We Asked a Pediatrician About Your Most Common Questions and Concerns (cont'd)
Q: What do you tell parents about colic?
A: I usually bring this up at the 2-week visit. The general definition of colic is three hours of inconsolable crying in a 24-hour period. I would argue that most babies don't fit that definition. But most children do have a fussy period, and it starts between 2 and 3 weeks. If you're warned about it by your doctor before it happens, then you're prepared for it and you're not doing all the funny things that I've heard happen.
Children start this usually in the evening, somewhere between dinner and bedtime, between 6 and 9 at night. So breast-feeding moms will invariably blame what they ate for dinner, and they'll be making all sorts of dietary changes. The children are pulling up their legs and doing all sorts of "gassy" things. Every culture has a cure for this. I had some parents from Britain who brought me in a bottle of what they call "gripe water," which is the British cure for colic, and we have Mylicon. The Chinese use a couple of herbal extracts, and my Indian patients have chamomile tea and chamomile drops. Every one of these has been studied and shown not to do a thing compared to a control group. But sometimes when children are colicky like that you feel like you just have to do something. So if you want to spend the 12 bucks on the Mylicon so you can do something, it's OK with me. It doesn't have any side effects, and it really doesn't have any proven benefit. When they gave a group of parents who had what were defined as colicky babies sugar-water and Mylicon, and they didn't know which they were giving, 33 percent of the babies in each group got better.
Q: Some doctors suggest that colic has more to do with hyper-irritability.
A: There's still no proven cause for colic. There are lots of possible causes. You have to ask yourself, what could it be? Is this some kind of intolerance to a milk protein? Is this a problem with the particular formula? Is this a problem with the mom's diet? But these causes are going to be more spread out throughout the day. Could this be reflux — is the baby experiencing some heartburn? There's also a form of constipation that babies can get. Yes, there is some hyper-irritability in some babies.
Every pediatric specialty thinks they might have the cause for colic. Gastroenterologists will look at the intestinal motility of infants and say "OK, the intestinal motility and peristalsis, which is the ability to move food smoothly through the intestines, are markedly different between about 2 weeks and 3 months, which correlates with colic."
We also know that if you look at a child's growth chart, it's really steep between about 2 weeks and 3 months. If you've ever had an older child experience growing pains, when do they have those pains? Between 6 and 9 o'clock at night. So there is some theory that some of colic may actually be bone pain. So in terms of the causes of colic, if anyone tells you they know, they don't know. It's one of those things where we just look and try to find it out. We do know that it's self-limiting. It goes away by 3 months.
As a pediatrician, you have to make sure that that's all you're dealing with. There are all kinds of things you have to worry about, from child abuse, shaken baby syndrome, to a hair tourniquet, where a piece of hair got wrapped around a finger, but these are all things that you get through the history. If you bring a baby in who's gaining weight and is fine the rest of the day, then you know what you're dealing with, and you just have to reassure the parents that this will go away. Because it starts at 6 p.m, I've had dads who start spending more time at work. It can affect relationships and marriages. I've had moms tell dads to change colognes, because it happens right when they get home. It's a difficult time. As long as parents know it's not their fault, it provides a lot of reassurance because there's a lot of anxiety that goes through parents' minds.
Q: Are there any tips that you offer parents about baby equipment?
A: One of the biggest problems is with handed-down equipment. I tell parents that they need to look for the Juvenile Products Manufacturers Association approval. Handed-down cribs can be quite dangerous. You shouldn't be able to pass a Coke can through the slats. I think that's about 2 3/8 inches, the amount of space allowed. If you can fit a can through, it's too dangerous, because a baby's head could fit through there too. Most parents are just buying new ones or making sure that it's approved.
For first-time parents, there isn't a lot of gear that they really need. We don't even have a list that we give out. We recommend having a really good thermometer and some Vaseline. I don't recommend the ear thermometers because the infant ear canal is so small and curvy that you can't get an accurate reading from the ear thermometers. I recommend a digital rectal thermometer. We have to make some pretty big decisions based on temperature. A child who gets a fever under 6 weeks is automatically back in the hospital. And so for me to make that decision, I really want a rectal temperature. We show how to do that in the office or even in the nursery. The babies are fine about it. It's really the parents who are cringing.
