Curing Colic: The 4th Trimester

by Harvey Karp, M.D.

"Just put cotton in your ears and gin in your stomach!"
--19th Century colic advice

Infant crying has been attributed to everything from the evil eye to exercise for the lungs to brain immaturity to severe stomach pain. In fact, the very word "colic" comes from the ancient Greek word "kolikos" meaning crampy pain and shares its root with the word "colon". Yet, despite all these theories, this extremely common problem has remained one of the longest standing medical mysteries on record.

And, it's tough to be around these red-faced, screaming young babies. It makes your skin sweat, your blood pressure climb, and causes great frustration when nothing you do seems to calm them. No wonder, most of us who have ever had to care for a crying newborn have probably muttered to ourselves, "Why couldn't they just come with a crying off-switch?" Well, perhaps they do and we just overlooked it!

In 1980, as a fellow in Child Development at UCLA, I learned something that astounded me -- some cultures around the world are "colic-free". In other words, their babies usually calm in a minute or less. And, I began to wonder, "Had those parents discovered the 'off-switch'?"

This question lead me on a twenty-year study of infant crying and a search for ancient techniques to help the 20% of our young babies who fuss and scream for more than 3 hours a day." Now, I think I know what's going on with these babies and it's not gas.

Gas is mostly a lot of hot air

Gas seems a logical cause of a baby's crying. After all, fussy infants often double up, make a pained sounding cry, have rumbling stomach, and pass gas. It's no wonder generations of physicians have given newborns opium, antispasmodics and burp drops to settle them.

However, although it's clear that some babies cry from milk allergy (~10-15% of colic) and a few from acid reflux (~3% of colic), intestinal pain can't be the cause of most cases of colic because:

  1. Colic starts at 2 weeks, ends at 3 months and peaks in the evening, yet gas starts at birth and lasts long after the 3-month birthday and occurs all day long.
  2. Fussy babies often calm in cars and with rocking…yet these don't stop pain.
  3. X-rays of infants show more gas after they stop crying then before they begin.
  4. Colic is totally absent from some cultures around the world…but gas isn't.
  5. Antispasmodic drugs may work because they are also highly sedating.
  6. Two double-blind studies have shown that simethicone is no more effective for crying than water.

As odd as it sounds, I think the real reason our babies get colic is because, in a certain respect, they're born 3 months too soon!

The Missing "4th Trimester"

Baby horses can walk and even run on their very first day of life. They are truly ready to be born when they leave their mother's womb. By comparison, our newborns are more like fetuses than infants. They have irregular breathing, tremors…and even need help to burp. It is only after 2-3 months that they smile, coo and finally seem ready to be here.

Our babies don't have big strong bodies, like horses, but they do have big brains. In fact, they are so big, at 9 months giving birth is an almost impossible squeeze. A dilated cervix is 10 centimeters in diameter (31.4 cm circumference) while a newborn's head has a circumference of 34-35 cm. Our big-brained babies have to come out after 9 months gestation; however, in many ways, they could really use a few more months of the stimulation of the uterus.

Yes, I did say stimulation. In the womb, fetuses are constantly massaged by the muscular walls of the uterus, frequently jiggled and 24/7 they are surrounded by the crash of blood whooshing through the placental arteries (a noise that is louder than a vacuum cleaner!).

Most parents around the world intuitively mimic the rocking, holding and shushing of the uterus, but in our culture, we are mistakenly taught to whisper and tiptoe around our babies, believing that they need a quiet and still environment. Nothing could be further from the truth! Rather than being over-stimulated, most of our babies are seriously under-stimulated.