Which description would the nurse provide the parent of an infant who is experiencing colic

In 1997, Philip Zeskind, a developmental psychologist at the Carolinas Medical Center, in Charlotte, North Carolina, and Ronald Barr, then a professor of pediatrics at Montreal Children’s Hospital and McGill University, studied the cries of seventy-six infants, including thirty-eight who had been referred to physicians for extreme fussiness or colic. They found that, after feeding, the colicky infants produced cries that were higher in pitch than the other infants’—at their loudest, the cries attained frequencies of more than twenty-one hundred hertz, nearly twenty-five per cent greater than the frequency of the non-colicky babies’ cries. In an article published in the journal Child Development, Zeskind and Barr wrote that their findings “contribute to the increasing body of evidence that complaints about excessive infant crying cannot be accounted for simply on the basis of reporting bias in overly concerned or emotionally labile parents.”

But parents may take small comfort from this study, which, like most others involving colic, doesn’t hold out the promise of a cure—or even of a potential therapy. For decades, pediatricians have assured parents that they should regard colic as little more than a passing nuisance, and, in the absence of clinical data, medical opinion on how to manage afflicted infants has tended instead to reflect general beliefs about what constitutes good parenting. Benjamin Spock, in the first edition of “The Common Sense Book of Baby and Child Care,” published in 1946, encouraged parents of colicky babies to hold and cuddle them: “Should you pick a baby up, or rock him gently, or carry him around while he has the colic? Even if it makes him stop crying, will it spoil him? We aren’t as scared, nowadays, of the danger of spoiling a baby as we used to be. . . . If a baby is screaming with colic or irritability, and picking him up or rocking him seems to help him, then do it by all means.” Spock’s manual, which sold seven hundred and fifty thousand copies the first year, was intended as a corrective to an earlier regime of expert advice that emphasized parental discipline and detachment. (One popular early-twentieth-century handbook asserted that crying—for between fifteen and thirty minutes a day—was “necessary for health. It is the baby’s exercise.” Another declared, “Mothers just don’t know, when they kiss their children and pick them up and rock them, caress them and jiggle them upon their knee, that they are slowly building up a human being totally unable to cope with the world it must later live in.”) As Ann Hulbert writes in “Raising America: Experts, Parents, and a Century of Advice About Children” (2003), trends in child-rearing advice have typically oscillated between “hard” and “soft” approaches, between calls for “parent-directed discipline” and calls for “child-focused bonding.”

At the moment, Americans are in a bonding phase, having discarded the hard style of Richard Ferber, whose name—to his chagrin—became synonymous in the late eighties with the idea that babies should learn to fall asleep by “crying it out,” for the softer styles of Harvey Karp, who, in his best-selling book and DVD, “The Happiest Baby on the Block,” describes a five-step technique involving swaddling, swinging, and shushing to stop babies’ tears; and of William Sears, the founder of “attachment parenting,” which stresses the importance of near-continuous physical contact between parents and infants. “Pick up your baby when he cries,” Sears and his wife, Martha, a nurse, urge in “The Baby Book” (1992), which claims to be inspired in part by the habits of mothers in the developing world who “wear their babies in slinglike carriers as part of their native dress.” The Searses write, “Imagine how you would feel if you were completely uncoordinated—unable to do anything for yourself—and your cries for help went unheeded. A baby whose cries are not answered does not become a ‘good’ baby (though he may become quiet); he does become a discouraged baby. He learns the one thing you don’t want him to: that he can’t communicate or trust his needs will be met.” In a chapter called “Parenting the Fussy or Colicky Baby,” the authors advise parents to perform various maneuvers with their infants, including “the colic dance,” “the colic curl,” and “the ‘I Love U’ touch.”

There is little evidence that physical maneuvers can soothe a colicky infant, and such advice may simply make exhausted parents who fail to follow it feel worse. “There were times when I felt myself very slow to go to the twins because I knew that it wouldn’t make a difference,” Amanda Chase told me. “But I still felt incredibly guilty. What kind of mother lets her child scream in pain? Were my babies going to have attachment issues?” At the colic clinic at the Brown Center for the Study of Children at Risk, Barry Lester, a professor of psychiatry and pediatrics at the Warren Alpert Medical School, at Brown University, treats mothers and fathers as well as infants. Lester, who is sixty years old and the director of the center, regards colic as a behavioral disorder that afflicts the entire family. “In the past, people mostly thought about colic as a physical or medical problem,” he says. “At the center, we look at how colic is affecting not just the baby but the parent-infant relationship. The crying will stop, but the relationship risks becoming disordered, and this can have a lasting effect on the child.”

