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Treating colic: Curing the colic myth

Published November 5, 2007 1:00 am

One doctor says most criers suffer from 1 of 2 specific maladies; families urged to get help during ordeal
This is an archived article that was published on sltrib.com in 2007, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Two and a half months ago, baby Isis came screaming into this world, and in the long, long days since, she's hardly stopped.

At first Shelly and Jeff Poole assumed their daughter had just been through a traumatic journey. But when the crying increased, they began to worry that something was terribly wrong.



"We thought maybe she had brain damage from jaundice," said Shelly.

So they embarked on an infant-calming odyssey: repeated trips to more than one doctor, a restrictive diet for Shelly, countless folk remedies, several prescription medications, a variety of slings, strollers and sleep positioners. Finally, they got some dispiriting advice:

"We can try this and we can try that, but it might just be colic and there's not much we can do," the family's pediatrician told them. "You might just have to figure out how to cope."

That advice is painfully common for parents of colicky babies. Some estimates say that as many as one in five infants suffers from inconsolable crying. It has also spawned as many pharmaceutical and folk remedies as it has sleepless nights, but there has been no definitive breakthrough.

Bryan Vartabedian and Barry Lester are two doctors pushing for change: better treatment not just for the baby but for the whole family.

Vartabedian, a pediatric gastroenterologist at Texas Children's Hospital and author of the book Colic Solved: The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult-to-Soothe Baby, believes that "colic is really a wastebasket term. Pediatricians use it when they have no idea what the heck is going on."

In his estimate, 60 percent or more of babies who are dubbed colicky have either milk-protein allergy or acid reflux disease, a condition in which the stomach contents come back up and irritate the esophagus.

Babies are especially prone to acid reflux for several reasons, he said. They drink only liquid, which is less likely to stay put, they don't benefit from gravity until they're old enough to sit up, and their stomachs don't empty effectively.

Both conditions are highly treatable.

Vartabedian is not the first to point to digestive issues as a major underlying cause, but he is waging a campaign to encourage parents to accept nothing less than a comprehensive medical workup of "colicky" children. His main goal is parent empowerment.

"If they feel that they've gotten the short end of the stick and have not had a [complete medical] history taken or a thorough exam done, they should look elsewhere until they feel that their baby is being well cared for," said Vartabedian, who was in Salt Lake City recently for a conference and is an assistant professor at Baylor College of Medicine.

Barry Lester agrees that there are many colicky kids whose reflux and allergies are undiagnosed. But he believes it's a smaller group than Vartabedian suggests.

A bigger problem is that entire families go untreated, said Lester, a professor of psychiatry at Brown Medical School and director of the nation's only clinic designated for treating colicky babies and their families.

Two babies who cry for hours on end in two different homes may spur completely different reactions in their families. For one, the crying may be annoying but survivable. For another, it may send a couple to the brink of divorce, drive a wedge between mother and child and cause older siblings to act out.

It's those cases that need the most medical intervention, he said, and not just from a physician.

Every family that comes to the clinic at the Infant Development Center at Women and Infants Hospital is seen by a pediatrician and a mental health specialist.

"Let's say a mother goes to their pediatrician and they're having a real problem with the baby crying, and the pediatrician says, essentially, 'Hey, lady, suck it up. This is normal. You'll get over it,' " said Lester.

"It raises doubts in the mother's mind about her ability to be an adequate mother. 'Am I making this up? Am I normal? What's wrong with me?'

"The insecurity and self-doubt makes the situation even worse."

The first step in treatment is telling the parents it's not their fault, he said.

"You didn't do this. You couldn't do this if you tried. There is no way you're responsible," he said.

Once that happens, they begin to see the baby in a different light.

Treatment is just as likely to include a prescription for a night out on the town without baby as it is a comprehensive exam for the infant. Developing routines to minimize crying and looking for signs of postpartum depression are also part of the plan.

The Pooles don't have access to Lester's Rhode Island clinic. But with the help of their pediatrician, family and friends, they've created their own treatment plan.

Shelly attends a postpartum depression group and sees a therapist. The couple has hired a baby sitter to take the baby out of their home so they can get some downtime. They even drove Isis to her grandparents' home in St. George so they could get a few days of sleep.

As a labor and delivery nurse, Shelly was stunned at how Isis' colic has taken over their family.

"I've held crying crack babies in my arms for 12 hours and it never bothered me," she said.

These days, the baby's crying seems to be calming - somewhat. But they are still shattered.

"We are so burned out now that we can't enjoy it. She's only 2 1/2 months old, and it almost feels like it's too late."

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* JENNIFER BARRETT can be contacted at jbarrett@ sltrib.com or 801-257-8611. Send comments about this story to livingeditor@ sltrib.com.

Signs of acid reflux and milk-protein allergy

BRYAN VARTABEDIAN TELLS PARENTS to look for these signs of reflux in their "colicky" baby: spitting and vomiting, constant hiccups, feeding disturbances such as pulling away from the nipple and grimacing, chronic irritability, discomfort while lying on the back, sleep disturbance and chronic cough and/or congestion.

* SYMPTOMS OF MILK-PROTEIN ALLERGY include blood-streaked stools, mucus in the diaper, crankiness, diarrhea, eczema, and wheezing and congestion.

Other colic suspects

* THE "FOURTH TRIMESTER": Physician Harvey Karp said babies basically are born three months too early, developed just enough to survive, but without all the systems functioning properly. Crying is one symptom of the baby's underdeveloped nervous system, he said.

* PROBIOTICS: Recent research out of Italy found that 95 percent of breast-fed colicky babies improved when given Lactobacillus reuteri, which boosts helpful bacteria in the GI tract. The research supports the notion that many cases of colic have their origins in the gut.

* TEMPERAMENT: Just like adults, babies have their own personalities. Some are more sensitive to light, touch, hunger and pain, according to Bryan Vartabedian. That may account for about 40 percent of colic cases, by his estimates.

A rundown of remedies

Barry Lester collects alleged colic cures for his "Colic Gizmo Museum - admission free." Most of them work some of the time, he said, but none of them work all of the time. Here are some of the more colorful methods:

* GRIPE WATER: A mixture of dill oil, sodium bicarbonate, and 3 to 5 percent alcohol, which is illegal in the United States. A virgin version is made with ginger, fennel or mint.

* CREATIVE SOURCES OF VIBRATIONS: Placing the baby, in car seat, atop the drier. Running the vacuum or shower while the baby sleeps. Heartbeat recordings or white-noise machines.

* THE "WHYCRY": A device that translates a baby's cries into one of five complaints: hungry, bored, tired, stressed or annoyed.

* CAR-RIDE SIMULATORS: Gadgets that attach to the crib mattress and mimic the sound of a moving car.

* RESTRICTIVE DIETS: Breast-feeding mothers can try removing foods that babies sometimes are allergic to, such as milk, eggs, wheat or nuts. Other common foods that may make a baby fussy: broccoli, coffee, tea, chocolate.

* "WEARING" the baby in a sling

* HERBAL TEAS and sucrose

* TIGHT SWADDLING around the baby

* A MECHANICAL SWING or bouncy chair

* A HOT-WATER BOTTLE on the tummy

* BABY MASSAGE

* LACTASE DROPS

* BATH POWDERS

* SPECIAL FEEDING positions

* EXERCISE routines

Source: Why Is My Baby Crying, by Barry Lester

 

 

 

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