One thing that I have enjoyed from time to time is a series of YouTube videos called "Everything wrong with..." Here is an example of someone slickly dismantling the 1999 version of the film "The Mummy" which gives you an idea of how this works. Egyoptologists will particularly enjoy this.
There are many things in paediatrics which lend themselves to a similar style of critique, none perhaps more than colic. Infantile colic is diagnosed in countless numbers of babies every day. Advice is given and treatments sometimes prescribed. All of it is nonsense from start to finish, so here is my "Everything wrong with Infantile Colic."
1 - Colic is not a diagnosis
The commonly touted diagnostic criteria for colic is, "Infantile colic is a benign process in which an infant has paroxysms of inconsolable crying for more than three hours per day, more than three days per week, for longer than three weeks" (1)
What you have there is a definition of a lot of crying. The implication that this excessive crying equals a diagnosis is utterly ridiculous. Babies cry for all sorts of reasons. Also, why is this particular pattern (3x3x3) of any significance compared to any other pattern? What if the baby is crying for 2 hrs and 45 mins, 7 days per week for 2 weeks and 5 days? Shall we tell the parent to come back in two days time and suggest that the child steps up to the plate because they're just not bringing their A-game?
If this was any other measurable value, we would be plotting it on a centile chart and monitoring the trend. There is a reason that we don't have centile charts for the normal amount of crying in babies, and if you don't know what is normal, how can you define what is abnormal?
In any case, this is simply an impractical definition. How much a child is crying and how much it seems like they are crying (to the parent) are likely to be two very different things. Why have such a precise definition when the information given will be subjective? I'm not suggesting that we do try to get precise figures, but maybe there is an app for that.
2 - Colic is not a pathology
Pathology is the study of the cause of disease. Firstly, it is debatable as to whether colic is a disease, mainly because we don't know what it is. Secondly, when we give a label of colic, we are saying that we have excluded pathology. There are plenty of reasons why a baby might be crying excessively and these need to be considered.
Gastro-oesophageal reflux disease
Non-IgE allergy (usually CMPA)
Urinary tract infection
Non-accidental injury
Meningitis
Osteomyelitis
Hair tourniquet
Injury (accidental and non-accidental)
Many possibilities have been suggested as causes for infantile colic. No specific cause has been found that would explain why some otherwise healthy babies seem to cry excessively in the first few weeks of life. What that leaves us with is supposition. It is often said that the crying is due to the sensations that a baby is experiencing in their abdomen. Perhaps they are getting used to normal peristalsis of the bowel (which does not occur in utero). Nobody knows.
3 - Colic is not treatable
As mentioned before, there have been several propositions made as to the pathology of colic. None have been substantiated but that doesn't stop the door from having been opened to treatments being offered. "It might be low-grade lactose intolerance..." - thus one of the popular colic treatments having lactase as the active ingredient. "It might be bowel gas causing discomfort..." - thus another containing dimethicone. I have no problems with a process of hypothesis and experimentation. This is how we get evidence for effective treatments. What is then needed is good evidence that a treatment that might (in theory) work, is genuinely effective. In my opinion, there is no good evidence that any effective treatments available for infantile colic. Of all the patient groups where we should avoid the use of ineffective medication, surely this is top of the "don't do it" list?
Bear in mind that to prove efficacy in a condition such as colic, the method would have to be a large double blinded randomised controlled trial. If not, the effect of the natural resolution of symptoms would make any treatment appear to be effective. For example, if we suggested that the family plant some potatoes and that this will treat the colic, by the time the potatoes are ready to harvest, the condition will have resolved. How impressed will they be? D'ya know something? I think I might write a book and create a web page about that. There's money to be made here.
While offering a treatment might seem both benign and helpful, I feel that it is neither of these things. Previous treatments for colic have been withdrawn from use due to cardiac side effects. A drug might be used for many years before the harmful effects are known. Pessimistic possibilities aside, my main issue with any ineffective treatment is that it can make things harder for the parents. When given a treatment (or suggested remedy), there is an expectation of symptom resolution which simply does not materialise. This is psychologically quite hard for a parent who is likely to feel quite desperate.
Instead, I prefer to be honest and tell the parents the truth.
The last point in that list is most important. Having a baby that cries a lot has a huge effect on parents and can potentially be a factor in parental mental health problems. Also, the frustrations caused by a baby that cries and cries have been implicated in safeguarding cases. While we can't take away the exhaustion or the stress, we do have the ability to absolve the parents of the feeling that they must always stop their baby from crying. I tell parents that if the baby has been cleaned, clothed, fed and loved, then there are times when it is necessary to walk away and leave the child to cry. If possible, family support should be made use of. Well meaning relatives need to understand that colic is harmless to babies in the long term, but harmful to parents in the short term.
Edward Snelson
Potato therapist
@sailordoctor
Disclaimer - Potato therapy requires years of training. Do not attempt to practice potato therapy without the appropriate qualifications.
