AND THE RULE OF THREES
Colic is defined not by physical problems but most commonly by time. A baby is considered colicky if she has unexplained crying for more than three hours a day, for at least three days a week, for three weeks running. By the time those numbers, or worse numbers, are racked up, parents are pretty stressed out.
A highly popular book, The Happiest Baby on the Block by Dr. Harvey Karp, suggests providing what he calls the “Five S’s.” Those are swaddling, side or stomach position while holding, shushing sounds, swinging, and sucking (bottle, breast, pacifier, or even a finger).11 For some families, these work like a charm. Others need additional help.
If the numbers in the crying pattern are lower than in the colic guideline of threes, the infant may still be considered fussy in her parents’ eyes. However one labels the problem, the crying will usually lessen as the infant matures in the fourth trimester and is better able to calm herself and regulate her sleep and wake cycles.
FUSSY OR COLICKY: MOTHERS AND FATHERS NEED SUPPORT
With a truly fussy or colicky baby, parents need help. No caregiver can do it alone, and adults have to take care of themselves if they're going to be able to care for the infant. Professionals like physicians, social workers, or mental health workers can help. So can parenting groups, a mother, father, or in-law, or a friend who has survived a colicky baby. Spouses and partners can take turns giving each other a respite. All of that can amount to a schedule of relief—time to catch up on sleep, leave the house, and spend some time without infant responsibilities. Time out from parenting is a basic need, especially when a newborn cries excessively. The fourth trimester is, in the scheme of things, a short time. But it's incessantly demanding and tense.
In 2003 Dr. Linda Gilkerson founded the Fussy Baby Network at Chicago's Erikson Institute. The network has expanded to include programs in cities throughout the country, including one at Southwest Human Development's Arizona Institute for Early Childhood Development in Phoenix; one at the Children's Hospital and Research Center in Oakland, California; one operated by the University of Colorado Denver at the Children's Hospital; and another at the Boston University School of Medicine. Similar programs are being developed in the Los Angeles and Washington, D.C., areas. There are other organizations similar to the Fussy Baby Network, such as the colic clinic Dr. Barry Lester founded at Brown University in Providence, Rhode Island.
Gilkerson wanted to provide support for parents concerned about their infants’ crying or temperament, a desire rooted in her experience with her own colicky son, Michael, during his fourth trimester. Dr. Gilkerson and Michael had endured an extremely difficult fourth trimester—for more than three months he cried inconsolably. There had been trips to the pediatrician, where he was declared healthy. Nothing was wrong, yet each day was unpredictable, adding to the stress. Michael would have endless crying bouts that his family came to call “Big Mac” attacks. He cried through feedings, diaper changes, and endless, futile attempts at comfort. Then a peaceful day would come, with no crying jags, followed by another day of “Big Mac” attacks. Through it all, he was a healthy baby. The diagnosis, common among babies who cry a lot, was the ill-defined “colic.” After each medical trip, Gilkerson went home assured that her baby was fine. But she received no advice on how to deal with excessive crying herself: how to help her baby through it, or what to make of it. Despite the assurances of good health, he remained fussy—and there seemed to be no end in sight.
By the end of the fourth trimester, the excessive, inexplicable tears and howls were almost over. She recalls a moment of shared pleasure that was a long time coming. “He was born on April 3,” Dr. Linda Gilkerson says. “I remember on July 4 [three months later], I was upstairs in the bedroom. I had my feet up like this,” she says, demonstrating the classic infant-holding, knees-up posture, “and it was a moment of discovery. There was a sense of no barriers, limitless joy. I think it was just those cheeks and the sparkling eyes and the ability to sustain the engagement.”12
She had already been hooked, in love with him since his birth, but now she felt he loved her in return. She could see it in his eyes, in his recognition of her, in his relaxed pleasure as he lay in her lap. It is a moment that all parents feel, when love moves in both directions and, for a lifetime, grows on both sides.
BABY ANNIE'S STORY: what is wrong with this baby?
Annie was born to John and Courtney Bowles on September 18, 2009. She was an inconsolable bundle the moment she came home. “That first night, she cried and cried. Nothing seemed to soothe her,” said Courtney. As a hospital social worker, Bowles had seen hundreds of newborns. But they seemed to sleep all the time, and she just wasn't prepared for Annie's crying. Her expectation had been that if Annie needed a diaper change, she'd cry for a few minutes, then coo with gratitude once clothed in a clean diaper. If she were hungry, she'd cry until she was fed.
Instead, she cried with a wet diaper, and continued crying with a dry diaper. She cried when she was hungry, and continued crying after she was fed. She cried when lying down, when sitting up in her infant seat, and when held this way and that.
Courtney and her husband tried swaddling, but Annie hated it, kicking through the tight wrap. Courtney talked to her, stream-of-consciousness talk that grew increasingly anxious—with an edge of fear to her voice—as Annie kept crying.
John would take her into the bathroom, the darkest room in the house, and flip on the fan, trying for a white-noise effect. They experimented with how they held her: upright with a face against her head, or in the traditional cradle position while pacing, pacing the hallway of their Chicago apartment. If something worked, they kept it up: three paces forward, quick turn, three paces back, quick turn. Cradled against an adult's pounding heart, Annie seemed to like the pacing—until one unpredictable moment when she didn't and cried some more.
“We worried that something was medically wrong,” says Courtney. “Every time Annie started crying, it panicked me. It affected me to my core.” After about six weeks, Courtney was crying almost as much as her baby. “I would doubt myself. I'd think, ‘I don't know how to soothe my own child. I'm a failure.’ “ For the first five weeks of Annie's life, they were weekly regulars at her pediatrician's free walk-in clinic. Annie would be declared wide-eyed, alert, and growing normally.
Courtney's mother, who had moved in to help with the newborn, had to leave after four weeks. At six weeks, when Courtney found herself panicking the minute Annie started to cry, she decided it was time to get help. She called the Fussy Baby Network's Warmline in tears. The next day they sent an infant specialist to the Bowles home. “By the time they see us, they're at their wits’ end,” says Michelle Lee Murrah, infant mental health practitioner with the Fussy Baby Network.13 They've read every parenting book they can lay their hands on, they've called their pediatricians, they may have rushed to the emergency room, they've heard the conflicting advice of their own parents, in-laws, and friends, and the baby still cries a lot.
When Murrah arrived at the Bowles's apartment, she attentively watched as Courtney and Annie did what they normally did. Courtney fed the infant and then put her on the floor. Mother and baby were down playing with the infant gym when Annie started crying. Murrah saw a yawn that Courtney missed. She wondered with Courtney what could be happening for Annie. Together, they continued to watch, and Murrah helped Courtney see Annie's sleepy signs. “She's tired,” said Murrah, and suggested she put Annie down and leave her alone. Courtney had never, for an instant, let her baby go to sleep without holding her. Murrah encouraged Courtney to give her just a few minutes to see if Annie could comfort herself to sleep. The two women talked while Annie cried in her crib. Courtney said she felt guilty, inadequate, a mother who couldn't comfort her child. Within a few minutes, Annie was sleeping as the women continued to talk.
