What to Do With a Cranky Baby?
I am sure that many of the more experienced parents have already dealt with the nerve wracking shouts of an irritable baby on those seemingly endless nights in early infancy. It is often that when parents describe what they are going through with their firstborn, that they breakdown and cry at my office. I can completely sympathize with their feelings. After waiting for 9 long months of pregnancy, going through a long and (very) painful labor, parents finally get to greet their precious newborns. And yes, after the long hours of planning a befitting Bris or a Kiddush, when the guests and in laws have left the couple to privately enjoy their new baby, a new challenge arises – the baby just won’t stay happy at nights!!!
I would like to offer some tips that may provide relief for those of you who are going or will go through this experience. But first, to demonstrate what not to do, I will describe a recent colicky baby seen at my office.
The “Cohens”, a pleasant young couple arrived at my office for a well visit for their firstborn girl “Chava”. Chava was a beautiful baby, born via a natural delivery and without any initial complications. After struggling for 2 weeks to nurse the baby, Mrs. Cohen decided to supplement Chava’s diet with infant formula. A milk based formula was suggested by her pediatrician in Brooklyn. A few days later however, Mrs. Cohen noted that Chava became very cranky. She would have frequent bursts of pain when sleeping or awake. She seemed to want to be held a lot, especially at nights. It seemed that from 7pm to 11pm, all Chava wanted was to be held. Chava was also noted to pass more gas during those episodes. At first, the concerned mother in law (with the gentle, concerned encouragement of her son) pushed Mrs. Cohen to feed Chava more often and try and quiet her shouts with formula, but to no avail, the shouts just got louder and louder. The parents also noted that with the extra feedings, Chava started having larger and more frequent spit ups at nights.
After a few days, the Cohen’s decided to visit the Pediatrician. He suggested that Mrs. Cohen should avoid eating dairy, and suggested a “gentle” formula with less lactose (Similac Sensitive or Enfamil Gentlease). The crying continued.
At the next trip to the Pediatrician, the Cohen’s were told to try a soy based formula (Isomil or Prosobee). The new formula did not work. Not only did Chava’s shouts continue, but she also started having more formed and less frequent bowel movements.
Back to the Doctor, and back with another formula. This time, the doctor suggested a formula made for milk allergic babies – Alimentum or Neutramigen. In contrast to the previously mentioned formulas, these ones are not kosher, but can be used for kids with true milk allergies. The Cohen’s noted that their pockets were getting lighter due to the more costly formula, but their sleep was getting yet shorted due to Chava’s cries. By now, with all the stress and sleepless nights, not to mention the vast diet restrictions that came on the agonizing mom, Mrs. Cohen’s milk supply had dwindled and dried. But on the brighter note, her bowel movements did loosen a bit, but now they did turn bright green.
At week 5, the Cohen’s already knew the entire crowd at the waiting room. It was interesting that with all the chatting noise in that room, no one heard the baby cry!!! This time, the doctor suggested an even better and more expensive formula, in which the milk is digested to its elemental molecules (Elecare or Neocate). But despite all the good intentions and the emotional, physical & financial sacrifice, Chava kept crying.
At 6 weeks, the Cohens finally left Bubby & Zeidy’s house and moved back to their residence in the Five Towns. They heard from a neighbor that Chava may also suffer from reflux and may need a medicine for relief. They wanted to know what my feelings were.
Hearing this entire story, may have taken 5 minutes of my time, but did provide me with all the necessary clues that Chava is fine. Chava demonstrated classic signs and symptoms of colic, and was probably going to outgrow her condition in the next days or weeks.
Here are the clues which were mentioned in the story:
Colic is a term used to describe Colic usually starts after 2 weeks of life.
Colicky babies usually cry more at nights between 7pm -11pm
Colicky babies are consolable when they are held. Colicky babies pass gas often during their bouts of pains (with some relief).
Colic pain happens in bursts, not a constant pain.
Colicky babies fair worse when they are over-fed.
I was so happy that the Cohen’s arrived at my office right then, because I was able to easily dispel the notion of Chava having a milk allergy and save the Cohens literally thousands of dollars. I suggested a list of simple and widely used interventions and switch Chava back to her original milk based formula!!!
Here are some of my suggestions for colicky babies:
During periods of the pains, give the baby 2oz of Chamomile tea (yes, made with regular chamomile tea bags) with ½ tsp of brown sugar. Chamomile has a calming effect on your baby’s gut. Brown sugar is a natural laxative that aids in reducing intestinal gas.
Mylicon Drops – these drops contain Simethicone, which binds and eliminates gas. It works in 50% of infants with gas.
Gripe Water – made of concentrated chamomile, also works well in 50% of the time.
Nursing Mothers – avoid eating foods that make you gassy such as cabbage, lettuce and beans. Avoid tomato sauce, pizza, lasagna, coffee, chocolate and spicy foods as those will exacerbate your babies spit up and cause painful heartburn. Drink lots of chamomile tea.
Elimination Diets – nursing mothers could eliminate one food for 3 days and observe any improvements. Start with dairy & soy, proceed to egg whites and end with nuts. If no significant improvement is seen after 3 days, you could re-introduce these foods.
Singing lullabies to your baby can be powerfully soothing
"White" noise - may soothe some babies. You can buy white noise machines, or try the sound of a fan, vacuum cleaner, washing machine, or dishwasher.
Stay Calm – do not shake the baby out of frustration. Colicky babies are usually easily consolable if you hold and gently rock them.
Colic pains peak between 6-8 weeks. 60 percent of colic resolve by 3 months, 90 percent resolves by 4 months of age. At that point, this babies turn to be the quietest, cutest little angels!!!
If symptoms persist or worsen, call and schedule an immediate appointment with your physician.
What are some other causes of pain in young infants?
Milk Allergy – the gold standard test that will confirm this diagnosis is – bloody stools. Yes, I have noticed that in recent years there is a definite surge in milk allergic infants, but they almost always have blood in their stools (on occasion, they may present with horrific eczema). A stool guaiac test could reveal microscopic blood and help determine if a child is allergic even before visible blood is seen in the stools. These stools can start of looking green for a long time before the parents see real, bright blood in their infant’s stool. Most milk allergies in infancy resolve by the first birthday.
Gastro – Esophageal Reflux – all babies spit up to some extent. This is normal. Babies with reflux however, have a lot of pain associated with spitting up. So harsh is the pain, that these babies may refuse to finish their bottles. They arch their backs a lot. When a baby with reflux experiences pains (heartburn) the pain is constant and they are not easily consolable, in sharp contrast to colicky infants.
Chava was changed back to her original tasty and inexpensive milk based formula. As with many of my other patients, she enjoys a chamomile tea a few times a day and on subsequent visits she found to be thriving. Her parents were also instructed to take some reflux precautions to minimize her spit up. Her nightly colic pains did resolved and her parents started sleeping soundly when she turned 3 months old.
Wishing you restful, peaceful and quiet nights!
David Elazar Simai M.D.