Module 9: Fussiness & Colic
In the first few weeks, fussiness and colic are common concerns. It can be hard to tell why your newborn is crying, and often times, you’re so sleep-deprived that you end up in tears of frustration, as well. This is a step-by-step approach for what to try if fussiness is an issue, and when to seek help from your PCP.
What Is Colic? How Is It Different Than Typical Infant Fussiness?
Colic is another name for when infants cry for >3 hours daily, multiple days a week, and over a duration of weeks to months for no apparent reason. It’s relatively common, occurring in around 20-25% of infants, so know that you aren’t alone in this frustrating situation. It can last up to 3-6 months, and it often disrupts sleep schedules, making your infant even fussier.
In typical infant fussiness, crying is more sporadic. While you may struggle figuring out the cause, it’s often due to something like gassiness, a wet diaper, lack of sleep, or under- or overfeeding. Crying episodes won’t last as long as they do in colic and will occur with less consistency.
In colic and in fussiness, infants can look really uncomfortable. This can manifest as clenched fists, legs curled up, a scrunched up and red face, or apparent stomach issues.
What Causes Colic?
Some infants are more sensitive to stimulation than others (think lights, noises, temperature, touch, discomfort occurring from a medical issue like gas), and have a harder time self-soothing. At this age, the nervous system is still developing, and it may interpret outside influences in an exaggerated way. There’s nothing wrong with this! All infants are different, and if yours has colic, they’ll find a way to self-regulate their responses to external input over time.
What Should I Try If My Infant Is Fussy?
Swaddling or Rocking: Swaddling helps your newborn imagine they’ve returned to the safe, calm environment of the womb. Wrapping them offers a sense of security (like how a weighted blanket relaxes adults). Similarly, rocking them in a gentle motion, walking around with them, or taking them for a car ride can offer the same type of reassuring sensation.
Noise Machine: Minimizing external stimulation (taking your newborn to a dark room without other family members) and turning on a noise machine can help. These mimic sounds from the womb and offer a comforting soundtrack to calm down to. If you use them, choose a lower sound setting and keep the machine 7+ feet from the crib, since if they’re too loud they can affect newborn hearing. Alternate options include a fan or “Shhhh” noises.
Check Hunger Cues: Was the last feed not super successful, and could the cries suggest hunger? Are they moving their fists to their mouth and turning their head? If so, you could try a feed. That said, also be mindful of overfeeding. Sometimes, giving too much milk as a way to calm your newborn can lead to reflux symptoms, which worsen fussiness.
Skin To Skin or Baby-Wearing: Offering touch reminds your infant that you’re nearby and releases calming hormones.
Offer Pacifier: When infants have something to suck on, it can help with self-soothing.
Check Diaper: Make sure it isn’t something a simple as a wet or dirty diaper, a quick fix!
Bicycle Kicks: If there’s a lot of gassiness or apparent straining from tummy discomfort, “bicycle kicks” (which is where you are moving your infant’s bent legs in a circular motion) can help with moving gas through the intestines.
What About Simethicone or Gripe Water?
These are common go-to options amongst families, and it’s easy to see why. We often want to feel like we’re trying something if our child is crying for hours on end! These medications aren’t shown to consistently improve colic. However, they’re not harmful, either. As a result, most Pediatricians are comfortable letting you try either to see if they help.
What About Their Diet?
In some cases, fussiness is due to gassiness or stomach discomfort from a food in mom’s diet, especially if breast/chest-feeding (think spicier foods or ones that tend to cause gas, such as cabbage). You can try eliminating these for a few days to see if they make a difference. I’d advise against complete elimination diets of any major food groups (like dairy or gluten) without to talking to your Pediatrician, though, since it may not actually be necessary and can cause extra anxiety.
In rarer cases, fussiness is due to something like a cow’s milk protein sensitivity or reflux. Usually, you’ll notice other symptoms like slow weight gain, larger-volume spit ups, mucus or blood in the stools (or greasier stools with a foul odor), or rashes. In these cases, a formula switch could be helpful. If you think this could apply to your infant, talk to your doctor about recommended options to switch to and if further workup or additional weight checks are needed.
Could It Just Be Constipation?
I talked a little about infant dyschezia in Module 2 (First Two Weeks), which is when infants are learning to interpret when to stool and how to coordinate their abdominal muscles to do so. It often looks like crying, fussiness, or straining. With dyschezia, the main thing to remember is that it’ll happen mainly around bowel movements. The same is true of constipation, where fussiness comes from trying to get large chunks of hard stool out, causing lots of discomfort and irritation. If crying is happening for hours a day (and not just around dirty diapers), it’s not likely to be due to infant dyschezia or constipation.
Is There Anything Else I Should Consider? When Do I Seek Further Care?
Hair Tourniquets: In moms with longer hair, it’s easy for a strand to fall out and get tangled or wrapped around a small newborn finger / wrist / ankle, slowly cutting off circulation. Always take a quick look and hands and feet to make sure there’s no hair tourniquets. If you notice one, go to your PCP. They’ll apply Nair (or an equivalent) to help degrade the hair, and make sure that there’s no lasting damage that needs addressing.
Hernias: If your infant has a known umbilical or inguinal hernia, and you notice sudden and severe fussiness that doesn’t resolve in addition to discoloration and severe swelling of the hernia, go to the ER. This is a medical emergency.
Infection / Meningitis: If there’s fever, a swollen fontanelle, and fussiness that is not consolable in spite of your best efforts, this is a reason to go to the ER, especially if <30 days of age. It’s important to rule out meningitis (infection of the brain or spinal cord).
If Crying Doesn’t Stop: Colic crying can last a few hours, but it shouldn’t last for an entire day without interruption. There should be the ability to soothe them after some time. If you can’t, this can indicate something more severe going on in the background, and is worth an evaluation with your Pediatrician.
What Should I Keep In Mind When Dealing With A Colicky Baby?
Never hurt your baby! It seems like such an obvious statement, but it’s much harder to remember when you’re insanely exhausted, hungry, brimming with postpartum hormones, and your infant is on their 4th hour straight of crying. It’s important to take advantage of any help or support you have (like your significant other, grandparents, friends, and babysitters) so that you’re able to get some quiet moments to yourself to exercise self-care and recharge.
If you notice yourself getting frustrated or angry, hand your infant to a loved one and walk away for a few minutes to take deep breaths and recoup. If you do feel this way, know it’s OK and natural. You aren’t any less of a parent for feeling it. It’s recognizing it and taking the steps to remove yourself from the situation so that you’re able to move forward calmly that’s important. Know that while it seems never-ending at this time, colic does fade over time. It won’t feel like this forever.
If you’re concerned about postpartum depression, see your OB/GYN or Pediatrician for help with getting connected to therapy, support groups, and other community resources.
