Every infant cries. It’s a part of being a newborn, yet infant crying still puts many of us on edge. As parents, we want to calm our babies and prevent crying; it’s simply instinctive to want to make it go away. The period of time when our babies cry most (between 1-2 months of age) can be entirely exhausting, unsettling, and unnerving. As we transition into parenthood, one of the most difficult challenges can be learning to soothe our crying newborns. One expert, Dr Ron Barr, refers to this period of crying as the PURPLE period. I’ll explain, but first, let’s talk a bit about colic and news today about using alternative “folk” treatments, and ultimately what it may mean when someone, a doctor or not, tells you that you’ve got a “colicky” baby.
This morning I did an interview for Good Morning America Health about a Pediatrics systematic review evaluating 15 large studies (including nearly 1000 babies) to determine if things like infant massage, probiotics, chiropractor’s manipulation, herbal supplements, and sugary/glucose solutions really helped “colicky” babies stop crying. The results proved unfortunate. No, these interventions don’t tend to help infants who are crying/fussy/screaming their heads off. Two things to think about with the new findings: first, when you’re frustrated with a baby’s fussing/crying, don’t reach for these remedies as solutions or as “cure alls.” As we know it now, there’s not a lot of evidence to use any of these remedies. Secondly, don’t confuse the word “natural” with “harmless” or “safe.” Many of these herbal and complementary remedies come with labels that say “natural.” Natural doesn’t confer safety. Some limitations of interpreting data from the 15 studies reviewed was the reality that little time was spent reporting side effects to interventions and therapeutics. It may simply be because there were few, but researchers are unsure. We only want to use medications in infants that prove effective.
The most important thing to do for a fussy infant is to find ways for you to soothe your baby. But know that you won’t always be successful. If your baby has been fed, burped, changed, is warm and comfortably dressed and they’re still crying, don’t spend all of your energy determining the why behind their cry. Unfortunatley, you likely won’t find the answer! Rather, spend time figuring out what helps: things like rocking, holding, walking outside, taking a stroller ride, taking a car ride, running a faucet of water for white noise, changing your babies position, or putting the baby down for a break in their crib. Breaks are key. This space can provide a break for both of you. What’s most important is that you as a caregiver, find soothing in times of stress, too!
As I prepped for the interview regarding the review of alternative remedies, it brought up a need for clarity of what is normal, and what is not, when it comes to crying in infants. So here’s some answers to general questions:
What is Colic?
Oddly, diagnosing colic can be controversial. Not every pediatrician uses the term. Infantile crying is expected and varies from baby to baby. The key point here is that ALL babies cry. From the moment they are born, infants have their first big important cry to clear fluid from their lungs. Then crying time starts to accelerate from 2 weeks of age with a peak around 6-8 weeks and then ultimately dramatically improves after about 3-4 months of age. By definition, colic goes away simply with time. But not all babies are alike, some cry far more than others.
- Colic has traditionally been defined using “Wessel’s Rule of Threes.” That is, infants who cry more than 3 hours a day, at least 3 days a week, for more than 3 consecutive weeks. However, the cut-off of three hours is entirely arbitrary. Although the rule of 3’s can help families define it, ultimately the label of “colic” doesn’t solve the frustrating crying. As any parent can attest, 2 hours and 59 min of crying versus 3 hours and 10 min of crying a day certainly isn’t very different. So defining colic is only a part of it. Sometimes, though, I think parents feel better having a label to the crying a name to help define it. It gives them scope for their struggles and frustrations. But having a diagnosis of colic doesn’t mean there is something wrong with your baby.
- Infantile crying is common and variable with some studies finding nearly 20% or more of babies demonstrating “excessive” crying every week. It’s hard to define what is normal and what is abnormal, hence the controversy in colic’s definition. Often how we experience our infant’s crying varies from parent to parent, too. Which again confuses the labeling.
- Most parents and pediatricians think of colic as crying that is more intense, difficult/resistant to soothing, and last for long periods of time. Dr Ron Barr, an expert on infant crying, told me that roughly speaking, “unsoothable” crying represents about 5-15% of all crying and fussing that infants do. The rest is made up by “fussing” (about 65%) and “crying” (about 35%).
- Excessive crying can be seen in all babies, no matter if they are breastfed or formula fed, 1st or 2nd born, boy or girl, premature or full term.
