Colic: What it is, How to handle it and Shaken Baby Syndrome in Malaysia - November 2024

Why is your baby crying like that? He is clenching his body, arching his back and screaming till he is purple in the face. And he hasn’t stopped crying for hours. Could it be colic? Most parents are terrified of the term colic because they know they are going to have to endure it for the long haul, or at least for the next few months until the insufferable wailing ends. As it is, you and your husband have not had sleep for days on end. You’re exhausted, overwhelmed and frazzled and just as you are hoping for a minute of rest, baby is starting to have another episode of his endless inconsolable crying yet again. What is Colic? Colic is a word that has been bandied about eversince babies started crying in this fashion a long time ago. Till today, there is no diagnosis per se, just a “behavioural observation” as doctors would say. Your baby is not sick, hungry, wet, tired, hot or cold, he is just inexplicably miserable and seems to be in pain. You’re at your wit’s end because you’ve rocked him, walked him, checked his diapers but it seems nothing you can do can console him. What is this terrible thing called colic? Generally speaking colic symptoms follow the Rule of Threes. Beginning within the first three weeks of life Lasting at least three hours a day Occurring at least three days a week But those are generalisations. The baby could cry all day and all night, every single day. It has been observed he will usually start crying at the “Witching Hour” of around 6pm and go on and on and on from there. Any baby can suffer from colic. The condition has no preference for gender, race, birth order or feeding method. The term colic comes from the Greek word kolikos meaning “suffering in the colon.” Doctors and scientists assume that colicky crying is the result of pain in the stomach, but often no clear answer exists as to why a colicky baby is so hard to soothe and the crying is so intense. Any baby can suffer from colic. The condition has no preference for gender, race, birth order or feeding method. Worldwide, the prevalence of colic occurrence is between 6-20% of infants. Colic typically begins in the first month and peaks at six to eight weeks then subsides by the time baby reaches three to four months of age. One day, it may stop just as suddenly as it started. But to parents of a colicky child ─ four months can look like a very long time. What Causes Colic? Some doctors say colic is caused by the immature and developing nervous system of a newborn which affects the digestive system. Others say it is due to an imbalance of melatonin and serotonin. Still others say it is due to gas and wind through improper feeding and insufficient burping. Some doctors say colic may be a sign of problems with the parasympathetic nervous system. Baby’s parasympathetic nervous system (also called the rest and digest system) is immature and if it is compromised, he will be tired, aggravated, likely constipated and he will want to scream and writhe around. Other doctors say it is a natural developmental stage that babies go through as they adjust to all the different sensations and experiences that come with life outside the womb. Still others attribute it to an imbalance of bacteria in the gut. One more theory points to an imbalance of the brain chemicals melatonin (a hormone that regulates the sleep–wake cycle) and serotonin (a nerve cell-produced chemical and neurotransmitter that regulates mood, appetite, digestion and memory). Colicky babies might have more serotonin, which makes intestinal muscles contract and this could be one reason babies with colic fuss more at night. Serotonin levels peak in the evening. As for melatonin, babies used to get plenty of the hormone from Mum in utero, but levels drop after birth until baby starts producing it on her own at three to four months ─ interestingly, at around the same time that colic typically disappears. This hypothesis should reassure mothers that they didn't cause the colic and that they haven’t failed to comfort their babies in any way. Typically, babies exhibit colicky crying symptoms in the first month of life. The crying bouts peak at six to eight weeks, then taper off in frequency and intensity when the child is four months of age or so. What You Can Do to Help Baby Stop Crying While the causes of colic are unclear, parents still have to deal with the crying and are often told to wait it out. Do not despair. Here are some things that you can do to try and soothe baby. Feed your baby in an upright position Try smaller and more frequent feedings Burp your baby often, in between feeding If you are breastfeeding, try making small changes in your own diet. Try to limit spicy foods, caffeine, shellfish and other known “windy” foods to see if baby is allergic Rock your baby while you sit in a rocking chair. Note: Do not get the traditional Sarong-Hammock or Sarung Buaian although older folks may swear by it. Studies have shown they are unsafe. For a baby less than three months old, vigorous rocking could cause brain bleeding (See Shaken Baby Syndrome below). The jaw of an infant is also very mobile, and flexion of the head on the neck in the baby hammock can potentially lead to compromise baby’s breathing. Put your baby in a wind-up or automatic swing (make sure your baby can support his or her head and the swing is not put at high speeds when baby is very young). The gentle swinging motion does help to soothe baby! Windup and electronic baby swings. They are really helpful in soothing babies. Clockwise ─ the traditional baby swing from Graco and the new modern electronic ones available today. Two of these on the right can be bought from Motherhood.com.my. (Image Credit: Overstock.com, motherhood.com.my) Give your