Infantile Colic


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Infantile colic and the "fussy Baby"

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Infantile Colic

  1. 1. Colic vs. High Needs Babies – What is the Difference? Introduction There are few times in our lives that are more stressful, or require more of us, than caring for a newborn. Infantile colic and infants that require substantially more attention, referred to as high needs newborns, are conditions that additionally complicate the first months. The newborn infant is a miracle in development. The brain makes thousands of new connections each day and, as parents, we have the privilege of witnessing this evolution. The first months are also full of unknowns for many parents. New parents must learn the intricacies of caring for the newborn, but even those that have older children can still have completely new experiences with each child. The basic behavior of the newborn infant is essentially reacting to bodily needs and physical discomforts. Many are obvious, and require only feeding, changing a diaper or repositioning. However, some behaviors are difficult to understand and respond effectively. The challenge and frustration can feel monumental when parents cannot determine the cause of discomfort or crying. There are also times that even when the cause of the discomfort and crying is understood, finding the action to relive it is elusive. The enigma of persistent crying of the newborn has been the subject of much medical research. [1] [2] [3] [2] [4] [5] Colic and the excessive fussy baby are the most common reasons parents seek medical advice in the first 3 months of infancy [6] and is responsible for about one-third of pediatric emergency room visits. [7] Unusually frequent and prolonged crying can cause significant stress and has even been reported to increase the risk of maternal post-partum depression. [8] This article will
  2. 2. discuss the common problem of the fussy “high needs baby” in contrast to an infant with colic. Infantile Colic Infantile colic is medically described as distinct, inconsolable episodes of crying and agitation in an infant with no known health problems and is appropriately fed. [9] The periods of crying and inconsolability of colic should meet the following criteria: each episode characteristically occurs at similar times each day, last more than 3 hours and occurs at least 4 days per week. [10] The infants behave otherwise normally during the remainder of the day. Prospective studies have reported that between 5-19% of infants meet the clinical criteria for the diagnosis of colic. [11] [12] The cause of colicky irritability and bouts of excessive crying is almost certainly due to pain, most likely colon pain. This is why pediatricians often recommend a change in breast-feeding patterns or formula. The High Needs Baby There are be times when it is difficult to differentiate between colic and, what is referred to as a, high needs baby. Many pediatricians use the term “fussy” baby for an infant that cries more than usual, but does have the same daily pattern or prolonged duration of crying. The term “high needs” describes a fussy baby that with additional emotional reactions that require being held and comforted more than is usually expected. This type of infant behavior is more likely due the baby’s temperament than physical discomfort. William Sears M.D. introduced term high needs baby, based on his daughter, and published the description in his first book[13] which has recently been revised. [14] A basic review of this section of the book can be viewed at The high needs baby differs from the infant with colic in several ways. Mainly, the crying episodes do not follow the characteristic
  3. 3. predictable pattern described in infant colic. The high needs infant typically does not have a “return to normal” in-between difficult periods. The high needs baby tend to have a persistent fussy, often times demanding personality. Parents often use the term “difficult temperament” or “forceful personality” to describe the disposition of their child. The behavior issues with the high needs baby are persistent, and not distinct episodes that completely resolve. The persistent features of the high needs newborn are a high intensity determination, active, fussy and demanding. High intensity behaviors of the high needs baby are: 1) more forcefully oppose or protest when needs are not met, 2) strong emotional reactions, 3) loud cry and 4) often feed at a frantic pace. The high needs baby awakens often during sleep times, requires frequenting feeding to calm or soothe, and begins to show signs of separation anxiety when left without parents (especially mother). Characteristics of Colic vs. High Needs Babies Baby’s Behavior Colic High needs Distinct, time-specific, episodic crying Yes sometimes Crying episodes: last over 3 hours :occurs at least 4/week Yes Yes Uncommon Sometimes Persistent hyperactivity/fussiness No Yes High intensity behavior No Yes Demanding personality trait No Yes Difficult sleeper No Yes Requires frequent feeding No Yes Although parents of a high need baby often feel overwhelmed by difficult behaviors, some of these personality traits can become useful as the child grows. Such features as intense, active and