Last December, I met Lester at his office in the clinic, which occupies a floor of a former foundry in a working-class neighborhood of Providence. “By the time they show up here, parents have tried every conceivable formula and every conceivable gadget—all the junk that’s out there that doesn’t work,” he told me. On a wall in front of his desk there was a long shelf filled with potions and devices that have been marketed as remedies for colic, including a bottle of British gripe water, CD recordings of a mother’s heartbeat, a machine that mimics the sound of wind rushing past a moving car, and one that, when attached to the underside of a baby’s crib, causes the mattress to vibrate. Lester also has a collection of slings, hot-water bottles, and heating pads intended for treating colicky infants, and an electronic device, apparently popular in Europe, called Why Cry, which “interprets” a baby’s cries. The machine, which is the size and shape of a P.D.A., records and analyzes the infant’s sounds, displaying its conclusions on a small screen: one of five facial expressions, accompanied by the word “hungry,” “bored,” “sleepy,” “stressed,” or “discomfort.” “This can cost more than a hundred dollars,” Lester told me. “And it is ridiculous.”

As a graduate student in the early nineteen-seventies, Lester spent two years in Guatemala studying infant malnutrition, the subject of his dissertation. One day, in a small village, he was startled by the sound of an infant crying frantically. This was unusual, he said, because “there is this nonverbal mother-baby communication in these societies. The baby rarely builds up to a cry, because the mother physically senses the baby’s needs.” A few days later, in another village, he heard the sound again. “Everyone in the village would stop what they were doing to see what was wrong,” Lester said. He wondered whether the infants, some of whom were malnourished, had suffered neurological damage. He recorded the cries on a tape cassette, and compared them with recordings of cries of well-nourished babies from the same area. He discovered that the malnourished babies’ cries had acoustic properties that were associated with neurological problems, and when he returned to the United States he decided to investigate whether particular infant cries could be associated with particular illnesses.

In the nineteen-eighties, Lester began a study at Brown of more than two hundred premature and full-term babies, analyzing their crying patterns and developmental problems. Some of the babies had colic, according to Wessel’s criteria, and the parents asked Lester for help. Researchers generally do not treat patients they are studying, but the families were desperate, and eventually Lester, with financial support from Women and Infants’ Hospital of Rhode Island, established the center at Brown, where he sees about seventy-five colicky infants and their parents each year. “Here is something that has no known cause and no known treatment,” he told me. “What could be more frustrating? For years and years, the mantra from doctors has been ‘Bite the bullet.’ The fact is, this message to mothers is devastating. The most common thing our patients say is, ‘I must be doing something wrong.’ It triggers a whole cycle: the mother feels inadequate and unable to parent effectively. And when these mothers get angry at their baby, they feel guiltier: ‘How can I get angry at my baby?’ The problem spirals out of control.” Lester tells parents that, instead of going to their babies every time they cry, they need to teach the babies to soothe themselves. As he puts it, the infants must learn to “self-regulate.” Lester’s approach is practical rather than medical; he doesn’t claim to be able to cure colic. But, by giving parents permission to put their babies down, he is treating the family members who may be suffering most.

One morning at the colic clinic, I met Juliana, a thirty-year-old woman from Guatemala, who was carrying her eight-week-old daughter, Maria, in a car seat. (The family’s names have been changed.) Juliana, a tall woman with shoulder-length black hair, was pale and had dark circles under her eyes. She and her daughter were shown into an examination room, where Juliana spent nearly an hour speaking, through a translator, with Pamela High, a professor of pediatrics at Brown and the medical director of the clinic, and Jean Twomey, a psychiatric social worker. Lester, who had introduced himself to Juliana, observed the encounter through a one-way window in an adjoining room. (He limits the number of adults in the examination room, so as not to overwhelm the babies and their parents.) In a telephone conversation with Twomey the previous week, Juliana had said that she worked as a day-care provider in her home, in Providence, and that in addition to Maria and a seven-year-old daughter she cared for three toddlers. The baby’s father worked in western Massachusetts and was rarely home. At the clinic, Juliana told High and Twomey that she found caring for Maria overwhelming. “She cries and fusses fifteen hours a day,” Juliana said. The baby also had trouble nursing; she would open her mouth and latch on to a nipple, but as she began to suck she seemed to choke. The baby cried most during the evening and the early hours of the morning, and Juliana typically slept for only an hour and a half each night, from about two-thirty to four*.* When Maria was four weeks old, Juliana’s pediatrician told her that the baby had reflux and prescribed Zantac, which Juliana gave her twice a day, though it seemed to have little effect.

