Not many things are more jarring than the sound of a screaming baby. For parents of infants with colic, this sound can seem endless. Colic is characterized by sudden crying in an infant, with no apparent cause. In order to qualify as colic, crying must occur for three hours a day, three days a week for three weeks, Alanna Levine, MD, a pediatrician and parenting expert in New York City said in an interview.

Approximately one-fifth of babies have colic, which typically starts when a baby is two to four weeks old, according to the American Academy of Pediatrics. “Usually by the time the baby is four months old, they’re coming out of it,” Levine said.

Most people believe that colic occurs in babies who are super-sensitive to external stimulation and have difficulty calming down. While colic is not necessarily dangerous for the baby, it can upheave family life. Crying typically occurs in the evening, which coincides with the time of day that parents are most exhausted or just getting home from work. Clinical Advisor spoke with two pediatric clinicians for tips on how best to treat colicky babies and their parents.

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Rule out medical causes

If a parent brings their child in for suspected colic, the primary care clinician should first conduct a physical examination to make sure that there is not another medical problem causing the crying.

Any crying that goes on for more than three hours warrants medical attention, Levine said. Parents should also be instructed to seek medical attention if their child’s crying is interfering with feeding, or if their child is lethargic.

Other common noncolic causes of relentless crying include a hair tourniquet, which occurs when a strand of hair gets wrapped around a child’s finger or other body part, cutting off the circulation and causing pain; a corneal scratch; or otitis media. “If all of these have been ruled out, then it’s time to start treating colic,” Levine advised.

Treating colic

Clinicians should focus on finding out as much as they can about the baby, such as details about the pregnancy, when the crying occurs, the infant’s sleep and feeding schedule, and family history, advised Jean Twomey, PhD, assistant professor of pediatrics at Brown Alpert Medical School and the Brown Center for Children in Providence, R.I.

Is the baby being fed enough or too much? Is reflux involved? Is a lack of sleep making the baby irritable? These are all questions that clinicians should be asking parents. Requesting that parents keep a diary to tracks the baby’s schedule, including feedings, sleep and crying, can also be useful to help clinicians spot patterns. “That really starts to inform our thinking about why the baby is crying,” Twomey said.

Sleep problems and colic often go hand in hand, according to Twomey. Often parents work so hard to help children settle down and get to sleep that the children never learns good sleep habits of their own. This lack of sleep is one of the top causes of irritability in children. Sometimes improving sleep may help reduce the crying, Twomey said.

Potential solutions

Colic often mimics the symptoms of other conditions, such as reflux or excess gas, as babies with both conditions seem to be straining from abdominal discomfort, according to Levine.

If the mother is breastfeeding and the child seems to be experiencing gas and discomfort, she should try eliminating foods from her diet that may be causing these problems, such as cauliflower or beans. Parents can also try to modify feedings, making them more frequent and smaller in size. Feeding upright and keeping babies upright after feeding can also relieve gastrointestinal discomfort.

There are also several comfort measures you can recommend to parents to help calm colicky babies:

Use a pacifier. While some parents worry about future dental damage from pacifiers, but the American Academy of Pediatrics reports that this risk is minimal in children younger than three. “I’m a big proponent of pacifiers—they can be a wonderful tool,” Levine said. Provided the baby is nursing well, you can also reassure parents that a pacifier will not interfere with breastfeeding.

Swaddle or wrap the baby. Holding the baby tightly in a blanket is another way to help soothe some infants.

Establish a strong bedtime routine. Bedtime routines should be the anchor of the day, Twomey said. The time a child goes to bed should never vary. Performing soothing routines each time can help a child settle down for sleep.

With all the different advice out there, advise parents to pick a course of action and stick with it. Jumping from one problem-solving technique to another may make the problem worse, Levine said.

Providing support to parents

In addition to focusing on the baby, clinicians should also pay close attention the well being of parents with colicky babies, as the condition can be particular stressful for them. These parents are often sleep-deprived, and may perceive the endless crying as a reflection of their failures as parents, Twomey added.

Intervention is particularly important because the early weeks with an infant are a critical time when it comes to forming strong family bonds. “One of the most helpful and reassuring things you can offer to parents is the fact that they’re not the only parents experiencing this problem,” Twomey said. Other families are going through the same thing.

Parents should also know that colic is likely the result of their child’s hypersensitivities, and that this stage generally resolves its own. Keep in mind that although it is helpful for parents to understand that their child will outgrow the problem, clinicians should also recognize that for a parent who is struggling to get through each hour of a single day, hearing that the problem will pass in a month or two is often not reassuring.

Clinicians should issue concrete and specific recommendations, as having real suggestions can restore confidence and help parents feel empowered to improve the situation. “Things can turn around quickly once everyone starts getting more sleep and the anxiety about the baby’s crying is alleviated,” Twomey said.

Clinicians should be certain to speak with parents about the potential dangers of shaking a baby out of frustration. Parents dealing with colic are often sleep-deprived and frustrated. They should be instructed to put the baby in a safe place and let him or her cry before losing control. Also suggest that they call a friend, neighbor or family member to come in and help so they can take a break, Levine said.

Often parents a colicky baby hesitate to leave the infant with someone else because of the crying. But they should realize that others are willing to help them, and that it is okay to take advantage of that assistance for their own sanity.

In addition to the tips above, primary-care clinicians should consider referring parents with colicky babies that do not respond to initial interventions to an infant mental health specialist.