  4. 4. persistent can be instrumental in surviving and even striving in our competitive world. The trick is to love and enjoy your baby as you learn to “manage” the behaviors. Coping with a High Needs Baby As you can imagine there are many suggested strategies to “overcome” your baby’s high needs. The basic framework includes the following. First, discuss these issues with your pediatrician or nurse practitioner to make sure there are no medical issues causing the behaviors. Occasionally, an indolent ear infection or constipation can be responsible for persistent crying and fussing. Parents, especially with the first child, compare behaviors and development to children of friends and acquaintances. This can be helpful as it provides a lose guideline of anticipated developmental milestones, but try not to compare behaviors and personality traits. Your baby is unique and special. Don’t be afraid to ask for help. Your doctor may refer you to a high needs baby support group where you can learn what other parents do in your situation. Support groups are also designed to listen to you. It helps to talk about the unexpected demands of raising a high needs infant. If unable to get out of the home to talk with others, there are online several support groups, including a fussybaby facebook site. Writing in a personal journal is another form of expressing yourself to relieve stress. Consider creating your own support team. It may consist of other parents with high needs babies, family and supportive friends. It is important to your baby that you take care of yourself. Parents need a break and time just to catch up, and even just sleep. The fact is that we are all better equipped to face our challenges when
  5. 5. better rested and allowed time to take care of our own needs. Taking parental breaks is good for the baby with high needs. Above all, remain positive. Chances are you are doing the right thing and your high needs baby will be just fine. Colic vs high needs The difference between colic and high needs infants is likely related to the origin of the behavior. Colic is proposed as episodic painful episodes emanating from the gastrointestinal tract. Colic associated crying carries a painful pitch and often responds to changes in formula. The behavior of the high needs baby is likely emotional and related to developing personality traits. These specific traits manifest as difficult behaviors during infancy but will likely evolve into, and respond to, a more conventional expression of behavior. References 1. St. James-Roberts, I., The origins, prevention and treatment of infant crying and sleeping problems : an evidence-based guide for healthcare professionals and the families they support. 2012, Hove, East Sussex ; New York, NY: Routledge. xiv, 260 p. 2. Barr, R.G., I. St. James-Roberts, and M.R. Keefe, New evidence on unexplained early infant crying : its origins, nature, and management. Pediatric round table. 2001, Skillman, NJ: Johnson & Johnson Pediatric Institute. xviii, 336 p. 3. Valman, H.B. and R. Thomas, ABC of the first year. 6th ed. ABC series. 2009, Chichester, UK ; Hoboken, NJ: Wiley-Blackwell. vii, 125 p. 4. Lester, B.M. and C.F.Z. Boukydis, Infant crying : theoretical and research perspectives. 1985, New York: Plenum Press. xxiii, 375 p. 5. Early development & parenting. 1992, Wiley: Chichester ; New York. 6. Kheir, A.E., Infantile colic, facts and fiction. Ital J Pediatr, 2012. 38: p. 34. 7. Gray, L., Berglund, A., Klein, R., & Gilkerson, L. , Urban crying in the emergency department., in Poster session presented at the meeting of the International Society for Infant Studies. 2004: Chicago, IL. 8. Radesky, J.S., et al., Inconsolable infant crying and maternal postpartum depressive symptoms. Pediatrics, 2013. 131(6): p. e1857-64.
  6. 6. 9. Reijneveld, S.A., E. Brugman, and R.A. Hirasing, Excessive infant crying: the impact of varying definitions. Pediatrics, 2001. 108(4): p. 893-7. 10. Leung, A.K. and J.F. Lemay, Infantile colic: a review. J R Soc Promot Health, 2004. 124(4): p. 162-6. 11. Canivet, C., I. Jakobsson, and B. Hagander, Colicky infants according to maternal reports in telephone interviews and diaries: a large Scandinavian study. J Dev Behav Pediatr, 2002. 23(1): p. 1-8. 12. Crowcroft, N.S. and D.P. Strachan, The social origins of infantile colic: questionnaire study covering 76,747 infants. BMJ, 1997. 314(7090): p. 1325-8. 13. Sears, W. and M. Sears, The baby book : everything you need to know about your baby--from birth to age two. 1st ed. 1993, Boston: Little, Brown. xiii, 689 p. 14. Sears, W., et al., The baby book : everything you need to know about your baby from birth to age two. 3rd ed. Sears parenting library. 2013, New York: Little, Brown, and Company. xiv, 770 p.