Crying can be extremely difficult on caregivers. Particularly because crying peaks in the late afternoon and evening when parents are already exhausted. This is a huge part of the diagnosis and a huge part of the therapy. Recognizing the toll on caregivers is essential for supporting the baby.
Is It Just Infants Who Have “Colic” and Excessive Crying?
Yes, again, crying is a part of every new baby’s life but varies dramatically between one to another and even siblings. Just like weight and height vary, crying varies dramatically between one healthy baby and another.
Tip: Colic and infantile crying generally improves after 3 months of age, with 60% of excessive crying resolving by 3 months!
Do We Know What Causes Colic?
The short answer: No. Now knowing for sure what causes excessive crying and colic is part of the problem with helping families understand that testing (blood work or radiology studies) and medication interventions, are overwhelmingly not needed. However, theories about colic and excessive crying look to food allergies, formula intolerance, gas formation and intestinal cramping. Many researchers believe crying is a normal part of an infants life and that the “painful” look on their face or sound of their cry may not represent a medical problem, but rather a spectrum of normal, infant crying.
Some babies may have high amounts of normal crying that are exacerbated by illness or cause. This could be a sensitivity to cow’s milk protein (dairy), or excessive gas, or an intolerance to formula or other proteins. If you think your baby is fussy in a typical pattern, or acutely changes in the way they cry or cries only with feeding, it’s absolutely something to share with your pediatrician.
We know that lots of other species, mammals and even non-primates who breast feed, have similar trends of rising distress or crying in first few months of life. Some researchers theorize the why behind all this crying lies in evolutionary terms: babies who cry are cared for, form attachements and better bonds with caregivers and parents, and are more likely to be picked up, held, and protected from predators.
What is the Period of PURPLE Crying?
PURPLE is an acronym to help define the normal pattern of crying for newborn infants. It describes the typical crying behaviors. Again, all infants cry with a Peak in the minutes or hours of daily crying around 6-8 weeks of age. Most babies will cry Unpredictably (unprovoked or unexpectedly), and their cries will be Resistant to the best of our efforts to comfort. Many normal, healthy babies will cry and it will look like they are in Pain, and they will cry for Long periods or time (up to an hour or more). And finally, they tend to cry most in the Evening when we’re all exhausted and run down.
Sometimes just knowing the range of normal can help us calm down. The most important thing for our babies is that we take care of ourselves, too, in our frustrations to soothe crying. Taking breaks can be essential and taking turns caring for babies when you get frustrated. Talk with your partners, nannies, or any other caregivers about the PURPLE period so they know, too, what to expect.
What Can You Do To Treat Colic?
Time, support for parents and caregivers, and partnerships with pediatricians are essential. Sometimes, having a baby evaluated for allergies or intolerance is part of the work-up to define additional treatments, but not in the majority of infants. Sometimes modifying a breast-feeding mom’s diet (restricting dairy, usually) can help and is worth a try. When you’re worried about your baby, call the pediatrician, visit with them, discuss your concerns and what your plans are to soothe and support your crying baby.
Most important in treating infantile crying is treating parent’s frustrations and giving them tools to HELP learn to soothe their baby! Many of my friends and patients have enjoyed reading Dr Harvey Karp’s Happiest Baby on The Block book (and DVD) as it gives them a set of tools to try to soothe their baby’s cries.
We know that excessive crying is a risk factor for child abuse and shaking of infants. We know that particularly in this time of recession, shaking of infants is higher than usual. Helping families find support and an action plan for crying is most important. Particularly because crying in infants is self-limited, meaning it gets better simply with time. Sometimes it’s hard for us to wait when we’re exhausted and overwhelmed. It’s okay to ask for help, even if it means seeing the pediatrician every week or more if needed.
How To Cope With Colic or Fussy Infants?
Bottom line is infantile colic is difficult to treat but the great news is it goes away with time! The majority of excessive crying stops around 3 months of age. Talk with your pediatrician about your concerns so together you can develop a plan on communicating about crying and/or evaluating potential causes of other causes of crying! If your babies cries seem to mimic the PURPLE period, resist spending time figuring out what makes a baby cry (you won’t figure it out) and spend energy putting in place plans for soothing, supports for you and your spouse, enlisting evening care from friends and family, respite care for you!, and find techniques to successfully deal with crying and soothe babies.
