Providence Clinic Helps Parents Cope with Colic

Dr. Barry Lester

Dr. Barry Lester says even fellow medical professionals "get frustrated about something they don't know how to treat," and parents wind up blaming themselves. Alice Winkler, NPR hide caption

itoggle caption Alice Winkler, NPR
Elizabeth, Kevin and Zachary Kretchman i i

Elizabeth and Kevin Kretchman found help at the clinic when son Zachary was troubled by colic. Debbie Elliott, NPR hide caption

itoggle caption Debbie Elliott, NPR
Elizabeth, Kevin and Zachary Kretchman

Elizabeth and Kevin Kretchman found help at the clinic when son Zachary was troubled by colic.

Debbie Elliott, NPR

Scroll down to read an excerpt from Dr. Barry Lester's book.

Colic is one of those things all new parents talk about. What to do about it is another matter.

Dr. Barry Lester runs what may be the nation's only colic clinic. It can be found in Providence, R.I., at the Brown University Center for the Study of Children at Risk, affiliated with Women and Infants Hospital of Rhode Island.

Lester rejects a generally accepted definition of colic, which is based on the so-called "rule of threes." If your infant cries for three hours a day, three days a week, for three consecutive weeks, it's diagnosed as colic.

First of all, Lester says, no parent should endure three weeks of that sort of crying before getting help. Secondly, he says, it doesn't address the quality of the cry. Babies who have colic are most definitely in pain, Lester says.

"A pain cry is different than a non-pain cry," he says. "Just talking about time isn't addressing the quality of the cry."

Elizabeth Kretchman was referred to the colic clinic when she went to be screened for post-partum depression. A study by the doctors here shows a strong correlation between colic and depression in mothers. They don't know if one causes the other, but they do know that as colicky babies improve, mothers feel better. And when mothers feel better, they respond better to a fussy baby.

Lester says mothers find a safe place at the clinic to voice all the things new parents are not supposed to admit. They may feel inadequate. They may not really like their new baby... or they feel they are somehow responsible for the baby's pain.

"I think one of the most effective interventions we do — and do as soon as we can — is to in a sense let the mother off the hook," Lester says. "And to say this is something going on in your baby. Not something you did."

Elizabeth and Kevin Kretchman say their son Zachary's colic affected their household and put a strain on their relationship, and doctors at the clinic say families ofen arrive in a state of crisis.

Things are looking up for the Kretchmans. But it still upsets Elizabeth Kretchman that she couldn't get help from her regular pediatrician. All he could suggest was switching infant formula.

Lester says that's pretty common, too.

"People get frustrated about something they don't know how to treat," he says. "So telling someone 'I have a diagnosis but I can't help you' is not something most people want to do."

And so, he says, most pediatricians just advise parents to hang on and tough it out for a couple of months.

Lester says just letting colic run its course is a bad idea.

"Early experiences change a baby's development and life forever," he says, leading to consequences such as a baby's inability to properly bond with a mother... emotional and behavorial problems... and in worst-case scenarios, child abuse.

Babies' cries are the primary trigger for shaken baby syndrome and other forms of child abuse.

Lester says he'd like to see pediatricians everywhere take colic more seriously: treat physical causes, get the family organized in a time of chaos and give parents the emotional tools they need to get through it.

"Sometimes what parents really need is a professional to say 'Do this.' Like, 'Go to a movie.' You know, 'I'm giving you a prescription to go out with your husband for dinner.' And because we said it, it's OK to do. Sometimes, that's what it takes."

Excerpt: 'Why Is My Baby Crying?'

Cover of Barry Lester's book 'Why Is My Baby Crying?'

Dr. Barry Lester says nearly all newborn babies have a basic cry and a pain cry... and they are distinct. Colic is a cry of very real pain. HarperCollins hide caption

itoggle caption HarperCollins

The following passages are excerpted from the first chapter of Dr. Barry Lester's book Why Is My Baby Crying?. The descriptions of basic cries are directed at babies in the first month of their lives.

