Monday, August 25, 2008

Colic is not a diagnosis

The medical definition of colic is, essentially, uncontrollable crying in an otherwise healthy child. Doctors know that it happens in a certain percentage of babies, and that it generally starts around weeks 2-3 and stops on its own around week 12. They don't know what causes it, though there are lots of theories, and the general consensus in this country is that it can't be cured, but must be endured.

A diagnosis of colic says, "We don't know why your child is crying, but we can't find anything wrong with her, and we think she'll get better on her own." Which is great, if you've actually looked at other options. When we first took spud to the pediatrician, he looked her over, checked her extremities, felt in her gut, and found nothing obviously wrong, then talked to us about colic, what it was like, and sent us on our way with instructions to get help with her so we could both sleep, and to call if she got noticeably worse.

The Happiest Baby on the Block, by the way, has some great tips for calming colicky babies, and we went through them all. But sometimes nothing worked. In fact, we had several ten hour nights where nothing worked, and either Christie or I was up all night with a crying baby while the other tried their best to sleep through it, which rarely worked. I say "Christie or I", but it was Christie who bore the brunt because she was still on maternity leave, and I was working all day.

So it was Christie who went to the doctor and, because it was a last minute appointment, saw a resident. Now, I've got nothing against residents. Christie's main doc through her pregnancy was a resident, and she was awesome. But this woman saw a crying mom with dark circles under her eyes, read colic on the chart, and started asking her screening questions for postpartem depression.

Now remember, at this point we had a baby who was either asleep or screaming. No middle ground. And she rarely slept for more than 20-30 minutes at a time because her gut kept waking her up, screaming. The only time she could sleep for more than that was if she was being held by someone who could immediately soothe her back to sleep. She could not sleep laying down, screamed when she had hiccups, and displayed roughly a dozen symptoms of gastroesophageal reflux disease, or GERD, which she had a family history of. And unlike traditional colic, her screaming was not limited to a particular time of day. In fact, if the resident had looked past the chart which said colic, she might have seen that the physically exhausted mom in front of her was holding a sheet where she had written down things our infant was doing that were not symptoms of colic, but were symptoms of GERD.

Christie asked, "Can you at least write a prescription for a heartburn medication that's safe for our baby so we can eliminate reflux?"

The reply: "We don't really like to medicate children unnecessarily."

Around this time, Christie's mom arrived in Columbia, and it was at her insistence that Christie called the doctor again and insisted that she be seen. This time, our actual pediatrician was available.

He listened. And he recognized that even though our baby was growing, and we clearly deriving nourishment, she was not "otherwise healthy". Within two days of putting her on Zantac for reflux and Alimentum (easy to digest formula), she was sleeping for 4-5 hours at a time. She has her fussy periods, as any baby will, and last night she had some serious gas pains, pretty much all night, but oh my god we have a happy baby suddenly. She's smiling all the time, and almost laughing.

Now, there are those who flat out say that colic doesn't really exist. I won't say that, because there have been plenty of times when spud was crying for no reason at all, and she does get fussy every single day right around dinner time. That's textbook colic.

But if you have a baby that's been diagnosed with colic, be aware that there may be more going on that just plain colic, and be especially aware that you may have to fight like hell to get recognition of that fact. And if you're a doctor (or physician in training), don't let an existing diagnosis of colic blind you to other possibilities.

BTW, when we went back for a followup, our pediatrician told us that if the Alimentum and Zantac hadn't worked, he was going to call a retired doctor he knew that specialized in infant colic to see if he could help. In other words, even if it really was just colic, he was working on getting us help with it, because he saw how desperate we were. And that is why we love our doctor. He's Dr. Nathan Beucke, by the way, with the University Physicians Green Meadows Pediatrics Clinic, and I highly recommend him.

2011 Update: Kid #2 actually does have reflux, and it is so, so different from colic.  I mean, really.  If he hasn't had his Zantac, he fusses every time he spits up, and cries for almost half an hour after every feeding, but if he's had his Zantac, nothing.

And here's my full post on colic, from the safe distance of month 4 and it's all done.


Emily said...

Wow. Congratulations. Phew. Isn't it amazing the difference between poor health care and good health care? I am so glad things are better. Now, get some sleep!

Heather said...

I wish we'd had a doctor like this with E-Beth. She had (and still has) all the symptoms of reflux.

She doesn't scream anymore, but she can't eat before bed without throwing up. I have the same problem, too.

I'm so glad you found something that works! :-)

Mike said...

Well, now her stomach's giving her trouble because of the rotovirus vaccine, but it's always something, right?