By Dr Howard Chilton
I’ve been a newborn baby doctor for the last 40 years. After about two of them, I lost count of the number of babies I was seeing with so-called ‘colic’. So many endless nights, so many tears, so much screaming … and that was just the parents.
Because of these tired, stressed families, I developed a lifelong obsession to talk to them about this disorder. This information is laid out in the evolutionary biology and medical literature, and it’s also known by a large number of parents whose babies have been through it and who have learned by experience how to prevent it.
But the start of any discussion about the behaviour of babies must be made in the light of their evolution.
Humans, after they started to walk in an upright posture, developed an athletic pelvis with a narrow birth canal as a consequence. Later humankind also developed a big brain. In order to give birth successfully through this narrow pelvis, their big-brained babies had to be delivered when still small, way earlier in pregnancy than before. We had to birth our babies prematurely.
Biologists call our babies “exterio-gestate foetuses”. That is, they are foetuses on the outside. I’m sure you have heard of the ‘fourth trimester’ of pregnancy. Three in womb, and another in your arms.
This tells us what babies expect of us. They are the most immature of all placental mammals. They are so helpless they cannot even cling and hold on to their mother efficiently. They need to be held and protected; they need security and love, they need feeding frequently and on-demand. We produce for them a dilute easily digested milk, designed for frequent feeding. We are a continuous contact species and have not evolved to be separated from our parents’ bodies for very long.
You can see how this might impact on babies’ crying behaviour.
But first, you need to make sure that the baby is not crying because they are hungry. Remember this ‘continuous contact’ milk is designed for frequent, even hourly, feeding. Their stomach can empty in 30 minutes. So if they are upset, try feeding them again.
Second, studies were done where large groups of parents were given diaries to record how much unsettledness, fussing and crying their babies had. The results were remarkable and consistent. Most babies start to become more unsettled at about 2-3 weeks of age, they are at their noisiest at 6 weeks, and then there is a gradual improvement until 3 months, when crying levels drop rapidly. Most of the crying was in the evening.
How much the baby cried and fussed depended on two factors.
- How closely the baby was held and where s(he)spent the day. Babies close to their parents cried less (and fed more), and those separated in cots and prams, cried more.
- The temperament of the baby – either settled and calm, or sensitive and ‘wired’.
The average amount of crying/fussing (at which half of the population cry more, and half cry less) in a Western society is 3 hours a day at 6 weeks. The babies in the developing world (or with attachment parenting) crying less and Western routine-based babies, separated in prams or cots, crying more.
These are all normal babies and the curve that describes this population of babies is a bell-shaped or ‘normal’ curve. This means that there are 10% of babies that are crying a great deal more than 3 hours, sometimes 8 hours or more, a day.
The studies about ‘colic’ say that the condition occurs in about 10% of babies. But it has exactly the same pattern as ‘normal crying’ as above. So what causes it? The vast majority of these babies have no pathology, no illness.
What this means is that these babies are merely on the highest centile for ‘normal crying’. They are still completely normal babies but they are more sensitive than average. No wonder after decades of research, no one can find a unifying pathological diagnosis. There isn’t one.
It’s not pain…
Let’s clear up one misconception right off. Colic has never been about pain in the abdomen or anywhere else for that matter. There is no question that the baby looks like he or she is in excruciating tummy pain. The baby doubles up, knees in chest, and screams like there’s a knife twisting in his gut. But it’s not about pain, it’s about stress and overstimulation of the poor baby’s sensory nervous system.
“Six O’Clock Colic”
The situation of babies screaming in distress primarily in the evening (“six o’clock” or “evening” colic) has been described for hundreds of years. As in the studies, it usually gets going when babies are around four to six weeks of age (though for some particularly sensitive babies, it can start from birth). It then increases in intensity to reach a maximum over the following couple of weeks then settles slightly before ceasing, often abruptly, at about three months of age (hence why it is also called “three-month colic”).
Premature babies have it earlier and more intensely. It was through the study of just this group of babies that developmental psychologists started to unravel the problem in the full-term. As premature babies near term they can become very distressed when their environment presents them with even minimal increases in stimulation. If you pick up such a baby, look at him and talk to him, he will often start stressing out, straining, crying and arching his back as his nervous system overloads with your input on his senses. With such as him, you can either pick up, or you can look at him, or you can speak to him. You just can’t do all of them at once.
The psyche of full-term babies is much more resilient than that. But they still have their limits. But let’s start at the end, and work backwards.
The three month old baby
At and beyond three months of age babies usually develop the ability to calm and regulate themselves more successfully. You can see this at work in a four to five month-old baby who is fed and happy and sitting in a little prop-up chair. He wants to play with his mother so he gazes at her across the room, chuckles and waves his arms to attract her. She can’t resist and approaches him, their eyes lock and soon they are talking nonsense, looking deeply into each other’s eyes and are totally engrossed in one another. The intensity of their so-called ‘serve and return’ interaction rises. The stimulation then increases to a level that makes the baby uncomfortable. There’s just too much stress in the game for him.
So he suddenly he looks away, switches off and totally ignores his mother.
He looks at the ceiling or at his hands in his lap as his mother wanders off. There he sits, his shoulders tense, his eyes downcast. Then over the next few minutes he calms and relaxes and starts to throw glances at his mum.
As he relaxes more his gazes last longer and longer.
Then the cycle starts again. He laughs and waves his hands to attract her, and back she comes.
The baby has learnt that when he gets over-aroused, stressed and uncomfortable if he looks away and ignores it, he can calm himself down. This is an invaluable lesson, the first element of a regulatory system that gives him control over the sensory input from his environment. It is also the start of the ability to concentrate undistracted on a task.
The six week old baby
Now, back to the beginning. The colic syndrome starts at four to six weeks of age. Before this, the boundaries of his attention do not stray much beyond his mother’s body and breasts, of its warmth and smell. But now his eyes can focus further and his horizons expand and he starts to take in his surroundings. It is about a week before he smiles.
Once he starts smiling, he attracts people around him like a magnet. Evolution has made the contours of his face and body specifically designed to make people around him want to nurture and care for him. They gaze at him and he gazes back. He watches the curtains flapping by the window. Then grandma visits and she can’t take her eyes off him. With this new attention, his excitement rises to a level that makes him uncomfortable but, alas, he has not yet developed the ability to decrease his attentiveness and calm himself. As the stimulation and stress levels rise he starts to get distressed. He becomes tense and begins to strain and groan, especially late in the day.
His parents become anxious, “Is he constipated? Why does he writhe and arch his back?” Soon his distress level makes him cry and scream. He is picked up and passed hand-to-hand around the family who gaze at him, trying to fathom the cause of his discomfort. The parents ask advice from Google to Hospital Emergency Departments and the cascade of advice starts.