Crying is normal. Colic is not. People who say that colic is normal not only are wrong; they also are doing a huge disservice to families who have colicky babies. Those families know it is anything but normal. Being told it is normal just makes those parents feel like there is something wrong with them. But it is true that to understand colic you first need to understand normal crying. So in this book, we will keep moving back and forth between crying and colic.

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We want babies to cry. Crying means a baby is robust, is intact, has energy, and can communicate. Physicians even talk about an infant's "respiratory effort" — a strong, lusty cry. When babies don't cry or when their cry is abnormal, this can mean there is something wrong.

Little babies can't talk with words, so for them the cry is their language. We are used to thinking that communication means language, as in words and sentences, and that you have to have language to communicate. (In fact, the word infancy comes from the Latin infans, which means "speechless.") But speech, or language, has two components. The first is the words themselves and their syntax (the grammar and all that stuff we hated to learn in school but which turns out to be quite useful because, after all, we are able to communicate.) The second component of language is its prosodic features: pitch, loudness, melody and intonation. In a sense, these prosodic features carry our feelings. Cry is all prosody. Babies don't have the words, but they sure have the feelings — and they communicate their feelings, their needs, and their wants through the prosodic features of pitch, loudness, melody, and intonation. Crying is a baby's first way of communicating. It is the language the baby uses before words.

Our job as parents is to understand our babies' cry language. We need to correctly interpret it so that we can figure out what the baby wants and respond accordingly. Our job is much more complicated than the baby's is. First we have to interpret the little tyke's screams. Then we have to figure out an action plan — what he needs, how to implement it, and how to provide the right kind of parenting. The baby's job is simpler. (After all, he's only a baby.) The baby has to tell us what's on his mind, what he needs, and make sure that he is communicating well by sending out clear and unambiguous signals so we can tell from his cry what's up. The only way he can mess up (and I'm not talking diapers) is to have an unusual or even abnormal cry. Right from birth, a baby is crying to tell us about his medical or neurological state.

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There are important parallels between abnormal, normal and colic cries.

Think about why an ambulance siren gets our attention. Humans are particularly responsive to higher-pitched sounds — the maximum acoustic response of the ear is above 800 Hertz (cycles per second). And sirens are not only high pitched; they change, they are dynamic. So are baby cries. What gets us going in a baby's cry is its high-pitched, warbling sound. Sounds at certain frequencies make people sit up and take notice. This is part of the biology of the human auditory system. In fact, there are evolutionary biologists who argue that baby's cries are programmed to be at certain pitch levels to ensure the baby's survival! When parents hear that loud, high-pitched cry, they can't help but look around to see what's wrong.

The cry is an information transmission system that sends affective messages — hunger, pain and need for attention. Crying has been called an acoustical umbilical cord that keeps the infant close to the mother. Ethologists, scientists who study animal behavior, call crying "a proximity-promoting and maintaining signal" — that is, it encourages the mother to stay with and soothe her baby.

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The newborn infant — and here I am talking about your basic healthy, full-term Gerber baby — has two kinds of cries in his songbook. His cry portfolio — his cryfolio — has a basic cry and a pain cry, and they are distinct. They are clearly, audibly different to the human ear whether you are a parent or not, whether it is your baby or not, whether you are male or female, whether you are an adult or a child.

Not surprisingly, the differences between these two kinds of cries show up if you subject the cry sound to acoustical analysis. I can look at an acoustical analysis of a baby's cry — a cryprint — and tell you exactly what kind of cry it is from the way it looks on the printout.

The pain cry is an emergency cry. It is the early warning system and it means something is really wrong. I remember talking to a mother, years ago, who called to say that her baby had been doing fine but that there had been a sudden change and the baby's cry had become high pitched. The mother took the baby to the pediatrician, but the baby was fine. Two days later the baby got a fever and was found to have an infection. In this case, the cry was an early warning sign. The cry changed before the baby had even developed the fever, and his mother was appropriately alert for signs of trouble.

