How Can You Tell If Your Baby Has Colic?

Excerpted from
The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer
By Harvey Karp, M.D.

In 1982, Dr. T. Berry Brazelton asked eighty-two new mothers to record how much their normal, healthy infants cried each day during their first three months of life.

The results of this study are shown in the figure below. When Dr. Brazelton did the math, he discovered that at two weeks of age, twenty-five percent of the babies cried for more than two hours each day. By six weeks, twenty-five percent cried for more than three hours each day. Reassuringly, he found that by three months almost all had recovered from their fussy period and few cried more than one hour a day (Persistent crying tends to vanish after three months which is why some doctors refer to it as "three-month" colic.)

When a baby is brought to me because of crying fits, I first ask about the parents' family history and the baby's birth, feeding habits, and general behavior. Next I examine the baby to make sure she's healthy and thriving. Once I'm sure that the baby is well, I consider if her crying pattern fits the "Rule of Threes," the formal medical definition of colic first formulated by Dr. Morris Wessel, a private pediatrician from Connecticut.

The "Rule of Threes" states that a baby has colic if she cries at least: three hours a day...three days a week...three weeks in a row.

Some doctors call babies colicky even if they don't fit the "Rule of Threes" but still frequently scream uncontrollably for no obvious reason.

Some parents in my practice also think that the "Rule of Threes" should be revised. They say the true definition of colic is when a baby cries so much her poor mom needs three nannies, three margaritas, and... six hands! (Okay, there's an exception to every rule.)

Parents often ask me if there's a way to predict which babies will have colic. While many doctors have tried to find a pattern to this problem, no consistent association has been found between colic and a baby's gender, prematurity, birth order, or their parents' age, income, or education. Colic can happen to anybody's baby. It is truly an equal-opportunity parental nightmare!

What Really Causes Colic?

Nine times out of ten, parents of colicky babies believe that their infants are suffering from some kind of pain. This would seem to be a reasonable guess, since colicky babies: are not relieved by the comforts of feeding and holding, often writhe and grunt, may start and stop their screaming very abruptly, have a shrill cry that resembles the sound they make when they're in pain (like after getting a shot).

Pain was what was on Sherry's mind when she brought her baby in to see me for a consultation about his incessant crying.

Charlie, a robust two-month-old, had a normal examination. This surprised his mother who was convinced that his daily frenzies must be the result of pain. When I asked her how she could be so sure, Sherry sheepishly admitted that she'd accidentally hit Charlie s head with the telephone receiver. She said, when that happened, I realized that his cry after getting whacked sounded exactly the same as his normal afternoon screamfest. I thought, That proves it, he's been in pain this whole time."

Was Sherry right? Was Charlie's crying caused by pain? Or had she somehow misread the situation? As you can imagine, since time immemorial, parents of crying babies have been analyzing their child's shrieks, trying to come up with an explanation for why their contented little infant at times suddenly "morphs" into one of the unhappiest babies on the block.

The "Evil Eye" (and Other Theories):
How Our Ancestors Explained Colic

Before I got married I had six theories about bringing up children; now I have six children and no theories. John Wilmot

It wasn't so long ago that people believed leeches could cure diseases and babies were born blind. Likewise, our ancestors made many guesses about why some infants cried so much. Deciphering a Stone Age baby's cry may well have been one of the first multiple-choice questions in history:

Your cave baby is crying because:

a. She's hungry.
b. She's cold.
c. She needs a fresh loincloth.
d. A witch cast a spell on her.

Over the centuries, wild theories have abounded about the cause of prolonged crying. Here are a few:

The Colic Clues -
Ten Universal Facts about Colic

In order to understand what causes colic, we first must agree on what it is. Researchers analyzing babies from all around the world have discovered ten fundamental traits of colic and colicky babies:

1. Colicky crying usually starts at two weeks, peaks at six weeks, and ends by three to four months of age.

2. Preemies are no more likely to have colic than full-term babies. (And their colic doesn't start until they are about two weeks past their due date.)

3. Colicky babies have twisted faces and piercing wails, like a person in pain. Often, their cries come in waves (like cramps) and stop abruptly.

4. Their screams frequently begin during or just after a feeding.

5. They often double up, grunt, strain, and seem relieved by passing gas or pooping

6. Colic is often much worse in the evening (the witching hour').

7. Colic is as likely to occur with a couple's fifth baby as with their first.

8. Colicky crying often improves with rocking, holding, shhhhing, and gentle abdominal pressure.

9. Babies are healthy and happy between crying bouts.

10. In many cultures around the world, babies never get colic.

Once scientists determined the colic clues, they compared them to the popular colic theories to determine which, if any, explained them best. The researchers immediately excluded many of the crazy old ideas and what remained are today's top five colic theories:

1. Tiny Tummy Troubles - babies suffer from severe discomfort caused by simple digestive problems (such as gas, constipation, cramps).

2. Big Tummy Troubles - babies suffer severe pain from true intestinal illness (such as food intolerance or stomach acid reflux).

3. Maternal Anxiety - babies wail because of anxiety they pick up from their mothers.

4. Brain Immaturity - immaturity of a baby's nervous system causes her to get overwhelmed and scream.

5. Challenging Temperament - a baby's intense or sensitive temperament makes her shriek even in response to minor upsets.

Each of these theories has its group of followers, but is any one of them the true cause of colic? Can any one of these theories explain all ten of the universal characteristics of colic?