Tag Archives: colic

New Era of Minimal Treatment (Pedcast)

Topic Introduction

The other day I was thinking about how recommended therapies, also known as the “standard of care”, have changed during my pediatric career for routine illness. It struck me that we have entered an era of minimalism with regards to treatment. It seems to me that medicine has aged into middle age, no longer eager to “treat” every condition with a therapy, assuming that medical science was smarter than mother nature. I think that concept is passe. No, we have entered an era where interventionism is out and natural healing is in. Hence the rise of integrated medicine, homeopathic medicines, nutritional and aroma therapies.  Let me give you a few examples of how previously recommended treatments have changed during my pediatric career and I think you will see what I am talking about. Let’s start with a short list of health problems pediatricians are frequently consulted about and I think you will see what I am talking about.

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Are Infant Colic and Migraine Related? (Article)

It must be a lot of fun to be a scientist and study things that are not understood, to try and make sense of them. This is what I was thinking when I read a recent report linking infant colic with mothers who suffer from migraine.  How in the world could these things be related? Colic is defined as attacks of excessive spells of crying and distress in early infancy for no apparent reason.  Similarly, migraine are attacks of severe debilitating head pain associated with fatigue, noise and light sensitivity, and incapacitation that occur for no apparent reason. I am imagining that the designers of the migraine/colic study saw some common features of colic and migraine and wondered,”Could it be that they relate?” Statistics say they are.

 

 

The authors of this interesting study did a retrospective statistical analysis where they looked for an association between mothers having documented migraine and having an infant who met the definition of colic.  Indeed, they did find that if a mother had a diagnosis of migraine, her infant was 2.6 times more likely to have the behavior that meets the criteria for colic.

 

Even though the authors found the statistical association between these two episodic distressful symptoms, they really didn’t explain why this would be.  I have my own Doc Smo theory, however. I believe that the common feature that tiny babies share with adult women who have migraine is a predisposing, genetic reactive temperament.  Yes, most psychologists agree that humans have a temperament just like animals.  Listen to the description of the temperament that researchers find in a child with migraine; “Children with migraine seem to be more anxious, sensitive, deliberate, cautious, fearful, vulnerable to frustration, tidy, and less physically enduring than comparisons.” (1)(2)  Doesn’t it make sense if you were an infant with an anxious, sensitive temperament that you might be overwhelmed easily by the intense physical stimuli of life outside the womb, especially in the first few months of life.  These babies mothers, with the same genetic temperament as their babies, may shut down periodically with a migraine when life is very stressful in order to protect their sanity. Screaming may be an infant’s way of blocking out external stimuli they find noxious just as a severe headache my protect an adult’s brain from stimuli it finds irritating.  It is my belief that the temperament we are born with is partly genetic and explains a lot of how we react to the world.  I believe this colic study confirms my suspicions.

 

I would love to hear your comments and thoughts at my blog, www.docsmo.com. Until next time.

 

Written by Paul Smolen M.D.

 

Smo notes:

1. http://europepmc.org/articles/PMC37480552.http://www.neurology.org/content/79/13/e112.full.pdf

2.http://www.neurology.org/content/79/13/e112.full.pdf

Happiest Baby on the Block (Book Review Pedcast)

 Help support DocSmo.com by buying this reviewed book using this affiliate link. You get Amazon’s best price and DocSmo.com earns a small affiliate marketing fee.  Thank you.


 

The Happiest Baby on the Block

by Dr. Harvey Karp

Bantam Books

June 2003

 

Welcome to another edition of DocSmo.com.  I am your host, Dr. Paul Smolen, a general pediatrician with now 31 years of practicing experience to share with you.  A few months ago I started reading and writing reviews of some of the interesting parenting books available to parents.  My hope is that I will learn a lot and I can share some of these insights with my listeners.  I might also inspire you to read and discuss books related to children.  I am excited to bring you a great book today by Dr. Harvey Karp called:  The Happiest Baby on the block.  I think you need to put this one on your must read list if you have very little babies around your house or contemplate new arrivals in the future. So lets get right into it, shall we?

Anyone who has experienced a colicky baby knows how difficult and frustrating it can be to try and console a very fretful infant less than 3 months of age. What is going on with these babies?  Why do they cry so much? You are doing everything possible and still they often cry inconsolably:  why?  Dr. Karp attempts, and to a large degree, succeeds in answering that question in his book, “The Happiest Baby on the Block”.   In a nutshell, here is what he believes is going on:  Dr. Karp believes that many human infants are born, unable to cope with the barrage of stimuli presented to them. Traditionally, we call these babies “colicy”.  He contends that human babies are born about three months before they have the coping skills they will need.  He speculates that if birth was delayed 3 more months, their brains would become so large that they would not be able to get through the birth canal.  Birth just has to happen because waiting is just not possible. He also contends that a colicy immature babies crying is their response to any irritation, both external and internal.  “Easy” babies have graded crying in proportion to what is bothering them, but “colicy” babies have a  “one size fits all cry”.  For them it’s all or none.

Dr. Karp takes all this information one step further. He believes that even the fussiest baby can be consoled and made content by simulating the conditions in the womb.  He thinks these really fussy babies are the ones that are really homesick for the womb, and that simulating conditions there is the ticket to baby happiness.  Things were pretty good in the womb:  warm, weightless, gentle motion, constant food with background music of the placenta.  Never hungry, never thirsty with no responsibilities.  Sounds pretty good.

Most of the book is spent with describing Dr. Karp’s method for simulating womb conditions, which he contends, will make even the fussy babies change into the “Happiest Babies on the Block.”  In a detailed way, he describes what he calls the 5 S’s of soothing a baby: 1. Swaddling, 2. Side position, 3. Swishy noise (loud), 4. Swinging, and finally 5. Sucking.  He calls the combination of these 5S’s the “Cuddle Cure” for infant crying.

So now for my take on this book.  I can’t hide my enthusiasm… Dr. Karp has written a classic.  This is a great book, which changes the way we look at very small infants. I think this book will be a must read for parents for decades. Dr. Karp has managed to take what is known about infant behavior and bring it to life for parents.  The book is easy to read and understand, extremely informative, and even funny.  You can tell that Dr. Karp is a practicing pediatrician because his advice is practical, practical, practical.    He understands what parents confront with a colicy baby; he sympathizes, and helps parents take charge.  He takes a look at infant crying from a cross cultural and biological viewpoints.  Amazing.

In the edition that I read, some of Dr. Karp’s advice is outdated or just wrong.  He advocates a side position for sleeping infants: a clear no from the AAP in today’s standards.   He advocates for co-sleepers, even giving “safe co-sleeper” hints.  The newest safe sleep guidelines specifically exclude co-sleeping.   He also recommends that swaddling be done with the arms inside the wrap, which some experts disagree with.

Mothers for generations have known about swaddling, soothing noise, swinging etc., but Dr. Karp has put these tools together into a “method”.    He should be applauded for his efforts and I think this book is a valuable tool for parents of young infants.  A classic.  A must read.  I give it 5 DocSmo stars on a 1-5 scale:  my highest rating possible.  Congratulations Dr. Karp.  Well done.

I welcome our comments at my website, www.docsmo.com.  If you enjoy thinking and talking about children, DocSmo.com needs to be in your weekly diet.  Most weeks, I add new content twice weekly.

This is Dr. Paul Smolen, Doc Smo, broadcasting from studio 1E in Charlotte, NC, and thanking Dr. Karp for his shedding so much light with his Happy baby insight.

Until next time.