DEBBIE ELLIOTT, host:
This is ALL THINGS CONSIDERED from NPR News. I'm Debbie Elliott.
What is the purpose of an infant's cries?
Dr. BARRY LESTER (Brown University Center for the Study of Children at Risk): They get parents real close to babies, so when a baby cries, mom shows up. So if you think of that from a kind of biological evolutionary perspective, you would say, oh, what a clever way to maintain survival of the species.
ELLIOTT: But when a baby's cries go awry you've got yourself a case of colic. Even if you've never had a baby of your own, you know just how hard it can be to listen to the sound of a baby crying.
(Soundbite of a baby crying)
ELLIOTT: The sound of a baby with colic is worse.
(Soundbite of a baby screeching)
ELLIOTT: If you're still with us, that was just 10 seconds. Imagine living with that soundtrack for three hours a day, or five, or 10, for two months straight. Colic is one of those things new parents talk about. But there doesn't seem to be a consensus about exactly what it is, what causes it, or what to do about it.
We spent an afternoon recently in Providence, Rhode Island at what's believed to be the nation's only colic clinic. It's part of the Brown University Center for the Study of Children at Risk and is run by Dr. Barry Lester.
Dr. LESTER: For many parents, especially first time parents, colic really is their first surprise. And it seems to come out of the blue. I mean very often what happens with colic is that, you know, you bring home your, you know, healthy, you know, eight pound Gerber baby and everything is going fine for the first couple weeks and you're not sleeping and you're exhausted, but you're sitting there thinking, six weeks, I'm going to get the smile, six weeks I'm going to get the smile, and that's what you're holding on to, among other things, as well as getting a good night sleep.
And then out of the clear blue you get, you know, as one mother here told us, the child from hell. She says, you know, I put this angel to bed and the child from hell woke up. There's no way that you can be prepared for it. So it's the first time that there's a true, sudden violation in your relationship with your baby. And it's a real test.
ELLIOTT: Lester says critical neural connections are formed when a baby is between three and six weeks old. And one theory is that this major neurological reorganization triggers colic in about 10 percent of babies. Other theories lay the blame on the developing digestive system. The word colic comes from the Latin word for suffering from the colon.
All babies cry, so how do you know if it's colic? There's a generally accepted definition called the 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. Dr. Barry Lester thinks that's a lousy definition for several reasons. First, who wants to endure three weeks of crying before getting help? Second, he says, it doesn't address the quality of the cry.
Dr. LESTER: I mean there are some babies who cry but the cry isn't all that bothersome. There are other babies who cry when the cry is very, very high-pitched and irritating. And one of the things that's characteristic about colic is that mothers will say all the time, he sounds like he's in pain. Okay, so a pain cry is different than a non-pain cry. So just talking about how much the baby cries doesn't capture the actual quality of the cry.
ELLIOTT: But perhaps most important, Lester says, is that the Rule of Threes doesn't take into account what colic can do to the whole family.
(Soundbite of a whimpering baby)
Ms. ELIZABETH KRETCHMAN (Mother): Shhh. You're tired?
ELLIOTT: Elizabeth Kretchman came to the colic clinic as a new mother who couldn't console her son Zachary.
Ms. KRETCHMAN: I was at my wit's end. I didn't know what to do. You already feel like you don't know what you're doing and then to have a baby that's kind of - everyone is saying he's kind of difficult. And I said he's not difficult. He's in pain. There's something going on.
ELLIOTT: Zachary is three-months-old now with a soft dusting of pale red hair. His dad, Kevin, also came to this day's session at the clinic. The family sits in a small exam room with a pediatrician and a psychiatric social worker.
Unidentified Woman: You look like a whole different person.
(Soundbite of laughter)
Unidentified Woman: (Unintelligible) met you about a month ago, I have to say.
Ms. KRETCHMAN: Yeah.
Unidentified Woman: Well, Karen, you know, sort of speaking about that...
ELLIOTT: The social worker asks all kinds of questions. When does the mom plan to return to work? How are they doing as a couple? Do they get out much? Does Zachary have a set bedtime? How's he eating? Then she pulls out color-coded charts based on diaries the family has used to track Zachary's crying spells.
Unidentified Woman: Now, let me try to spread these out. Yeah. The crying and fussing per day...
Ms. KRETCHMAN: Mm-hmm.
