Identifying and treating your baby’s long bouts of crying and discomfort.

Once upon a time, when parents brought their crying, hurting baby into a doctor’s office for medical evaluation, they often walked out with a diagnosis of colic. New insights into the hidden causes of colic now enable parents to get a plan from their health care providers to help heal those tummy hurts.

My quest for the cause of colic began in the early 90s with the first edition of The Baby Book. Instead of simply passing it off as colic, I used the term “hurting baby,” which motivated both the doctor and the parents to keep searching for why their baby is hurting and what they can do. I began uncovering medical reasons as to why colicky babies hurt and, even more importantly, what to do about it. I still remember a crying mother in my office saying to me, “Doctor, I’m not leaving your office until you find out why my baby is hurting, and please don’t just pass it off as colic.”

My investigations revealed two main hidden causes of colic:

     1. Gastroesophageal Reflux (GER)

This is the most common hidden cause of colic. As food passes down the digestive tract there is a donut-like muscle at the junction of the esophagus and the stomach. When food enters the stomach, this muscle automatically contracts, preventing the regurgitation, or reflux, of irritating stomach acids back up into the esophagus.

For some babies this protective muscle takes many months to mature, during which time babies give that hurting cry. Call this “baby heartburn.”

Clues to GER

  • Baby is in more pain when lying flat.
  • Frequent wet, sour burps and acid breath.
  • Baby shrieks in pain after a feeding.
  • Baby seems more comfortable when being held in the upright position.
  • Baby is restless and suffers frequent, painful episodes of night walking.
  • Throaty noises: gagging, choking, raspy breathing.
  • Baby spits up soon after feeding and the pain usually accompanies the spit-up.

How to heal the hurts

  • Feed baby according to my Rule of Twos — Twice as often, half as much. Smaller volumes empty faster from the stomach. This applies to both breast-fed and bottle-fed babies.
  • Keep baby at an upright 30-45 degree angle and soothe them for 20-30 minutes after a feeding.
  • In the early days of trying to learn more about colic, my wife and I coined the term “babywearing” because we noticed that mothers in our medical practice would often say, “The more I wear him, the happier he is.” The combination of being in the upright position, in the arms and cheek-to-chest is just what the hurting baby needs.
  • Breast-feed as often and as long as possible. Breastmilk is mom’s best medicine for reflux because mother’s milk empties from the stomach twice as fast as formula and the frequent feeding of breast milk acts like a natural antacid. Also, what’s good for baby is also good for mommy. During breast-feeding, mothers produce relaxing hormones that help them cope with the crying of a hurting baby. Mother’s milk also contains enzymes that aid digestion.
  • Burp baby well. Trapped air bubbles in the stomach aggravate re ux. To minimize air swallowing, burp baby when you move from one breast to the other. If bottle- feeding, use a collapsible bag nurser to lessen air swallowing, and burp baby after every few ounces of milk.

Mention your suspicion of GER to your health care provider who, after you have tried the above simple remedies, may prescribe antacid medication. The good news is that reflux usually subsides after the first three to six months, especially between six and nine months — the age at which babies spend most of their time upright.

      2. Food or formula sensitivities

If GER has been ruled out and a breast-feeding baby is still hurting, suspect baby has a temporary sensitivity to foods in mother’s diet — usually cow’s milk, wheat, nuts, soy or corn, in that order. If baby is formula feeding, your health care provider may advise a hypoallergenic formula. Besides being better tolerated by sensitive intestines, some of these formulas are digested more quickly.

‘Dr. Daddy’ to the rescue

Mothers comforting hurting babies naturally wear out. I remember years ago when Martha was upstairs resting and one of our re ux babies started a crying outburst. Realizing that our baby’s favorite pacifier was temporarily out of service, I needed to come up with a uniquely male colic comforter. This is when I discovered the neck nestle: snuggle baby’s head into the groove between your chin and chest. While swaying back and forth, croon a slow, repetitive tune such as Old Man River. The deeper male voice and the stronger vibration of the male voice box against baby’s head will often lull the fussy baby right to sleep.

Whatever the cause of colic, given the help of your healthcare provider and a big dose of parental intuition, this temporary hurting stage will soon pass.

Bill Sears, M.D., is a father of eight and the author of 42 books on family health, including The Healthiest Kid in the Neighborhood. A practicing pediatrician for over 40 years, he is an Associate Clinical Professor of Pediatrics at the University of California, Irvine, School of Medicine. Dr. Sears is a fellow of the American Academy of Pediatrics (AAP) and a fellow of the Royal College of Pediatricians (RCP)