The Colic Revolution - Screaming Into the Twenty-First Century

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

(Page 3 of 3)

Our experience and medical research tell us that babies scream for a reason. While Colic Solved doesn't intend to suggest that there aren't high-need babies or those with sensitive developing nervous systems, it is here to introduce the idea that something physical may in fact be wrong.

In a sense, this book is the result of a revolution in pediatric medicine - a culmination of technology and insight. Advances in endoscopy (viewing the inside of body organs or cavities with a device that uses flexible fiber optics), pharmacology, and nutrition have allowed us to rethink why babies cry. In the twentieth century, we called it colic only because no one knew any better. And while developments in conquering diseases such as polio and smallpox obviously take center stage, other seemingly less impressive advances are important minor characters. Our understanding of the irritable baby is one of them.

Technology Has Changed Our Babies for the Better

So what are the changes in pediatric health care that have created a better understanding of why babies do what they do?

• The creation of pediatric gastroenterology as a specialty. While there have been pediatricians dedicated to the understanding of pediatric digestive health since the early 1900s, it was the formal organization of the field of pediatric gastroenterology that has created an atmosphere of organized discussion and research. The subspecialty of pediatric gastroenterology was recognized by the American Board of Medical Specialties in 1988, and since then the number of trained gastrointestinal (GI) specialists conducting research and setting the standards of care has continued to grow. Alongside the expansion of gastroenterology as a pediatric subspecialty has been the development of smaller endoscopes (flexible-tube optical instruments that use fiber optics to illuminate the inside of the intestinal tract) for understanding what happens in a baby's digestive system. pH probes came into popular use by pediatric gastroenterologists in the 1980s, allowing doctors to begin to associate patterns of reflux with patterns of irritability. (pH is a measure of acidity or alkalinity of a substance.)

• Identification of reflux as a key contributor to a number of common conditions. Beyond simply understanding acid reflux (the backflow of stomach acid into the esophagus, the muscular tube that carries food and drink to the stomach) in babies, this evolution of technology involving fiber-optic endoscopes and pH probes has allowed the correlation of reflux with other problems such as asthma, sinus conditions, and feeding disorders.

• The advancement of infant nutrition. Understanding of the growing immune system has led to the development of hypoallergenic formulas, specifically superhypoallergenic formula, which became available for common use in the early 1990s. This has revolutionized the care and feeding of the infant with severe allergic disease. Our ability to understand the reactions of the intestinal immune system has been furthered by our ability to "see" intestinal allergy with endoscopic technology. And while we continue to learn more and more about the incredible benefits of breastfeeding, formula manufacturers are learning from it to benefit babies who can't breastfeed. Formulas, which were once nothing more than a vehicle for protein, fat, and carbohydrate, now sometimes contain long-chain fatty acids that have been shown to improve visual and cognitive function in infancy and beyond.

• The evolution of pediatric drug development. The development and improvement of safe, effective antacids for use in children have revolutionized the way we see and care for the screaming baby. The technology of drug delivery has provided pediatricians with more options for facing the challenge of administering medicine to infants and children. And recent changes in federal law now mandate clinical trials (research studies) in children for many of the new drugs being released for adults.

• The popularization of the Internet. While many doctors consider it a curse, the Internet has empowered parents to network and ask questions about their baby's misery. Parents whose babies have been dealt the once dead-end diagnosis of colic now are learning in chat rooms and on Web sites that there may be identifiable and treatable problems at work. While the Web has the downside of sometimes offering too much information, its ability to raise questions is unparalleled.

So as we enter the twenty-first century, it sure seems like a great time to be a baby, particularly one who screams. All of these developments have made it easier to help the fussy baby.

Why Hannah Is Screaming

We now know that children with the type of irritability described as colic often suffer with either reflux or milk protein allergy.

A major study reported in 2004 by one of the world's most respected reflux researchers created quite a stir in the medical community. Clinical researchers treated a group of irritable babies with hypoallergenic formula. The babies whose symptoms didn't lessen when they were given hypoallergenic formula were then evaluated for the presence of gastroesophageal reflux using endoscopy and a pH probe (you'll learn more about these in Chapter 8, "A Parent's Guide to Tests and Studies," but for now understand that this is how reflux is formally assessed). Of 60 markedly irritable infants between the ages of 1 and 6 months, 66% had pH probe results consistent with abnormal reflux and 43% had evidence of acid reflux injury shown by biopsy of the esophagus. While the report's authors make it clear that proving an absolute cause-and-effect relationship between crying and obvious reflux can be difficult, the results are thought-provoking.

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.