baby a warm bath to mimic his time in the womb. You may also want to take a bath with him for some skin-to-skin time Carry him and pace around the house Give your baby a pacifier Gently rub your baby’s stomach or massage him to relieve gas Swaddling a baby helps get babies to fall and stay asleep on their backs. In hot Malaysian weather, make sure the swaddling material is cool. (Image Credit: Mama Natural) Wrap or swaddle your baby in a soft blanket. He will feel more secure as swaddles mimic the time when he was in the tight confines of the womb Put your baby in a stroller and go for a walk. Sometimes, going on bumpy ground to change the motion now and then tends to help Go for a drive with your baby in the car seat Turn up background noise or put on white noise. Here is a recording of white noise that you could use. A metronome or clock with a loud tick-tock also works. Below is a video of white noise. Magic White Sound https://www.youtube.com/watch?voewj_XEM1js Put baby in a well-cushioned bassinet and place him on top of a running washing machine. The vibration works. (But please make sure you are there to hold him down) Bicycle baby’s legs. Here is an excellent video on bicycling baby's legs. How To Relieve Gas and Colic In Babies and Infants Instantly https://www.youtube.com/watch?vOAe1C-kAliU Wear your baby whenever you can. Put him in a sling, wrap or carrier to give him movement and closeness to you But when the Crying Still doesn’t Stop Colic has been said to abate by itself by the time the child is four months old. If by that age the pain and crying doesn’t stop, your baby may be having a medical condition. Is he: Frequently waking up with painful cries? Showing poor weight gain? Having frequent respiratory or intestinal illness? Straining, grimacing, and drawing legs to chest with bowel movements? Frequently spitting up his milk when he burps and crying more after feeding and when lying down? Has symptoms suggesting allergies, such as rashes, diarrhea, runny nose and wheezing? If you answer Yes to some of these symptoms, you must schedule an appointment with your doctor to examine your baby thoroughly. Shaken Baby Syndrome in Malaysia A crying baby who is screaming day after day for hours on end can push parents over the brink. Colic is the number one trigger for Shaken Baby Syndrome (SBS). crying baby who is screaming day after day for hours on end can push parents over the brink. This is why colicky babies are at higher risk for Shaken Baby Syndrome (SBS). It is the number one trigger that can make parents "lose it." Here is some information on SBS in Malaysia taken from MyHEALTH portal, Ministry of Health Malaysia. They say in the first year of life, 95% of serious head injuries (other than from a motorcycle accident) result from abuse. Bleeding in the outer lining of the brain of a young child, usually below two years old, is called subdural haemorrhage. Subdural haemorrhage is often seen in shaken babies. Shaken Baby Syndrome (SBS) is caused by violent acceleration/deceleration injury from shaking. The infant’s relatively large head and poor neck support make it predisposed to acceleration and deceleration forces associated with rotational forces, much like in a whiplash injury. The soft, pliable skull and brain lead to stress on the bridging veins which tear with the force applied, leading to a subdural haemorrhage. About 20 to 30 babies are referred to Hospital Kuala Lumpur every year for SBS. This is just the tip of the iceberg as some of the babies may have died at home or before they can be referred from another hospital. Subdural haemorrhage can also be caused by impact injury when the child is thrown violently against a wall, floor or other objects or is struck on the head/face. This usually happens when the parent or childminder does not know what to do with a crying baby, who continues to cry, leading to frustration and impatience in handling the baby. The parent or childminder may then inadvertently shake the baby hard for a few seconds in an attempt to stop the baby from crying or slap the baby out of rage. In a few instances, the childminder has been known to shake a baby’s cradle so hard that the baby falls out of the cradle. PURPLE-Cry In Malaysia, colicky behaviour or incessant crying in the first six to eight weeks of a baby’s life is referred to as “PURPLE cry”. Basically it is still the Rule of Threes for colic but explained a little more thoroughly. PURPLE is an acronym for: P : Peaks around two months. U : Unpredictable, often happening for no apparent reason. R : Resistant to soothing. P : Pain-like expression on the baby’s face, even without any source of pain. L : Long bouts, lasting 30 to 40 minutes or more. E : Evening crying is common – what many parents know as the “Witching Hour” is now a scientifically proven fact. Signs & Symptoms of SBS The face of a Shaken Baby (Image Credit) MedlinePlus The signs and symptoms of a shaken baby are: child is usually pale retinal haemorrhages (bleeding on the inner lining of the eye) present in between 75-90% of shaken babies vitreous haemorrhage (bleeding in the vitreous part of the eye) multiple fractured ribs (caused by squeezing of the chest) skull fractures (with impact injury) Help for Parents Parents of a colicky baby, if you feel stressed out, angry and frustrated: leave the baby in a safe place like a cot with the sides up or playpen, make sure your baby is comfortable and leave the room for a few minutes. Give yourself a few minutes to calm down. call your friend or relative for assistance or help you with household matters or with the other children. Remember: Babies do not die from crying too much but they may if shaken! For more information on baby care, please visit Motherhood.com.my

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