The pain cry is usually high-pitched, loud, and of sudden onset and includes long periods of breath-holding. Often the very first "waaah" or burst of this cry is prolonged and then is followed by a long period of breath-holding. Many mothers say it is the breath-holding that makes them jump up and say, "There's something wrong with my baby." You heard the first "waaaah" and are waiting for the second. Instead, you hear silence. That's the breath-holding. There's a very scary moment before you hear the second "waaaah" that lets you know your baby is OK and hasn't stopped breathing — but you still know that something is wrong. When mothers of colicky babies say to me, "He sounds like he's in pain," it is because they are hearing a pain cry.

The other cry in the newborn cryfolio, the basic cry, is used for everything else. It is most typically heard when the baby is hungry, which is why it is often called the hunger cry. It is the same cry the baby uses when his diaper is dirty or for any other nonemergency issue. The basic cry has a more gradual buildup and a lower pitch. It does not have the long periods of breath-holding or the frantic, emergency quality of the pain cry. That's why mothers hearing that cry will often say "Oh, she's just hungry," or "She just wants to be picked up." They are fairly nonchalant about it, and that's fine.

But not all babies are created equal. In the same way that adult voices are unique, there is a certain indviduality to each baby's cry. You see, there is the sound of a sound and there is also the sound inside the sound. The sound of the cry sound is the basic or pain cry. The sound inside the sound — or the cry within the cry — is the unique part of your baby's cry. it is your baby's cry signature. This is why mothers say their baby has a "bored" cry or a "wet" cry. Some babies do develop different kinds of cries within the overall structure of their basic cry that come to have special meaning for their mother. But one baby's "bored" cry is not the same as another's — and not all babies have a "bored" cry.

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All of these observations have to do with the newborn to 1-month-old infant. Crying in infants at this age has a reflex quality, as opposed to the more voluntary quality that happens after the first month. At around 4 to 6 weeks, there are changes in the baby's nervous system that involve the vocal cords and the voice box (larynx). At that point, the baby starts to gain control of his vocal cords, a prerequisite for speech and language development. (Soon, the baby will coo and babble and start doing all those cute baby things.)

Once the process of voluntary control starts and the baby discovers that she can make sounds when she wants to, her cry is no longer just a reflex. She will cry for the same reasons as she did before, but there is a new dimension now. The baby can initiate the cry. And make no mistake about it, babies love this. It is as if they have discovered a new toy, their first internal toy. And look at the power that comes along with it! "I can make Mommy come whenever I want." Now we have the baby crying for attention, which is different from crying because of hunger or pain.

This is where the battle starts. It is the first time that the baby's will is pitted against the mother's will. Once the attenion cry has been added to the baby's cryfolio, once Mom says "He is doing it on purpose — he just wants attention," the battle line is drawn. When the cry is just from hunger or the baby's needing a diaper change, parents don't feel they have a choice about responding. But once a baby can cry on purpose, parents are faced with their first opportunity to say no. The baby asserts his autonomy — and the challenge begins.

How parents deal with these early issues will set the stage for the relationship they will have with their child for the rest of their lives. When colic is thrown into the equation, the first challenge becomes the first crisis.

Excerpted with permission from Why Is My Baby Crying? by Dr. Barry M. Lester, Ph.D, with Catherine O'Neill Grace, published by HarperResource, an imprint of HarperCollins.

Books Featured In This Story

Why Is My Baby Crying?

The Parent's Survival Guide For Coping With Crying Problems and Colic

by Barry M. Lester and Catherine O'Neill Grace

Hardcover, 175 pages | purchase

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Why Is My Baby Crying?
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The Parent's Survival Guide For Coping With Crying Problems and Colic
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