But most babies who cry a lot don’t have colic.  I haven’t made this diagnosis more than 2 or 3 times in my 20+ year career.  There is usually some other explanation for a baby’s fussiness.

For starters, true “colic” refers to a baby who cries all day and all night.  If your baby cries only at night, for example, and seems fine during the day, she probably doesn’t have colic, and may not have any medical problem at all.

A persistently crying baby with no other symptoms should be examined, to rule out an ear infection or other medical illness.  But most commonly, the medical exam is normal.

Here are some of the possible causes for fussiness in babies.

Overstimulation:  When my daughter was born, our friends and relatives were as excited as we were.  We had many visitors.  She slept all day, but then screamed all night.  Once we finally figured out that we needed to limit visitors during the day, she was more alert in the day, we all slept better at night.  TV is another important cause of overstimulation; I recommend that the TV be limited to an hour a day within the baby’s hearing.

The “fussy period”:  At a few weeks of age, many infants will start crying every evening.  The infant may start to get wound up just after supper, then wail on and off until he exhausts himself before midnight.  These infants sleep fine the rest of the night, and they seem fine in the daytime.  This “Fussy Period” is well known.  It is frustrating but not serious, and most babies grow out of it by about 6 weeks of age.  This is another manifestation of overstimulation.  During the day, do what you can to limit the noise, and handle the baby gently; when the baby is wailing, certainly offer feedings, holding, and other comforts; and get through it as best as you can.

Parental excitement: The noise that a screaming newborn makes is close to intolerable.  Exhausted, frightened parents can be desperate to calm the baby.  But please be assured that if the baby is gaining weight, is feeding well, and has no other sign of illness, then it is very unlikely that the screaming represents a medical emergency.  In fact, parents can inadvertently overstimulate a screaming baby.  Vigorous bouncing, loud “shh”‘ing, and patting the baby may inflame his mood, causing a vicious cycle.  Instead, the most effective action is to role-model the calm behavior that you would like the baby to perform.  You can hold the baby close, move slowly if at all, and speak quietly if at all.  The louder the infant becomes, the more quiet and soothing you can try to be.  It may take an hour, or much longer!  But, through your role modelling, your infant will learn self-soothing; he will learn to manage his own emotional state, which is a very useful skill for anyone to learn early.

Teething: probably not a cause of infant colic.  Infants may start chewing and drooling for months before the first tooth breaks through.  But infants under 2 months old are unlikely to have behavior changes due to teething.

Formula “allergy”:  Most infants can handle any commercially available formula.  But some will have a formula intolerance, manifested as persistent vomiting, diarrhea, or constipation.  Simple crying without other symptoms is rarely due to formula intolerance; but a change in formula might be worth a try.  Try switching to a soy formula, or Nutramigen (or their generic substitutes).  Don’t bother with low-iron formula; there is not enough iron in formula to cause intestinal problems, although the iron is needed to prevent anemia.  Don’t switch to another formula in less than 5-7 days; rapid formula changes will leave you unsure which one helped the most.

Gastroesophageal reflux:  In my experience, “silent reflux” is the most common medical cause of persistent crying in infants.  Stomach contents may not reflux all the way into the mouth, but the discomfort of having stomach acid refluxing into the esophagus can cause crying and arching.  Keeping the baby upright during and after feeds can help.  If not, a visit to the office might be useful; the baby should be examined, then we might try thickening the milk with cereal, or medication.  Sometimes XRays are needed.

A persistently crying newborn can be frustrating, or even frightening.  But there’s usually a treatable cause.  So don’t give up hope – and try to get some sleep!

–  David Epstein, MD

The number of infants reported to have died by accidental suffocation and strangulation (“ASSB”) in bed quadrupled, starting in 1992, after staying stable for the previous 8 years, as reported in the January 2009 issue of Pediatrics.  Some of the increase might be due to “reclassification” of other types of death, such as SIDS, which appear to be dropping impressively.  However, there is concern that a recent trend towards allowing very young babies to co-sleep with parents may be connected to these tragic accidents.

The issue is controversial because the recommendation to avoid cosleeping with infants conflicts with some cultural practices.

For more recommendations, Nemours KidsHealth and Georgetown University have websites giving balanced information.

–  David M. Epstein, MD

Now, a review article in the AMA’s pediatrics journal (April 2009) reassures us that pacifiers may be okay for breastfed babies, after all. 4 randomized trials were reviewed; babies were assigned to the “pacifier” or “no pacifier” groups. All four studies showed no effect of pacifier use on breastfeeding outcomes. In fact, more than half of babies in the “no pacifier” groups actually were given pacifiers by their parents, but these babies breast-fed just as well.

In several observational studies, babies not using pacifiers did breastfeed somewhat more, but the authors speculate that this might be due to family attitudes towards breastfeeding, rather than an effect on breastfeeding by pacifiers. That effect would be difficult to distinguish with this type of study, which is why the randomized trials carry more weight.

Why does it matter? The American Academy of Pediatrics recommends that babies should be offered a pacifier for naps and sleep after 1 month of age (after nursing is established), for the first year or so of life. (Some studies suggest that pacifiers during sleep might reduce the chances of SIDS, although this is not definite.)

So now I feel comfortable reassuring parents that it’s ok to use pacifiers when their infant sleeps. I still recommend that an alert but fussy infant should be offered a feeding before giving a pacifier, to encourage on-demand feeding. And in any event, the use of pacifiers (and bottles) should be ended by 15 months.

(Archives of Pediatric and Adolescent Medicine 2009; 163(4): 378-382)

– David M. Epstein, MD

You can run a quiet fan, or buy “noise machines” from a baby store.  Or, for a buck or two, you can download an hour-long “white noise” track, burn it to a CD or mp3 player, and play on “repeat” to help soothe your baby (or yourself for that matter!) to sleep.  Click on the links below:

Try this one for simple, monotonous white noise.
Or check out one of these for something slightly less monotonous.
Finally, here is a website with several free white-noise downloads.

–  David Epstein, MD