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Increased crying in the first 3
to 5 months of life has been the cause of parental frustration, stress,
and anger for generations. In clinical terms, it is usually referred
to as colic. Practically, it includes all infants brought to clinicians
for concerns about crying, usually in the first 4 months of life.
Based on varying clinical definitions, clinicians then decide whether an
infant has or does not have colic, undertake many (or no) investigations,
and may or may not recommend therapies.
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In the last 30 years, clinical and nonclinical studies, including
both experimental and naturalistic observational ones, have provided
a more complete understanding of the nature and functions of early
crying and its clinical manifestations. This has led to a reconceptualization
of increased excessive crying and colic.1 Current
evidence supports 2 concepts as important to our understanding of
this behavior.
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The first is that early increased crying in the first 4 months
(including most cases of colic) is a manifestation of normal behavioral
development rather than an indication of abnormalities in either
the infant or their caregivers.2 Essential to this
concept is that all infants manifest a similar pattern and similar
forms of distress along a spectrum of quantity
and intensity, from fussiness to inconsolable crying, or colic. Those
infants at the higher end of the spectrum are more likely to present
due to a clinical concern.2,3 Since virtually any
illness will increase crying, a small number of infants (probably
less than 5%) that present with crying complaints are also
found to have abnormal cries and/or pathogenetic processes
associated with this crying.3-5 However, these
abnormalities are superimposed on a normal developmental increase
in crying common to all infants. The vast majority (over 95%)
of infants with increased crying and colic are healthy infants with
normal behavioral development.
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The second concept is that, developmentally, there are 3 primary
age-related patterns of early increased crying (see Figure
83-1). The typical and most well-known pattern includes an
increase in overall distress (fussiness, crying, and inconsolable
crying together) that begins at about 2 weeks of age, peaks sometime
in the second month, and then decreases by 3 to 5 months to lower
and more stable levels. This pattern is typical of all normal infants,
and the amounts vary widely among infants.2,6,7 However,
in those in whom some defined threshold is exceeded (often called
the Wessel criteria; crying for >3 hours per day, for >3 days per week,
for >3 weeks2,8), this is most often referred to
as typical colic. In the second pattern, crying increases into the
second month but continues after 4 months at previously high levels, usually
accompanied by loss of positive caregiver-infant interactions and
continuing distress for both (see dotted line [B] in Fig. 83-1B). This pattern may occur in about
3% of infants.9,10 It has been referred ...