Fortunately, most colicky babies aren’t physically sick. Rather, they’re sort of “homesick”—struggling to cope with life outside Mama’s womb. But how can you know when your infant’s cries are a sign of sickness?
Here’s a primer of the ten red flags that doctors look for to decide when a baby’s cry signals illness, plus a review of the ten red-alert medical conditions that these red flags may indicate.
Whenever you’re worried about your baby, you should, of course, contact your doctor for guidance. When you do, he’ll likely ask you these two questions to help him decide if your baby has colic or something more serious:
1. Is your baby growing well and acting normal in all other ways?
2. Is your baby calm for long periods of the day?
If you answer no to either question, then your doctor will ask you how your baby acts when she isn’t crying. He is looking for these ten red flags:
1. Persistent moaning (groans and weak cries that continue for hours)
2. Supershrill cry (unlike any cry your baby has made before)
3. Vomiting (any green or yellow vomit or vomiting more than one ounce per episode and more than five episodes a day)
4. Change in stool (constipation or diarrhea, especially with blood)
5. Fussing during eating (twisting, arching, crying that begins during or shortly after a feed)
6. Abnormal temperature (a rectal temperature of more than 100.2°F or less than 97.0°F)
7. Irritability (crying all the time with almost no calm periods in between)
8. Lethargy (a baby sleeping twice as long as usual, acting “out of it,” or not sucking well over an eight- to twelve-hour period)
9. Bulging soft spot on the head (even when your baby is sitting up)
10. Poor weight gain (gaining less than a half ounce a day)
Whenever a doctor sees a crying baby who exhibits any red-flag symptoms, she tries to determine whether this indicates one of these ten serious—but treatable—medical conditions. Please remember, most of these conditions are very, very rare. (Excluding babies who cry because of food sensitivity or acid reflux less than one percent of infants with severe, persistent crying are affected by the problems listed below.)
1. Infection: From Ear Infections to Appendicitis
You might think the best way to tell if your baby has an infection is to take her temperature, but many sick newborns don’t get fevers. So even if your crying baby doesn’t have fever, you should consider that her fussiness may be a sign of infection if she acts lethargic or irritable for more than a few hours. Call your doctor immediately. He may check her for:
Ear Infection—These babies may just get fussy and upset; they rarely pull on their ears.
Urine Infection—These babies can have smelly urine, but usually don’t.
Brain Infection (meningitis)—These infants have bulging soft spots, vomiting, lethargy, and irritability that rapidly worsens over just a day or two.
Appendicitis—Extremely rare in infants, it may cause a hard stomach, poor appetite, and constant irritability. Intestinal Infection—A baby with “stomach flu” vomits, has diarrhea, and usually has been in contact with a sick relative.
2. Intestinal Pain: From Intestinal Blockages to Stomach Acid Reflux
Some stomach problems cause pain and may explain crying in ten to fifteen percent of colicky infants (in descending order of seriousness):
Intestinal Blockage—This is an extremely rare medical emergency that may occur right after birth or weeks later. Babies suffer from waves of severe painful spasms plus vomiting and/or the cessation of pooping. With intestinal blockages, the vomit often has a distinct yellow or green tint. (During the first days of life, a breast-fed baby’s vomit may also be yellow, because that is the color of colostrum. However, if your baby has yellow vomit, never assume it’s from your milk. Immediately consult your doctor to make sure it isn’t the sign of a more serious condition.)
Stomach Acid Reflux—This cause of burning pain occurs in approximately one to three percent of fussy babies.
Food Sensitivity—Five to ten percent of fussy babies get better with a change in diet and so presumably have this condition. Besides crying, it may cause vomiting, diarrhea, rash, or mucousy blood in the stools.
(For a complete discussion of reflux and food sensitivities see Chapters 4 and 14.)
A “Pain in the Rear”: Can an Overly Tight Anus Block a Baby’s Intestines?
In 100 A.D. the physician Soranus opined that a tight anus could block a baby’s intestines, leading to spasms. He recommended stretching the anus to relieve a baby’s crying. Over the next two thousand years, medical practitioners followed his advice and routinely stuck fingers up the behinds of crying babies. Today, however, we know this problem is extremely rare and probably never causes colic.
