Colic - The Diagnosis For All Occasions

Colic Solved: The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult to Soothe Baby
by Bryan Vartabedian M.D.

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Unfortunately, not everyone has a pediatric gastroenterologist as a father. In many cases, babies are left alone to cry, either by parents who don't know how to advocate for them or by doctors who don't know where to turn. In fact, in Hannah's case the diagnosis was colic because there was nothing else to explain her problem and the symptoms loosely fit with something that her pediatrician had been taught many years ago.

So What Is Colic?

The quest for the cause of colic or even an agreed-on definition of it over the last half century has amounted to something of an optical illusion. Like one of those abstract images that you must stare at for minutes on end before actually identifying the picture, colic has been something of an elusive diagnosis among pediatricians. And the many who never quite see it ultimately agree that they see it just so they won't have to continue squinting.

I'll have to admit that from early on in my career I was never able to see the pretty picture when it came to the illusion of colic. While I've evaluated and treated thousands of irritable babies, the problem is that I've never seen colic and can't get straight answers about what it is or what it looks like from those who claim to have seen it. Like the UFOs that seem to land everywhere but at Harvard and MIT, colic has evolved into one of our culture's greatest urban legends - a mythical explanation meant to explain the seemingly unexplainable.

A Baby Cannot "Have" Colic

The problem comes with the fact that colic is a description and not a disease. This descriptive term has, in turn, been morphed into a real and recognizable condition that served an important role for parents and pediatricians in our not-so-distant past. Much as fables and myths help provide order and explanation for different cultures, colic was once a comfortable resting place for weary pediatricians dealing with weary parents. And when medical science failed to offer any better explanation, it served to conveniently absolve the pediatrician from any further responsibility to parent or child.

Because colic represents a pattern of behavior and not a disease, a baby cannot "have" colic or have it "diagnosed." Much like fever or weight loss that typically represent signs of some other problem in a child, colic doesn't stand on its own as a diagnosis. To use the words diagnosis and colic together suggests that intelligent, established criteria, backed up by clinical research, were used to come to that conclusion. But unfortunately, such criteria or compelling clinical studies don't exist. In the words of a distinguished researcher on the topic of infant irritability recently quoted in the Journal of Pediatric Gastroenterology and Nutrition, "The term colic implies a mechanism responsible for the distress displayed by these infants. Such a mechanism has never been demonstrated."

Colic - Whatever You Want It to Be

But colic advocates and researchers who have built their careers on the urban legend that is colic will beg to differ. The criterion they use, as determined in 1954, suggests that the diagnosis should be considered in babies who experience inconsolable screaming for 3 days a week, for 3 hours a day, for at least 3 weeks a month. Unfortunately, if your baby screams for only 2 hours and 45 minutes for only 20 days straight, you're a day early and a dollar short. Had I created criteria for colic, I would have suggested adding the fact that you haven't had sex with your spouse in 3 months, you're up 3 hours each night, and you're 3 weeks away from losing your job unless you get some sleep. But I wasn't practicing in the 1950s, and things were different then.

If we give our 1950s' researchers the benefit of the doubt and accept the out-of-thin-air rule of threes, as it is called, not everyone sticks to it. In fact, when it comes to the diagnosis of colic, everyone seems to have his or her own rules. A colleague whom I work closely with will diagnose colic only if the baby cannot be put down. Another employs a white-noise rule - the diagnosis is confirmed if the baby settles with the sound of a vacuum cleaner, hair dryer, or other loud neutralizing sound. It seems that the number of random, self- imposed criteria for diagnosis are limited only by the imagination.

So despite the complete absence of a consensus of what constitutes colic, it remains nonetheless a convenient wastebasket diagnosis that can be retrofitted to suit the need of the individual making the diagnosis. If you haven't caught on, colic would appear to be a well- orchestrated five-letter defense mechanism for doctors who are either outdated, outwitted, or just plain out of ideas.

Copyright © 2007 by Bryan Vartabedian. Excerpted by permission of Ballantine Books, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Dr. Vartabedian practices Pediatric Gastroenterology and Pediatrics in Houston, Texas. Dr. Bryan Vartabedian, a male, graduated from the University Mass School Med with a MD and has been in the profession for 16 years.