Infantile Colic

Infantile colic and the "fussy Baby"

1. Colic vs. High Needs Babies – What is the Difference?

Introduction
There are few times in our lives that are more stressful, or require
more of us, than caring for a newborn. Infantile colic and infants
that require substantially more attention, referred to as high
needs newborns, are conditions that additionally complicate the
first months.

The newborn infant is a miracle in development. The brain makes
thousands of new connections each day and, as parents, we have
the privilege of witnessing this evolution. The first months are
also full of unknowns for many parents. New parents must learn
the intricacies of caring for the newborn, but even those that have
older children can still have completely new experiences with
each child.

The basic behavior of the newborn infant is essentially reacting to
bodily needs and physical discomforts. Many are obvious, and
require only feeding, changing a diaper or repositioning. However,
some behaviors are difficult to understand and respond
effectively. The challenge and frustration can feel monumental
when parents cannot determine the cause of discomfort or crying.
There are also times that even when the cause of the discomfort
and crying is understood, finding the action to relive it is elusive.
The enigma of persistent crying of the newborn has been the
subject of much medical research. [1] [2] [3] [2] [4] [5]

Colic and the excessive fussy baby are the most common reasons
parents seek medical advice in the first 3 months of infancy [6]
and is responsible for about one-third of pediatric emergency
room visits. [7] Unusually frequent and prolonged crying can
cause significant stress and has even been reported to increase the
risk of maternal post-partum depression. [8] This article will

2. discuss the common problem of the fussy “high needs baby” in
contrast to an infant with colic.

Infantile Colic
Infantile colic is medically described as distinct, inconsolable
episodes of crying and agitation in an infant with no known health
problems and is appropriately fed. [9] The periods of crying and
inconsolability of colic should meet the following criteria: each
episode characteristically occurs at similar times each day, last
more than 3 hours and occurs at least 4 days per week. [10] The
infants behave otherwise normally during the remainder of the
day. Prospective studies have reported that between 5-19% of
infants meet the clinical criteria for the diagnosis of colic. [11] [12]
The cause of colicky irritability and bouts of excessive crying is
almost certainly due to pain, most likely colon pain. This is why
pediatricians often recommend a change in breast-feeding
patterns or formula.

The High Needs Baby
There are be times when it is difficult to differentiate between
colic and, what is referred to as a, high needs baby. Many
pediatricians use the term “fussy” baby for an infant that cries
more than usual, but does have the same daily pattern or
prolonged duration of crying. The term “high needs” describes a
fussy baby that with additional emotional reactions that require
being held and comforted more than is usually expected. This type
of infant behavior is more likely due the baby’s temperament than
physical discomfort. William Sears M.D. introduced term high
needs baby, based on his daughter, and published the description
in his first book[13] which has recently been revised. [14] A basic
review of this section of the book can be viewed at askdrsears.com

The high needs baby differs from the infant with colic in several
ways. Mainly, the crying episodes do not follow the characteristic

3. predictable pattern described in infant colic. The high needs infant
typically does not have a “return to normal” in-between difficult
periods. The high needs baby tend to have a persistent fussy, often
times demanding personality. Parents often use the term “difficult
temperament” or “forceful personality” to describe the disposition
of their child. The behavior issues with the high needs baby are
persistent, and not distinct episodes that completely resolve.

The persistent features of the high needs newborn are a high
intensity determination, active, fussy and demanding. High
intensity behaviors of the high needs baby are: 1) more forcefully
oppose or protest when needs are not met, 2) strong emotional
reactions, 3) loud cry and 4) often feed at a frantic pace. The high
needs baby awakens often during sleep times, requires
frequenting feeding to calm or soothe, and begins to show signs of
separation anxiety when left without parents (especially mother).


Characteristics of Colic vs. High Needs Babies
Baby’s Behavior Colic High needs
Distinct, time-specific, episodic crying Yes sometimes
Crying episodes: last over 3 hours
:occurs at least 4/week
Yes
Yes
Uncommon
Sometimes
Persistent hyperactivity/fussiness No Yes
High intensity behavior No Yes
Demanding personality trait No Yes
Difficult sleeper No Yes
Requires frequent feeding No Yes


Although parents of a high need baby often feel overwhelmed by
difficult behaviors, some of these personality traits can become
useful as the child grows. Such features as intense, active and

4. persistent can be instrumental in surviving and even striving in
our competitive world. The trick is to love and enjoy your baby as
you learn to “manage” the behaviors.


