatrician, visit with them, discuss your concerns and what your plans are to soothe and support your crying baby.
Most important in treating infantile crying is treating parent’s frustrations and giving them tools to HELP learn to soothe their baby! Many of my friends and patients have enjoyed reading Dr Harvey Karp’s Happiest Baby on The Block book (and DVD) as it gives them a set of tools to try to soothe their baby’s cries.
We know that excessive crying is a risk factor for child abuse and shaking of infants. We know that particularly in this time of recession, shaking of infants is higher than usual. Helping families find support and an action plan for crying is most important. Particularly because crying in infants is self-limited, meaning it gets better simply with time. Sometimes it’s hard for us to wait when we’re exhausted and overwhelmed. It’s okay to ask for help, even if it means seeing the pediatrician every week or more if needed.
How To Cope With Colic or Fussy Infants?
Bottom line is infantile colic is difficult to treat but the great news is it goes away with time! The majority of excessive crying stops around 3 months of age. Talk with your pediatrician about your concerns so together you can develop a plan on communicating about crying and/or evaluating potential causes of other causes of crying! If your babies cries seem to mimic the PURPLE period, resist spending time figuring out what makes a baby cry (you won’t figure it out) and spend energy putting in place plans for soothing, supports for you and your spouse, enlisting evening care from friends and family, respite care for you!, and find techniques to successfully deal with crying and soothe babies.
3 step action plan is great for helping a fussy infant:
- Walk, talk and comfort your baby. GO OUTSIDE where crying isn’t as loud and you can be relieved by space. This often helps comfort baby and stop the crying. The fresh air and break from all the noise inside will help you, too.
- If crying goes on a long time and parent/caregiver is frustrated, it’s okay to WALK AWAY for a time period. Put baby in crib on their back or in bassinet and take a break for 10-15 minutes. Have a Diet Coke, walk outside, and sit on your porch. TAKE A BREAK! You baby will be FINE and you’ll do better and have more energy when returning to your baby’s cries.
- Never shake a baby. It won’t stop the crying and it can have serious or even deadly results. Harming or hitting a baby will never curb crying. And know with ongoing gentle comforting, holding, and soothing, you can never spoil and infant! All that love will only help support your bond with your baby.
What do you think, how did you baby do in the first few months? Did your baby have excessive crying? Colic? What worked??