Colic

Many parents are accurate in their judgments of crying, but some may be influenced by their anxiety or expectations. Because the presenting complaint is usually parental concern about infant crying, accurate assessment of the crying is the first goal. Behavior diaries kept prospectively by parents are the method of choice, with detailed questionnaires and interviews being used where diaries are impossible. The resulting information can assist diagnosis and may provide parents with reassurance and insight.

Many parents link their baby's crying to digestive disturbances and are likely to want to change their method of infant feeding. As noted earlier, such disturbances are rare—evidence suggests no more than 2 percent of infants overall, and 10 percent of infants who are presented with crying problems, have gastrointestinal disorders, and these cases can usually be identified by their symptoms. Siobhán Gormally (2001) adds other symptoms of organic disorders for parents and physician to look out for, including a high pitched cry, lack of a time-of-day peak, failure to thrive or weight loss, a positive family history of migraine, maternal drug ingestion, and persistence of symptoms past four months of age. She stresses the importance of infant skin, eye, skeletal, neurological, gastrointestinal, and cardiovascular assessments, highlighting the need for parents to involve physicians in the decision process.

Where infants lack these symptoms, and are otherwise healthy and putting on weight normally, there is no evidence-based reason for assuming that their crying has a gastrointestinal cause, or for treating it with a change of feeding method or diet. In practice, clinicians differ in how readily they recommend a dietary change as a treatment for persistent crying. Where this is contemplated, the disadvantages need to be balanced against the possible gains. One is that breast-feeding is beneficial for young babies, whereas excluding cow's milk protein from a lactating mother's diet is likely to be trying for her and her family. A second is that research trials using dietary change to treat crying have seldom produced clear-cut advantages. Typically, some infants have improved somewhat, but continue to cry above normal levels, whereas other infants have not benefited at all. Other pitfalls include a high placebo rate–where babies seem to improve initially following any change—and the danger that an infant will be considered generally allergic or fragile by parents.

The alternative to dietary change is to use behavior management strategies to support parents and to help them to minimize the crying until it resolves. This approach follows from the evidence, cited earlier, that some parents are especially vulnerable to persistent infant crying, highlighting the need to consider this as a family, rather than infant, problem. Elements of this approach can include:

• Viewing the first three months of infancy as a developmental transition, which all babies go through more or less smoothly.
• Reassuring parents that it is normal to find crying aversive and discussing the dangers of abuse and shaken baby syndrome.
• Examining the notion that crying means that there is something wrong with a baby of this age and introducing alternatives—such as the possibility that it signals a reactive or vigorous baby.
• Discussing ways of containing and minimizing the crying, and highlighting positive features of the baby.
• Considering the availability of supports and the development of strategies which allow parents to cope, take time out and "recharge their batteries."
• Empowering parents and reframing the first three months as a challenge to be overcome, with positive consequences for themselves and their relationships with their babies.

Also implicit in this approach is the need for health services to find means of identifying and supporting the most vulnerable families, and to continue to monitor the infant, at least until the crying problems have resolved.