Coping with a High Needs Baby
As you can imagine there are many suggested strategies to
“overcome” your baby’s high needs. The basic framework includes
the following. First, discuss these issues with your pediatrician or
nurse practitioner to make sure there are no medical issues
causing the behaviors. Occasionally, an indolent ear infection or
constipation can be responsible for persistent crying and fussing.

Parents, especially with the first child, compare behaviors and
development to children of friends and acquaintances. This can be
helpful as it provides a lose guideline of anticipated
developmental milestones, but try not to compare behaviors and
personality traits. Your baby is unique and special.

Don’t be afraid to ask for help. Your doctor may refer you to a high
needs baby support group where you can learn what other
parents do in your situation. Support groups are also designed to
listen to you. It helps to talk about the unexpected demands of
raising a high needs infant. If unable to get out of the home to talk
with others, there are online several support groups, including a
fussybaby facebook site. Writing in a personal journal is another
form of expressing yourself to relieve stress.

Consider creating your own support team. It may consist of other
parents with high needs babies, family and supportive friends. It is
important to your baby that you take care of yourself. Parents
need a break and time just to catch up, and even just sleep. The
fact is that we are all better equipped to face our challenges when

5. better rested and allowed time to take care of our own needs.
Taking parental breaks is good for the baby with high needs.

Above all, remain positive. Chances are you are doing the right
thing and your high needs baby will be just fine.

Colic vs high needs
The difference between colic and high needs infants is likely
related to the origin of the behavior. Colic is proposed as episodic
painful episodes emanating from the gastrointestinal tract. Colic
associated crying carries a painful pitch and often responds to
changes in formula. The behavior of the high needs baby is likely
emotional and related to developing personality traits. These
specific traits manifest as difficult behaviors during infancy but
will likely evolve into, and respond to, a more conventional
expression of behavior.


References

1. St. James-Roberts, I., The origins, prevention and treatment of infant crying and
sleeping problems : an evidence-based guide for healthcare professionals and the
families they support. 2012, Hove, East Sussex ; New York, NY: Routledge. xiv, 260
p.
2. Barr, R.G., I. St. James-Roberts, and M.R. Keefe, New evidence on unexplained early
infant crying : its origins, nature, and management. Pediatric round table. 2001,
Skillman, NJ: Johnson & Johnson Pediatric Institute. xviii, 336 p.
3. Valman, H.B. and R. Thomas, ABC of the first year. 6th ed. ABC series. 2009,
Chichester, UK ; Hoboken, NJ: Wiley-Blackwell. vii, 125 p.
4. Lester, B.M. and C.F.Z. Boukydis, Infant crying : theoretical and research
perspectives. 1985, New York: Plenum Press. xxiii, 375 p.
5. Early development & parenting. 1992, Wiley: Chichester ; New York.
6. Kheir, A.E., Infantile colic, facts and fiction. Ital J Pediatr, 2012. 38: p. 34.
7. Gray, L., Berglund, A., Klein, R., & Gilkerson, L. , Urban crying in the emergency
department., in Poster session presented at the meeting of the International Society
for Infant Studies. 2004: Chicago, IL.
8. Radesky, J.S., et al., Inconsolable infant crying and maternal postpartum depressive
symptoms. Pediatrics, 2013. 131(6): p. e1857-64.

6. 9. Reijneveld, S.A., E. Brugman, and R.A. Hirasing, Excessive infant crying: the impact
of varying definitions. Pediatrics, 2001. 108(4): p. 893-7.
10. Leung, A.K. and J.F. Lemay, Infantile colic: a review. J R Soc Promot Health, 2004.
124(4): p. 162-6.
11. Canivet, C., I. Jakobsson, and B. Hagander, Colicky infants according to maternal
reports in telephone interviews and diaries: a large Scandinavian study. J Dev
Behav Pediatr, 2002. 23(1): p. 1-8.
12. Crowcroft, N.S. and D.P. Strachan, The social origins of infantile colic: questionnaire
study covering 76,747 infants. BMJ, 1997. 314(7090): p. 1325-8.
13. Sears, W. and M. Sears, The baby book : everything you need to know about your
baby--from birth to age two. 1st ed. 1993, Boston: Little, Brown. xiii, 689 p.
14. Sears, W., et al., The baby book : everything you need to know about your baby from
birth to age two. 3rd ed. Sears parenting library. 2013, New York: Little, Brown,
and Company. xiv, 770 p.