Dr. Tafadzwa Kasambira, M.D., M.P.H. is a pediatrician who received his undergraduate training at McGill University in Canada, and graduated in 2002 from Tufts University School of Medicine, where he also completed a degree in public health. He completed his pediatric residency training at Harvard University in 2005, and completed a fellowship in infectious diseases at Johns Hopkins University in 2008. He has been a medical officer at the FDA for the last six years. He and his husband are the proud fathers of three children.
One of several dictionary definitions of “colic” is the following: “A condition marked by recurrent episodes of prolonged and uncontrollable crying and irritability in an otherwise healthy infant that is of unknown cause and usually subsides after three to four months of age.”
These words will likely strike a painful chord in all parents who have endured the incredibly stressful experience of caring for an infant who has (or has not) been diagnosed with colic. Many of us remember that time as if it ended last week, though years may have already passed. Some have forgotten what it was like, but others cannot now hear an infant crying in public without developing palpitations.
The ironic thing about that traumatic time is that most children get through it fine. They develop into healthy, happy, boisterous children, with little memory of the trauma they went through, while we parents are sometimes left to tend to the emotional battle scars.
My husband and I are two of those “survivors,” and our 6-year-old daughter, whom I will call Wordgirl, is a violin-playing, Spanish-and-English speaking, high flying gymnast who talks a mile a minute and possesses loads of energy. This girl was once a newborn who would see the bottle coming near her mouth, and let out a blood-curdling scream that could cause a house to shake.
We would have to psyche ourselves up to feed her each bottle. She would suck on the nipple for two seconds, then arch her back and wail for a full minute…suck again because she was starving, then wail as the milk hit her stomach. This went on for months, while my husband and I – first-time parents, at that – were at our wits’ end. It did not help that both of us are Type A, male professionals – we needed answers, and we needed them yesterday.
We would buy new types of bottles each week, change the formula constantly, give her Simethicone® drops, and utilize different positions for burping or soothing her. When my ideas from my pediatric training were exhausted, I would turn to my medical colleagues. We called her own pediatrician (since I am emotionally unable to be my own kids’ official doctor) frequently, and were constantly met with the same frustrating line: “It’s only colic. She’ll grow out of it. Wait it out for a few months.” We began to wonder if our concerns were being dismissed out of an erroneous assumption that two fathers were just clueless about the normal development process of newborns.
As a parent watching your tiny infant suffer through her most basic task in life, namely, that of eating, this was heartbreaking, and just not good enough. We knew that this was not normal, regardless of what the books, my own knowledge, and her pediatrician told us. There was something wrong, even to our nascent parental minds. We let her pediatrician go and chose another, then set up an appointment with a pediatric gastroenterologist. That was the beginning of Wordgirl’s recovery, and of our own.
Approximately 16-26% of healthy infants between the ages of one and four months are said to have infantile colic, based on the fact that they cry “excessively,” a time period loosely defined to be more than three hours per day, three days a week, for three weeks or longer. Crying often occurs in the late afternoon or evening, and is intense and high-pitched. The baby is difficult to console, and may have clenched fists, curled up legs and tense abdominal muscles.
The cause of infantile colic is unknown. Several potential clinical causes that have been explored include gastrointestinal etiologies, allergic causes, an underdeveloped and immature nervous system, changes in bacterial flora within the gut, and intolerance to lactose.
In otherwise healthy infants, gastro-esophageal reflux disease (GERD) is not often seen as being a cause of excessive crying or irritability in infants. Diagnosis of the condition requires the recognition of clinical symptoms and support from endoscopy, during which a specialized tube with a camera and light is placed down the throat. Abnormalities in the esophagus, stomach, and initial part of the small intestine are noted, and may include irritation and inflammation, or narrowing of the esophagus due to acid reflux.
Many infants who are diagnosed with colic, however, such as our daughter Wordgirl, receive oral acid-blocking medications to reduce the acidity of the stomach and thereby reduce gastro-esophageal reflux. Physical methods are also advised, such as giving smaller, more frequent feedings, burping more often during each feed, and holding the baby upright while giving a bottle.
Her pediatric gastroenterologist also diagnosed her with a condition known as milk-soy protein intolerance (MSPI), an ailment in which the infant cannot tolerate certain proteins found in milk and/or soy. Classic symptoms include vomiting, bloody stools, watery diarrhea, and weight loss. Babies who have MSPI may appear hungry and anxious to eat, but have great difficulty when taking a bottle that contains milk- or soy-based formula.
Management of MSPI involves giving elemental milk formula, in which milk proteins (e.g., casein) are hydrolyzed into smaller pieces that the body will not recognize as milk protein, and are therefore digested more easily. Such formulas include Alimentum® and Nutramigen®, and the more completely hydrolyzed formulas for infants with more significant issues with MSPI, Neocate® and Elecare®.
Wordgirl’s symptoms were not typical of MSPI, although her response to the elemental formula was. The milk tastes horrible (I did try it, only once), but she soon realized that the milk did not cause her the pain that she had previously experienced. Her crying ceased; her weight began to increase again; and she became the happy baby during her feeds as she was outside of them.
There are many lessons that I hope to impart by sharing the story of our difficult first year with Wordgirl. The first is that as a parent, you should trust your instincts. Babies cry. But if you feel that the crying is out of proportion to whatever notion you perceive as being “normal,” contact your child’s pediatrician. If you feel that you are not getting the help that you feel that your child needs, find it. You and your baby’s pediatrician should be partners in the common goal of keeping your child growing and healthy.
Legal Disclaimer: This article is designed to provide general information related to pediatric care. The information presented on this article should not be construed as formal medical advice, nor is it intended to create a doctor-patient relationship. The content is intended solely for informational and not for treatment purposes.
This article is not a substitution for professional medical diagnosis or treatment.
Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics 2000;106:184-190
Kattan JD, Cocco RR, Jarvinen KM. Milk and soy allergy. Pediatr Clin North Am 2011;58(2):407-426
Vandenplas Y, Rudolph CD, DiLorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49:498–547