3 step action plan is great for helping a fussy infant:
- Walk, talk and comfort your baby. GO OUTSIDE where crying isn’t as loud and you can be relieved by space. This often helps comfort baby and stop the crying. The fresh air and break from all the noise inside will help you, too.
- If crying goes on a long time and parent/caregiver is frustrated, it’s okay to WALK AWAY for a time period. Put baby in crib on their back or in bassinet and take a break for 10-15 minutes. Have a Diet Coke, walk outside, and sit on your porch. TAKE A BREAK! You baby will be FINE and you’ll do better and have more energy when returning to your baby’s cries.
- Never shake a baby. It won’t stop the crying and it can have serious or even deadly results. Harming or hitting a baby will never curb crying. And know with ongoing gentle comforting, holding, and soothing, you can never spoil and infant! All that love will only help support your bond with your baby.
What do you think, how did you baby do in the first few months? Did your baby have excessive crying? Colic? What worked??
Katie says
While I had read extensively about this before, and knew that this type of crying could be very normal, the thing that shocked me with my baby was how distressing this crying would be for me. Especially when you add sleep deprivation to the mix. It sounds absolutely horrible, but there were times when I could envision exactly the situation that leads to parents harming their children. Not because I had any intention to do that, or because I ever got close, but because I could just picture what could lead up to it.
Our little stinker was quite a crier, for sure. She went through this typical peak time, and was worst at about 2 months. Hers was a little tricky to interpret, though, as she ended up also having infant GERD which also seemed to be causing her a fair amount of pain. For awhile I attributed all of the crying to normal infant crying, and the \purple\ crying. However, at 2 months, and then 2.5 months when she continued to worsen, I constantly had spit up on me, a screaming baby with each spit up, spit up all night long, and she had not gained any weight in over a month, I realized that we may have a combination of things going on. An elimination of dairy for a few months, along with a sleep wedge made for us at Children’s was the ultimate answer. It didn’t make things completely better, but the change was pretty drastic.
As for the crying, running water was our best friend! The magical combo was: Go in the bathroom, turn off the lights, turn on the bath tub (I can’t imagine the amount of water we wasted!) and bounce, bounce, bounce on the exercise ball while holding her tightly and swaddled. We finally got an iPhone app that sounded just like our running bath tub, and that thing went with us everywhere. My iPhone became a permanent accessory in her carseat.
Just thinking back on all this, I’m so thankful for my wonderfully sweet (yet still opinionated) 7-month-old!
DS says
I like to joke with parents when they come to the ER with their colicky, fussy babies about how hard it is to be a baby and how they’re just going through a high-maintenance phase (after I’ve ruled out illness and injury, of course).
Adrianne says
My 3.5 month old baby cried all day, every day, for over two months. Putting him on hypoallergenic formula at 3 weeks was the ONLY thing that helped him, until I figured out, at 14 weeks, that he had reflux the whole time. His pediatricians told me over and over that it was “just colic,” that it would end between 3-4 months, and that I would just have to deal with it (not in those words, but that’s pretty much what they said). Unfortunately, they did not even consider that he may have had silent reflux. After two ear infections, a very difficult course of antibiotics, and then feeding difficulties, *I* figured out that it all added up to reflux. Within days of being on prevacid, he stopped crying when taking bottles. In the past week, he has become a new baby. It makes me sad that this could have been stopped so much sooner if we had just tried a course of meds a month ago!
David C. Bailey says
What are “…non-mammals who breast feed…?”
Wendy Sue Swanson, MD says
David,
What I mean is non-primate mammals. Little guys like guinea pigs and rats. With your astute pick-up, I’m editing the post.
Thank you for helping me see my mistake!
wss
Viki says
I guess I think of colic is unexplained crying. I thought my 1st might have colic but through careful observation, we eventually found the things that bothered her. It was more than one thing so it took some time. I charted when my babies nursed, how long, when they slept, how long. I cross-ref’d what I ate and drank. I also charted their BMs – color, texture, smell.
Just a quick note that most kids who can’t tolerate cow’s milk also can’t tolerate other animal milk (goat or sheep). Also 50% of kids who can’t tolerate cow’s milk are intolerant of soy as well. If I’d know those details early on, it would have made my eliminate diet more productive.
