If you or your spouse find yourselves pacing the floor for hours on end with baby in arms, or take endless car rides in hope that junior will stop crying and fall asleep it might be colic! Colic is now defined as paroxysmal crying lasting several hours a day in an other wise healthy child.

The cause of colic is unknown. The consumption of cow's milk has been proven in a small number of cases, as a milk or milk formula allergy to the child, or via milk drunk by the nursing mother and milk proteins passed on to the baby. Different reasons such as low progesterone levels, air swallowing, congenital hypertonicity, neuralgic immaturity, physiologic immaturity of the intestinal tract, and parental tension have been cited as causes, but have not been proved via double-blind studies.

A study has suggested that colic occurs more in infants of smoking mothers,while another study suggests it is more common among breast fed infants of professional mothers. However so far there is no proven correlation between race, socioeconomic status, birth order, age, or emotional health of the parents or whether a infant is bottle or breast-fed. The evolution of the concept of colic has changed dramatically since the days I remember in Medical School. Colic was defined as a child who cried all day ""no matter what you did" and was felt to be of Neuralgic origin/maturity; unrelated to what or how a baby was fed and how a parent handled the child. I will never forget a renowned Pediatric Gastroenterologist talking about his middle of the night house calls to rescue frantic parents, his gyrations including holding a child and "dancing up and down on one foot" to do anything that would quiet or help the child.

Fortunately, over the years, I have seen very few parents with that "true" 24 hr a day, miserable, crying child; but I have seen many children who could have developed into that pattern. Various researchers have defined colic in different ways, a popular reference being the concept of continuous crying for 3 hours or more during 3 or more days of the week. In the classic syndrome, infants with colic tend to have a low threshold of response to external stimuli, a high activity level that increases with age as the crying increases, unpredictable biologic rhythms, and a cranky or negative mood. And yet in respected research papers, the "normal" baby has been described as crying an average of 2 - 3 hr. a day at 6 weeks of age. While infants tend to divide into the "easy" child (generally as a parent you can do almost anything reasonable, any way you want, and you will still have a smiling, easygoing baby) and the "hard" child (a child who is more "irritable", more sensitive to external stimuli and changes, described as "colicky") It is important to realize that neither type of child is basically good or bad; but certainly the "hard" child requires greater consistency as a parent, and a interaction and support mechanism between the parent and the pediatrician. When evaluating and dealing with the fussy or colicky child, it is very important that the pediatrician takes time to due a through history and evaluation of the situation, reassure you as parents that there is nothing inherently wrong with your child (or yourselves's) as parents, and them move forward to minimize the crying and make things as positive as possible. This evaluation is important to be sure there are no "organic" problems which need to be pursued, but should not include a lot of lab tests or x-rays unless there is a definite indication for them. A good pediatrician, can rapidly judge the normal from the abnormal, and as parents you should not want a lot of tests done to "prove" things unless there is some legitimate reason for doubt.

What can be done? In spite of the general teaching in this country that colic was a normal "neuralgic" phenomenon; over the years I have observed multiple improvements with adjustments of feeding techniques and diet. Currently the literature is full of articles showing milk protein sensitivity as one of the main causes of colic; with improvement in up to30-35% of children either switched to a hypoallergenic formula or if the mother is breast feeding, taking the mother off milk and dairy. (We now know that most of what a mother eats passed through to her milk, and milk protein is one of the higher antigens). The current situation in this country seems closer in touch with European teaching, that diet and parenting techniques influence colic.

Therefore, one of the first things to try if you have that "colicky" fussy child, particularly if there is a concurrent pattern of excess gas, diarrhea, or vomiting (and your physician has not found any other problem); try eliminating milk and dairy. As a nursing mother it is easy to try yourself off milk and dairy for 1 - 2 weeks; for a baby on formula, talk with your doctor, and consider a trial of one of the hypo-allergenic formulas. A common alternative to ""cows-milk "formula is soy; but anywhere from 25-33% of children allergic to milk, may also be allergic to soy.A larger factor than diet or milk sensitivity, appears to be parenting technique and a parents response to that "colicky" child. While it is true that many children are very sensitive to external stimuli, once you know your child is basically healthy and that this is his or her "pattern;" you should try as parents to initiate care plans and patterns that will help to minimize the problem now as well as let your child progress forward by 3 - 4 months of age in a positive way. If the early months of crying and fussing are met by unanswered concerns, frustration, anger, feelings of guilt and inadequacy as a parent; it is hard to progress on to later stages in a positive way.

It has been my experience in the office, and it is now written in journals, that having a planned organized response to your infant can do wonders to decrease crying. A baby always deserves a response when crying; that response should be based on the general reasons a baby will cry. Well babies cry because: 1) they are hungry; 2) they need to suck, but are not hungry; 3) they want to be held; 4) they are bored and are looking for stimulation; and 5) they are tired and need to sleep.