The Pain of Being… Colicky

Read This Before Calling an Exorcist — Interesting New York Times article summarizes the medical dispute about the nature and meaning of colic. Not just an academic debate, this has desperate significance to all parents at their wits’ end with one of the one in five infants beset with the bouts of frantic inconsolable crying. It also might be interesting to the rest of you psychonauts, even with no involvement with parenting colicky infants.

Although it has been discredited, the belief persists that colicky babies are in pain — particularly digestive distress or teething pain. Anti-gas drops and gum salves are widely sold over the counter as remedies for colic. One of my medical school classmates was actually one of theprimary researchers establishing that colicky infants are not less well than comparison subjects. The backlash against that commonsense but inaccurate notion leaves some pediatricians going to the opposite extreme and asserting that colic is normal, so normal that in fact one should walk away from the crying infant if they cannot readily be soothed. Others, who note that a child won’t be labelled colicky unless its crying causes problems in the family or interferes with interactions with the child, suggest that it is thus the family that needs treatment, not the infant.

My daughter was protractedly colicky as an infant, and I came to believe that colic arises from the greater constitutional vulnerability to sensory overload some babies must have, starting from as soon as they become awake and alert enough to be bombarded by the unending, unfiltered barrage of sensory stimuli their brain is not yet mature enough to mediate or filter. As the brain and mind mature, one of the things that happen is that the experience of reality becomes more and more mediated, less and less raw. Prior to that, that rawness, I imagine, could be mighty painful for some… in fact, I do not understand why it is not distressing for all! (As an aside, I have often wondered if the recently popular concept of ‘sensory integration deficits’ in older children, if you are familiar with that, represents a vestige of the same phenomenon. Certainly SID children are those for whom run-of-the-mill sensory stimuli are unpleasant, and they work hard to avoid and limit stimulation and novelty. Someone ought to do the research to see if they are more likely to have been colicky infants, perhaps especially severely or protractedly. Or perhaps less likely; what if it is more that some babies work through that vulnerability during their infancy through the process of being colicky, while others remain vulnerable to sensory overload later on because they haven’t dealt with it effectively sooner?) I was only half-facetious when I wisecracked to sympathetic and often equally sleep-deprived parents that colic is the first version of existential angst, the pain of being. (I also sometimes discuss this notion of the meaning of colic when I give talks to families of those afflicted with Alzheimer’s dementia. I think that, ironically, the agitation in Alzheimer’s may arise from the same impingement by unmediated painful sensory overload as the deterioration in cognitive abilities removes alot of the mediating filtering functionality. Even further afield, I often think of the hallucinogenic experience, much as Aldous Huxley did, as one in which the decks are cleared of much or all of the artifices mediating between the mind and raw experience. The difference is that the hallucinogen-user has more-or-less intact cognitive machinery to process the experience and make sense of it, for better or worse. The breakdown in the cognitive machinery for making sense of various aspects of experience of course also plays a pivotal role in the mental illnesses I treat and study, particularly my fascination with schizophrenia.)

In any case, my approach to soothing my daughter was to swaddle her tightly (swaddling is a time-honored technique in diverse cultures which probably arose and persists because it works!), put her in a sling and go for long strolling walks. I imagined this was a simulacrum of the swaying, warm secure dark and swaddled prenatal environment.

Now comes pediatrician Harvey Karp creating a sensation with a five-step method he claims will calm babies — colicky or otherwise — in minutes. He says he is mobilizing a baby’s innate self-soothing instincts. The method is attracting testimonials from any number of parents who swear by it as well as from pediatric professionals, and it makes sense to me, perhaps because it is flatteringly congruent with what I figured out with my own daughter, although going further.

“For the first two weeks of life, Dr. Karp said, newborns sleep and eat. Then, over the next 10 weeks or so, they enter a state of quiet alertness. Their brains increase in size by 20 percent as circuits mature and make functional connections.

The infant’s job is to cry when it needs help, stop crying, stay awake and stay asleep, Dr. Karp said. Infants must learn to turn their attention on, so as to watch and learn, and turn their attention off, to recover and sleep.

Eighty percent of babies have no problem doing this, he said. They cry for a reason and then calm down.

But a subset of infants cannot stop crying. They cannot gather themselves. For them, the three months after birth is a tremendous challenge.”

Dr Karp’s solution is essentially a way of operationalizing the back-to-the-womb concept. He says the conditions in the womb essentially put the fetus into a calm trancelike state. But, interestingly, he challenges the notion that the womb is a quiet dark place and says that understimulation is distressing as well. According to Karp, in addition to being a place where the infant is packed tightly (thus swaddling), the experience of the womb is jigly and noisy, with the whooshing sound of blood flowing through the placenta right by the infants’ ears, ‘louder than a vacuum cleaner’. Thus, soothing the colicky child involves a swaddled, head-down posture, lots of jiggling, the caregiver making shooshing sounds right in the infant’s ear, and ‘nonnutritive sucking’, e.g. on a finger.

Probably not a bad program for those of us of any age who still suffer from the pain of being…