Is colic associated with PDD or sensory integration disorder or other neurological development delays? Of the children I know who cried inconsolably for hours each day (and night) in their infancy, it seems most went on to have challenges in childhood.
Congrats on the GMA sport!
Wendy Sue Swanson, MD says
Viki, you bring up an exceptional distinction just taught to me by Dr Ron Barr (the physician behind the public education campaign to support families: The Period of PURPLE crying). He notes that infants who cry excessively under Wessel’s rule of threes and thus stop by 4 months of age have no increased risk for developmental challenges. The 6% of infants who cry excessively after 4 months of age may have increased risk for challenges later in their life. HOWEVER, only half of that 6% of high-criers was also having high-crying at 2 months of age. So, these are two distinct groups of babies with very different patterns. Some who don’t start crying excessively later in their infancy.
The point here is, if your baby starts to have more and more crying after 4 months of age, it is worth talking with your pediatrician. That crying is not colic, by definition or pattern.
Katie Boman says
This is important info for new AND new-again mothers; I have a 4&1/2 year old daughter, and we are expecting a new baby in October. We are happy and look forward to loving our new baby very much, but the purple period is one I’m dreading, and at nearly 40 myself, the purple period is what had my husband and I discussing taking permanent measures to prevent more children. Fate plainly had other things in store, lol….
My daughter was, I’d say, borderline on the colic issue. She never cried for longer than an hour at any one go, but she was often inconsolable, and it was often in the middle of the night. And on top of sleep deprivation, and post-partum emotional distress, my state of mind was heavily complicated by feeling that not only did I need to be a paragon of motherhood, but also a paragon model of a wife. For me, this meant that I rarely felt that I could ask my husband, who was our sole provider, to lose any sleep. I never thought of harming my precious girl, but there were a couple of times that I tried to harm myself. One night early in month 3 I made an earnest effort to knock myself unconscious by ramming my head into a wall after getting my husband to take over with our baby. Totally irrational, but at the time I was sure it was the only way I was going to get more than 3 hours of sleep in a row,( or in any one 24 hour period, for that matter,) since our small apartment made it impossible for me to go anywhere far enough away from her crying for me to try to get any sleep, so hubby’s loss of sleep would be a waste anyway.
This time around…lol, THIS time around hubby will lose just as much sleep as I do if I have to make a written schedule. This time around, he’ll be the one sleeping on the couch while the baby fusses in bed with me., rather than me pacing the apartment while he saws logs undisturbed. This time around, I won’t hesitate to employ earplugs. But of course my sincerest hope is that, this time around, I’ll be more prepared for the experience and simply won’t be so distressed by what was ultimately normal baby behavior.
Wendy Sue Swanson, MD says
Katie,
Thanks for sharing your story. I’m so sorry you had such a difficult time with crying. You are not alone. You bring up a very important issue: The extreme frustration and anguish some parents feel with their crying infants. And, although I didn’t discuss it in the post, you also bring up the complexity of postpartum depression in this mix, too.
A great website to look at for support is: http://www.dontshake.org or http://www.purple-crying.info
It’s always worth talking with your pediatrician, your OB, your family doctor, or midwife about feeling of frustration, self-harm, thoughts of suicide, or overwhelming anger when it comes to infant crying. Moms (and Dads) are not alone in this feeling and there is help for you!
Sometimes even just a night away outside your apartment is ABSOLUTELY the thing to prioritize.
Additional local resources:
Parent Trust for Washington Children http://www.parenttrust.org. The Family Help Line 1-800-932-HOPE (4674) Calls are free. Call them for free parenting toolkit. Person to Person parenting coaches Mon – Fri 9 am -10 pm & Sat/Sun 10 am – 6 pm.
Amy Owens says
Thank you Dr. Swanson for bringing attention and clarity to these issues. I weathered the newborn period with our second child so much better. Knowing what to expect and what is normal newborn behavior is so helpful.
Vera says
We’re expecting our fourth baby… the first three were not criers, which worries me – no one gets FOUR happy babies, right? Although, by your statistic of 20%, I guess we’re safe for one more ha!
I have a half-sister who was born when I was 16 and she was very colicky – I remember babysitting her and just walking with her up and down the hall with her screaming and screaming. I can imagine how hard that must be on parents after prolonged periods (I did not live with my sister at that time).
