“Colic” is kind of a catch-all term for fussy babies, typically manifested by increased crying or fussiness. Some babies are more easy to console than others. In any regard, colic can cause significant distress in parents...sometimes even more distress than the infant!
Colic typically occurs at 4-6 weeks of age, nobody seems to know exactly what causes colic, but how do you deal with it? A fussy baby can wreak havoc on your lifestyle. Dr. Harvey Karp's book "The Happiest Baby on the Block" details the 5 "S's" of Swaddling (tightly wrapping) the child, letting the child Suck on a pacifier or breast, making a "Shhh" sound, laying them on their Side (when supervised), and Swinging them in your arms. This seems to help calm most infants with colic. These tips can be found in Dr. Karp's book, which offers tremendous advice for parents.
- Swaddling - wrapping the baby up
- Sucking - give baby a pacifier
- Shushing - loud shh sound
- Side - lay baby on side (under supervision)
- Swinging - gentle swinging motion
So when do you worry about a fussy baby? First off, give them a good “look-over”, make sure nothing is wrapped around their fingers or toes (it’s weird, but sometimes hairs from the home can do this), they don’t have any new rashes, and don’t feel hot to the touch. After all of that, we move on through the alphabet and to “C”...two good phrases to keep in mind is “Colic is Consolable” and “Colic is a Cry you know”. The cry is typically one that sounds familiar to you (you’ll learn your baby’s cry pretty quickly). It should not be a shreaking cry and you should be able to calm down your baby with the above tricks by Dr. Harvey, or by our final “C”: placing them in their favorite “Comfort place” which may be a swinging chair, crib, or even carseat. If none of these work you probably should call your Pediatrician or take the baby to be examined at the hospital.
Some babies have stools after every feed and some every-other-day. You will begin to know your baby's stooling patterns as time goes on.
Breastfed babies do tend to stool more often than formula-fed infants.
So, when do you worry? When the infant seems to be in pain or if they are passing large, hard stools, then they may have either significant gas or constipation. To help with gas, you can “burp” your baby a little more, and some parents swear by simethecone, but there’s really no evidence behind this. For constipation, it really depends on the baby’s age as to what the options are. Occasionally, miralax may be added, but this depends on the infant’s age and feeding habits, so speak with your Pediatrician first.
As silly as it may seem, parents often obsess about their baby's stools. To give you an idea of what to expect: stools typically start off as dark, sticky and “tarry”...this is called meconium and can be a mess to clean up! However, the stools should eventually “transition” and start to look "yellow and seedy" around day 2-5 of life. If this is not the case in your baby, let your Pediatrician know. Babies are born with high blood counts because they have to "steal" oxygen from Mom when they are in the uterus, as the baby gets to breathe its own oxygen, these cells are broken down and the by-product is what we call bilirubin. Babies clear these broken down cells by stooling the bilirubin out...which is what gives their stools that yellow color.
If your baby’s skin or eyes starts to look "yellowish" this could be because their bilirubin levels have become high.
Typically, you will have a couple of visits in the first 2 weeks of life, and the pediatrician will look for this. And, a baby that is eating, gaining weight, and stooling yellowish stools is usually clearing their bilirubin just fine. But, as always, if you have concerns, if the baby seems more tired or “lethargic” than usual or is showing disinterest in feeding, then call your Pediatrician. The Pediatrician may check a blood test to measure the infant’s bilirubin levels to ensure that it's not too high. Very high levels can lead to deposition of the bilirubin in the brain, which can cause cerebral palsy, eye abnormalities and a number of neurological problems, so if your Pediatrician recommends the blood test, you should have it done.
So what might the doctor do if your baby’s bilirubin number is too high? Well, there are two options:
- 1. The doctor may recommend feeding more or supplementing with formula because the level can be reduced by stooling.
- 2. The other way babies can get rid of bilirubin is by light on the skin, so your Pediatrician may recommend what is called "bili lights", which is a special sort of light with a specific wavelength to help them clear the bilirubin from their bloodstream.
The light helps babies convert the bilirubin to a form that can be excreted in stool and urine. This usually means the baby needs to be in the hospital and in an “incubator,” which is basically an enclosed crib with lights. To get the maximum benefit from the lights, typically your doctor will recommend keeping the baby under the lights as much as possible and without clothes on. This can be tough for parents who want to try out all of those fabulous new baby outfits, want to wrap the baby in a blanket or “swaddle” them...but try to resist this, as the more light the baby gets, the bilirubin will clear faster and (hopefully) you and your family will leave the hospital earlier. Your pediatrician may also recommend adding formula to help the baby feed more, so they stool more to help clear out the bilirubin from their blood. All of this being said, sometimes high bilirubin levels are caused by more serious medical problems or physical abnormalities. So, if the bilirubin levels do not lower as expected, your baby may need additional testing or imaging to be sure there's no additional problem causing the elevated levels.
A fussy baby can be stressful and there is always concern about something more serious. The above information can help you in consoling your newborn. Additionally, it’s meant to give you an idea of what’s abnormal such as a baby that you cannot console, a newborn that looks “ill”, lethargic or is not feeding well, has abnormal stooling patterns, or develops yellowish skin or eyes. If you notice any of these abnormal findings or recognize anything concerning in your infant, you should seek appropriate medical care.
Karp, H. "The Happiest Baby on the Block." Bantam publishing. 2003.