The PURPLE baby and the 5 S's
by Doctor Laurence H. Miller on 03/27/12
What is colic? The term has been used for about 100 years, but it is still shrouded in mystery. All babies cry. Some babies cry more than others. In 1954, Dr. Morris Wessel described "infantile colic" in the Journal Pediatrics, as "paroxysmal fussing in infancy", in a baby "under 3 months old crying more than 3 hours a day, for 3 or more days a week". To meet the definition, it is critical that the baby have no existing discoverable medical illness. It is necessary for a doctor to evaluate a baby who is so distressed for a prolonged time to "rule-out" such conditions as: scratched cornea of the eye, ear infection, a "hair tourniquet" (in which a long hair, usually Mother's, is wrapped tightly around a finger, toe, or penis, so that it cuts deeply, painfully into the flesh), intestinal obstruction, serious infection, or severe cow's milk intolerance. (In babies with severe cow's milk intolerance, catastrophic gastro-intestinal symptoms can appear with relentless vomiting, bloody diarrhea, and even cardiovascular shock. Soy intolerance is also present to the same degree in up to 30 % of these infants. So switching such a baby to soy formula is a terrible idea; you are making a bad gamble with the infant's safety!) Once that examination has been performed, parents will need to accept that it is NORMAL for THEIR baby to cry A LOT for that part of his/her life. Easier said than done! It is painful for parents to have to listen to and watch their much-loved infant in obvious pain. In this situation, I try to comfort parents by advising them, that if they are distressed by the sound of their crying baby, that is a good thing! Through eons of evolution during which survival for human babies was very tough, the baby that cried with the right pitch/quality, in such a way as to get adults to care for them, would be a baby much more likely to survive! (If one likes the sound of his baby crying, there is something terribly wrong, and perhaps that baby should be promptly brought to the authorities for safe keeping.)
To educate parents to this situation, Dr. Ronald Barr, of Vancouver, Canada, developed a program called "PURPLE crying". "PURPLE" is an acronym describing the six characteristics of this crying baby:
1. P(eak) age the crying behavior is present; from approximately the 6th through the 9th week.
2. U(nexpected) appearance of distress in the baby, without warning.
3. R(esistant) to soothing; unlike earlier crying behavior, these "attacks" aren't calmed easily.
4. P(ainful) appearance on the baby's face and in his manner.
5. L(onglasting) attack of intense crying that can persist for as long as five hours.
6. E(vening) is the time of day it usually comes on.
Getting relief for these children (and parents) is problematic. Some babies, sometimes, just won't quit howling! It isn't advisable to give Gripe water as a treatment. Just because it's "over the counter" and "has herbs" in it, that doesn't guarantee it is safe. Over the years, American capitalists have come up with many ideas to cash in on families' suffering from colic:
taking the baby for a ride in the car, placing a vibrating device under the crib mattress so that the baby feels like she is riding in a car at 50 miles per hour, a papoose for carrying the baby on your chest. An explanation why these efforts may help is that the baby feels the way he did back in the womb, and that is very calming.
There are a few free recommended maneuvers a parent can try that can really help ("not guaranteed- but you get your money back if baby's still crying!").
Conveniently, they all begin with the letter "S".
1.S(waddle): wrap the baby snugly in her light blanket, into a little bundle. When baby's flail their arms and legs while crying, it sets off startling reflexes that can upset them even more. So immobilizing them can stop the vicious circle.
2.S(waying): gently, softly, slowly hold the baby in your arms and slow dance, rhythmically.
3.S(sssshing): making this soft sound can be soothing (to the parent as well as baby)
4. S(tomach) positioning often calms the baby who molds against the mattress, perhaps feeling more secure.
5.S(ucking) a pacifier could be compared to meditation, reducing stress.
The "take-home" message is that it IS normal for babies to cry. There is a "range" of normal that increases in the number of hours per day as the baby ages into the second month of life. I was fascinated to notice that each of my daughters, born eight years apart, were "angels" their first month, but began to suffer almost daily attacks at six weeks old with what seemed to be cramping abdominal pain.
The baby seemed to be trying to push out a bowel movement, so it occurred to me that gently inserting a well lubricated thermometer about 3/4 of an inch into the rectum could give relief. The majority of the time, it was a great success. Baby would push against the inserted thermometer and, usually, gas or stool would shoot out as I'd withdraw it. Some medical authorities disapprove of this technique. They worry that it could be "habit forming"; that baby (or mommy) will become overly dependent on anal stimulation to have a bowel movement. One doesn't have to worry about this if we limit the maneuver to once in 24 hours. Also, consider that the Miller babies showed this urgent, crampy behavior for a period of about 7 to 10 days in the middle of their second month, and never again!
But let's explore a bit more this apparent behavior of seeming to strain at pushing out stool. Why is baby struggling? Perhaps it's partly because baby's instinct when they get this feeling of pressure is to clamp down all the muscles they can. So they tighten the muscles in their face, neck, arms, abdomen, limbs, and rectum! Now we may have hit on something! It makes sense to constrict/tighten all those other muscle groups; but it's counterproductive to constrict the anal sphincter if one is trying to pass a bowel movement. It will happen eventually. But only with a great deal of force. My suspicion is that babies calm by their third month because they are finally "getting it" and have learned to squeeze all muscles except the anal sphincter in order to pass stool.
More on the possible "cause" of this challenging time in my next post...