Jen B says
I apparently cried nonstop for six months- at least, that’s the way my mother remembers it. She said she was up at 2 am trying to soothe me and had a revelation: “My God… I’m never going to sleep again. I’m going to die of lack of sleep.” Luckily that wasn’t true, but I’m sure it felt true! She’s not sure if I had colic, or something else wrong, or was just miserable. Doctors told her I’d grow out of it. I had a brief return to lots of crying and screaming during adolescence, but otherwise have been just fine… and very grateful to her for putting up with my early shenanigans!
Amy says
Hello, I have a question, what about Fennel tea? Is it good for babies? I used it for my non stop crying baby and it really really helped, I saw the difference. If I didn’t give my baby Fennel tea, he would scream so hard. How safe is it? It is herbal supplement. I purchased it at european deli store, it was made in Europe.
Heather says
I love the reassurance this post provides!
As a mom of twins, I remember lots of crying and countless hours spent soothing my babies. While two crying babies had its challenges at times, I also remember realizing that it would be often that one of the kids was crying. This realization helped me cope and gave me space to do my best to take care of their needs, cuddle and soothe them without feeling inadequate when one of them was crying. I do admit to putting them in their cribs, grabbing a Diet Coke and a spot on the steps for a couple of minutes a few times along the way. That’s great advice for parents of kids of any age!
Wendy Sue Swanson, MD says
@Heather,
You bring up a great point. The “diet coke” break can be used when we’re frustrated by the whining, squabbling, of older children! We all get frustrated. We have to take care of ourselves every day too, despite it never feeling like a priority. If it’s pulling off the road during a tantrum or screaming match in the back seat or stepping outside. I’ve had many parents tell me about the “time-outs” they take from their toddlers, too!
mir says
I just extracted 6 teeth (and capped the rest) of a 16 month old whose mother&grandmother used to give him sugar water whenever he cried (oh, wait, it was “for his stomach”).
Oh well, his front teeth will come in in 6 or 7 years …
(they had rotted down to grey nubs, there was no way to save them and lord knows the dentists will try anything)
Not to mention that it affects his speech and jaw development, and it is a setup for caries in his adult teeth because his mouth flora has changed irreversibly. Sad.
Jennifer Bart says
My son is almost 4 months old, adjusted age; 6 months actual, and he has periods of “purple” crying in the evenings quite often. In fact, I just got him to sleep tonight after about an hour and a half of inconsolable crying.
He was born at 31 weeks, 2 lbs, 9 oz, and is still quite small (12 lbs). Still, he is on track developmentally for his adjusted age.
He has reflux, but it’s quite under control with Neocate formula, Prilosec, and Zantac.
I am really looking forward to ending the purple crying periods. They are very distinctive-always in the evening, always for no reason, and they end just as suddenly as they began. When he’s in the midst of a crying stretch, absolutely nothing soothes him. His usual toys, teethers, swing, bouncy chair, walking, rocking, driving, NOTHING soothes him. And believe me, we’ve tried it all.
Other than these periods, he’s a happy boy. His daycare provider can’t believe it when I tell them how he cries at night-he cries very little during the day, and most days they report he was “happy and busy playing, took normal naps for an infant his age.”
I’m longing for the day when the crying stops. My husband and I keep reminding ourselves that just like the bed rest and NICU, this too, shall pass. It helps that we have a sense of humor about things.
I just hope all this crying doesn’t mean he’s in some sort of horrific pain. He flails his arms and kicks his legs when it’s happening, too, and usually cries himself hoarse, poor little guy. His doctors have all said there’s nothing wrong with him (except for the reflux, which is being treated and display completely different symptoms).
Any day now I’m hoping it will stop!
Jenny says
Thanks for this article. My first child cried what seemed like constantly, only slept for short periods of time and only when held, and wanted to breastfeed constantly. It was the hardest 4 months of my life, compounded by sleep deprivation and depression. I expected having a baby would be nothing but joy, so I felt like a failure with a baby who I couldn’t make happy. Dr. Sears’ book, “The Fussy Baby” was very helpful to me – it made me realize that I had to stop taking everyone’s advice (don’t breastfeed or hold so much, let him cry it out, it’s just gas, ect…) and just follow my instincts to get through it. At 4 months, my son made a dramatic switch and turned into the happiest, most content baby around. And at 5, he is still so easy going, and super smart. When you are in the middle of it 3-4months is a lifetime, but it will get better!