Unidentified Woman: ...has been - two and three-quarters was a low day.
Ms. KRETCHMAN: Ah!
Unidentified Woman: And five was a high day. So - and for sleep we get - it's a little choppy.
Ms. KRETCHMAN: Yeah.
ELLIOTT: 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.
Dr. LESTER: One of the most effective interventions that we do - and do as soon as we can - is to in a sense to let the mother off the hook and to say this is not something that you did. In fact, sometimes I'll say to mothers, you couldn't do this even if you tried.
ELLIOTT: The clinic also gives parents, like Elizabeth and Kevin Kretchman, advice on how to cope.
Ms. KRETCHMAN: There were times where he - I couldn't get him to stop crying and I would have to put him down and walk away just because - I didn't think I was going to hurt him, but I didn't want to handle him more roughly than I should, you know, out of my own frustration. So - and they actually gave me permission to do that when I came here, that it's okay to just put him down and take a break, because it seems like a distant memory, but he would cry, there was a time where he was crying all day, every day. And he'd come home and I would...
(Soundbite of Zachary crying)
Ms. KRETCHMAN: Aww. Aww.
ELLIOTT: He'd come home and you'd be like - here.
Ms. KRETCHMAN: Yeah. I just - yeah, I was...
(Soundbite of laughter)
Ms. KRETCHMAN: Because I would be up with him at five in the morning and he'd come home around six, so it was just 13 hours of him crying. But that's been such a change since we've been coming here. It really - we went over the diaries and I think the longest out of the three days that he had fussed was five hours, which may seem like a lot to some. But that's really quite a reduction.
ELLIOTT: Was it hard for you to come home to that?
Mr. KEVIN KRETCHMAN (Father): It was really difficult. I think after working all day, and then basically from that point on until one, two o'clock in the morning, I'd be taking care of the baby. And just the crying and the fussing and not even eating dinner; trying to eat dinner before like on the way home because I knew once I got home I wouldn't be able to.
ELLIOTT: What do you do?
Mr. KRETCHMAN: I'm a substance abuse counselor, so I'd have - I deal with difficult people all day and then I come home and deal with difficult infant all night.
Ms. KRETCHMAN: I don't like you to call him difficult.
Mr. KRETCHMAN: He is difficult. You can change the wording any way you want. It was hard. He was struggling and my wife was struggling. And then therefore as a family we were struggling.
ELLIOTT: The doctors says families arrive at the clinic in crisis. During our visit, a new patient came in but doctors said the mother was in too fragile a state to talk with us. One couple, now beyond the worst of it, says they are suffering from post-traumatic stress disorder.
For the Kretchmans, things are now looking up. Zachary is being treated for acid reflux, and doctors have suggested drastic changes in the family's routine to help him sleep better. But it still upsets Elizabeth Kretchman that she couldn't get help from her regular pediatrician. All he could suggest was switching infant formula. Dr. Lester says that's pretty common.
Dr. LESTER: People get frustrated about something that they don't know how to treat. So being able to tell someone I have a diagnosis for you, but sorry, I really can't help you, is not something that most people want to do. So maybe you just wish it away and, you know, it'll go away.
ELLIOTT: And so, Lester says, most pediatricians just advise moms to hang on and tough it out for a couple of months. But if colic is a short-term problem, why not just let it run its course?
Dr. LESTER: Because early experiences change the baby's development and life forever. You know, what's going on in early infancy is that the baby is forming critical relationships, developing emotional systems, and if those systems get derailed, then they can have consequences later on, long-term consequences.
ELLIOTT: Consequences like baby's inability to bond with mom or others, emotional and behavioral problems that can affect intellectual development, and in the worst case, child abuse.
So Dr. Barry Lester says he'd like to see pediatricians everywhere take colic seriously and do what they do at the colic clinic in Providence, Rhode Island: treat any physical causes, get the family organized in a time of chaos, and perhaps most important, give the parents the emotional tools they need to get through it.
Dr. LESTER: Sometimes what parents really need is for a professional to say, go to a movie, you know. I'm giving you a prescription to go out with your husband for dinner, you know. And all of a sudden, well, because we said it, it's okay to do. Sometimes that's really what it takes.
ELLIOTT: Our story was produced by Alice Winkler. You can read an excerpt from Barry Lester's book, Why Is My Baby Crying, at our Web site, npr.org.
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