High took notes as Juliana described Maria’s behavior. After a few minutes, the baby began to fuss. Juliana picked her up and offered her a bottle of formula, but Maria took only a few sips. Her cries grew louder and more insistent, and she began waving her arms and jerking her legs toward her belly. Over the next hour and a half, Juliana repeatedly picked up Maria in a futile effort to soothe her. At one point, she handed the baby to High, who was also unable to calm her. “She does have colic,” the pediatrician said. “But that diagnosis doesn’t help us much.” She told Juliana that when Maria cried she should try to determine whether the baby might be hungry or wet, or want to suck or be cuddled. “When you’ve done all of that, if she is still fussing and crying, it’s O.K. to put her down in a safe place for five to ten minutes so she can learn to calm herself,” High said. Juliana looked skeptical, and High repeated the advice. Finally, Juliana nodded. She said that her mother had recently visited from Guatemala and told her, “You are letting the baby get away with too much. The baby is boss.”

High prescribed a higher dose of Zantac, though she noted that Maria did not spit up much and told Juliana that it was unlikely that reflux alone was causing the colic. (A physical cause for colic can be identified in fewer than ten per cent of cases.) Then Lester entered the room and smiled warmly at Juliana. He told her how much he had enjoyed working in Guatemala. “You are a good mother,” he told her in Spanish, “and you have a beautiful baby, but she can be difficult at times. It’s hard not to blame yourself. But it’s very important to teach her how to calm herself.”

After Juliana left the clinic, High said, “Moms feel they need to do everything in response to a screaming child. One of the key things we teach moms with colicky babies is that this unhealthy symbiosis needs to be broken. The baby must learn self-soothing.” As the mother learns to let the baby cry, Lester said, “the baby will realize ‘Gee, I can do this.’ ”

High and Twomey told me that the physician who referred Juliana to the clinic noted that she was very depressed. Four years ago, High conducted a survey of more than four thousand Rhode Island women, comparing the incidence of maternal depression and inconsolable infant crying. “Depression and colic were strong predictors of one another,” High said. “The problem in the mother and the problem in the child exacerbate each other.” High and Twomey occasionally refer mothers to a mental-health clinic at Women and Infants’ Hospital for psychiatric care.

Lester believes that some infants who suffer from colic are “hypersensitive to normal stimuli”: they perceive and react to changes in their bodies (such as hunger or gas pangs) or in their environment (such as loud noises or the experience of being touched) more acutely than do other babies. In the mid-nineties, he studied forty-five children between the ages of three and eight who had had colic as infants (and had been seen at his clinic). He found that thirty-four of them—about seventy-five per cent—suffered from behavioral problems, including a limited attention span, tantrums, and irritation after being touched or coming in contact with particular fabrics or tags in their clothing. “Some of the kids would get very annoyed and refuse to put on a hat,” he told me. The children apparently objected to the sensation of having fabric on their head.

Lester speculates that many colicky infants are so sensitive to stimuli that physical contact with their parents is unlikely to soothe them, a theory that may be supported by data from societies in which babies are held continuously. Ronald Barr, the co-author of the 1997 study on infant cries, has analyzed data gathered by Harvard researchers between 1969 and 1971, during a study of the !Kung San, a tribe of hunter-gatherers in Botswana who practice a version of attachment parenting. “We found that the !Kung San carry their babies upright, have skin-to-skin contact day and night, breast-feed every 13.69 minutes for the first one to two years of life, and respond within fifteen seconds to any fret or whimper,” Barr, who now teaches at the University of British Columbia, told me. “The duration of the crying is fifty per cent less among the !Kung San compared with Western babies, but the !Kung San still have what we call colic, with episodes of inconsolable crying.”