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Parenting a constantly irritable infant is one of the most stressful challenges a new parent can face. What are you supposed to do when your infant is crying inconsolably at 3 a.m. and nothing seems to soothe him for more than a few minutes? Friends may tell you your baby is "colicky." You don't care what it's called, as long as there's a way to fix it. Is there? Read on.

What is Colic?

The definition of colic used by researchers is: "A healthy, well-fed infant who cries for more than three hours per day, for more than three days per week, for more than three weeks."

Unfortunately, colic is not a well-understood condition. Here's what is known:

* Colic usually starts at about 2 weeks of age in a full-term infant (or later in a premature infant).
* Colic almost always goes away by 3 or 4 months.
* There is no difference in the prevalence of colic for boys and girls, whether you breastfeed or bottle feed, and whether the baby is first born or not.
* Scientific studies have shown that children who had colic are no different in terms of personality, mental health, intelligence, etc., than children who never had colic.

What Causes Colic?

Despite many scientific studies, no single common cause for colic has been found. The fussiness of colic has many different causes, and that's why there is no one way to help it.

Some theories of the cause of colic include:

* Digestive woes, perhaps due to intolerance to cow's milk protein or lactose
* Reflux (heartburn due to stomach acid and milk flowing back into the esophagus)
* An immature digestive system in which the intestinal muscles are often in spasm
* Air (gas) in the intestinal tract
* Increased hormonal levels that cause stomachaches or a fussy mood
* Hypersensitivity to an environment full of stimulation (sound, light, etc.)
* An intense temperament in the newborn period
* An immature nervous system

Take note that all of these hypotheses come from the baby, not the parent. Remember this if you start to blame yourself for your baby's fussiness.

First Steps to Address Colicky Behavior

Before looking to treat your baby's "colic," make sure he is thoroughly examined by his pediatric provider to check for a medical reason for the fussiness.

Some of the possible medical reasons for irritability in an infant include:

* an infection (for example: an ear or urinary infection)
* evidence of reflux or gastrointestinal distress
* pressure or inflammation of the brain and nervous system
* an eye problem (for example: a scratch or increased pressure)
* an abnormality of the rhythm of the heart
* a bone fracture
* a hernia
* a hair wrapped around a finger or toe

Treating Colic

Based on your baby's needs, your pediatric provider can help you devise a strategy to try to help him calm down. This usually means trying one intervention at a time to see if it helps and, if it doesn't in a few days, moving on to another one.

Here, in no particular order, is a list of some of the interventions for colic:

Feeding/Nutrition

* Change from one cow's milk formula to another.
* Change from a cow's milk formula to a soy formula.
* Change from a regular formula to a "predigested," hypoallergenic formula.
* Add Lactase to the formula.
* Avoid eating certain foods (such as caffeine, milk, certain vegetables) if you are breastfeeding.
* Change the type of nipples on the bottle, use bottles with plastic liners, and burp your baby frequently to decrease air swallowing during feedings.
* If bottle feeding, and not currently limiting milk intake during feedings, try reducing it if it seems excessive. (And alternatively, try avoiding any limitations on milk intake during a feeding if you are currently doing so.)

Changing Sensory Stimulation

* Swaddle your baby
* Try more time in a front baby carrier
* Take him for a ride in the car (but not when you are sleepy!)
* Put him in the car seat on or near the dishwasher or dryer (be careful the seat doesn't vibrate and fall off!)
* Use "white noise" (such as static on the radio or the vacuum cleaner), classical music, or a "heartbeat tape" next to the crib
* Try infant massage
* Put a warm water bottle on his belly
* Have him suck on a pacifier
* Soak him in a warm bath
* Try an infant swing
* Increase or decrease the amount of stimulation in the environment.

Medications

* Anti-reflux medicines, if reflux is suspected. They may cut down on acid production and/or help to move the milk downstream.
* Herbal teas (e.g., chamomile, mint, fennel, verbena, but NOT star anise, which can be toxic)
* Anti-gas drops
* "Gripe water" (But check the ingredients first. Most contain only herbs, but some from Europe may have alcohol or even phenobarbital, which, of course, you should avoid.)
* Homeopathic drops, which some parents say have helped

NOTE: Make sure to check with your pediatric provider before giving your child any medication, including over-the-counter drugs, herbs, and supplements.

Sometimes parents think an intervention has worked when really the colic just got better on its own. And other times, parents don't find an intervention that works well and just have to wait for the fussiness to improve on its own at 4 months or so.

Beware of magic (and expensive) "cures" that are guaranteed to work for all babies. There is no such thing.
Coping Strategies for Parents

It is challenging to have a colicky baby. And it is normal and common to harbor feelings of anger and resentment toward your cranky little one. You are not a bad parent because your feelings turn dark and sour in the bad times. Do not feel guilty that you have these feelings. Everyone does.

However, if you think your angry, resentful feelings could get out of control and you could actually harm, shake, or strike your baby, get help right away. Put your baby in a safe place, like the crib, and leave the room. See if your spouse or a friend or neighbor can be with him while you get some space. Or bring your baby to his pediatric provider and discuss your worries about losing control.

Here are some strategies to help you more gracefully survive this tough time:

* Take a break! If you've tried everything and your little one is still crying away, it's perfectly fine to put him to bed and let him continue to cry for a while without you holding him.
* Let others care for your baby while you do something completely frivolous for yourself in the real world. Get out of the house for a while.
* Don't guilt trip yourself about this too much. You didn't do anything to make your baby "colicky."
* Remember that this period in your baby's life doesn't last forever. You will get past this difficult stage.
* Don't go it alone! Seek support and help wherever you find it.

When to Worry

Don't hesitate to bring your baby in to his pediatric provider to be rechecked for a possible medical cause, especially if:

* His growth and/or development are not going well.
* He has symptoms of a possible medical problem (e.g., fever, lethargy, decreased feeding).
* You are so distressed that you are worried you could hurt him.
* The colic persists for more than 5 months.