Crying before, during, and after feeding
Immediately before a feeding: hunger, thirst, challenging temperament
During a feeding: the gastro-colic reflex, the milk flow is too slow or too fast, the milk has a strange taste, stomach acid reflux
Immediately after a feeding: continued hunger, the gastro-colic reflex, needing to burp, needing to poop, wanting to suck more, food allergy, stomach acid reflux
3. Breathing Trouble: From Blocked Nostrils to Oversize Tongues
The most common cause of breathing trouble is a condition where a baby’s tiny nostrils are blocked. Babies don’t know how to breathe through their mouths, except when they’re crying. That’s why babies who are born with tight nostrils, or who have noses swollen shut from allergies or colds, get so frantic.
If you want to check for blockage, place the tip of your little finger snugly over one of your baby’s nostrils, closing it off for a few seconds. She should easily be able to breathe through the open nostril. Then repeat this test on the other side.
If your baby can’t breathe or gets agitated when you do this test, call your physician. If it seems the nostril is blocked from mucus, ask the best ways to clear it. And do your best to rid your home of dust, molds, sprays, perfumes, cigarette smoke, and anything else that might make her nose congested.
Very rarely, an infant will have trouble breathing if her tongue is too big for her mouth so it falls back into the throat and chokes her when she lies on her back. This problem is obvious from the moment of birth because her tongue will always stick out of her mouth.
4. Increased Brain Pressure
When pressure builds up inside a baby’s head, it also causes:
If your baby fits the symptoms described above, contact your doctor immediately.
5. Skin Pain: A Thread or Hair Twisted Around a Finger, Toe, or Penis
In years past, the sudden onset of sharp screaming in an otherwise calm baby made parents search for an open safety pin inside the diaper. Today, however, thanks to pin-less diapers, that no longer happens. Now a parent who hears that type of abrupt, shrill cry should look for a fine hair or thread wrapped tightly around their baby’s finger, toe, or penis. This problem requires immediate medical attention. (Doctors often treat this problem by applying a dab of hair-removal cream to dissolve the hair.)
6. Mouth Pain: From Thrush to Teething
Thrush, a yeast infection in the mouth, is easy to recognize because it causes a milky white residue on the lips and inside of the mouth that cannot be wiped away. Thrush may also cause a bumpy red rash in a baby’s diaper area and/or itchy, red nipples in a breast-feeding mom.
Thrush rarely causes fussiness, but on occasion it can cause crying from an irritated mouth. Fortunately it is easy to treat, and recovery is rapid.
Many parents ask if teething causes their baby’s crying. This is extremely unlikely, because teething two-month-olds are as rare as hen’s teeth. However, if you think your baby is having teething pain, give her some acetaminophen drops and see if it gives any relief (ask your doctor for the correct dosage). This medicine won’t help colic, but it may reduce mild teething pain.
7. Kidney Pain: Blockage of the Urinary System
A blockage of the kidney is a very rare cause of persistent crying that occurs any time, day or night. Unlike classic colic, which begins improving after two months, crying from kidney pain gets worse and worse.
8. Eye Pain: From Glaucoma to a Corneal Abrasion
Eye pain, also very rare, may come from glaucoma (high pressure inside the eyeball), an accidental scratch of the cornea, or even from a tiny, irritating object stuck underneath a baby’s eyelid (such as an eyelash). Your doctor should consider these problems if your crying baby has red, tearful eyes and severe pain that lasts through the day and night.
9. Overdose: From Excessive Sodium to Vitamin A
Persistent, severe crying can result from giving babies excessive amounts of sodium (salt). This may occur when a parent mixes formula with too little water. It has also rarely been described after the first week of life if a breast-feeding woman is making so little milk that her breast milk becomes very salty. These babies are easily diagnosed because they are losing weight, not drinking any other liquids, and are both irritable and lethargic all day long.
Excess Vitamin A is an extremely rare cause of infant crying. It only occurs in babies who are given high doses of supplemental vitamins or fish oil.
10. Others: From Migraines to Heart Failure
Some extraordinarily rare conditions that have been reported as the cause of unstoppable crying in young infants include: a bone fracture, sugar intolerance in babies fed fruit or fruit juice, migraine headache, hyperthyroidism, and heart failure. These babies don’t merely cry for three hours a day—they act poorly all day long.