If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. This is a reference book. Read only the topic of interest to you.
When children are not sleeping well, the cause might be the father, the mother, the baby or any combination. Even if the root cause or trigger might occur within the father, or the mother, or the baby, as time passes, interactive effects develop between all three. In order to help solve sleep problems, without judgement, it is important to consider all possible causes (Blog Posts 17 and 18).
Parents may have symptoms of anxiety or depression or habitual thoughts and beliefs that might, or might not, contribute to or cause sleep difficulties in their child. This topic is confusing because some studies look only at the father’s role and others look only at the mother’s role. Some research suggests that a colicky (Blog Post 20) baby might trigger these symptoms in the parents. Interactions between each parent and the baby are important. Therefore, it is difficult to make firm conclusions about the direction of effect. Blog Posts 39–42 describe studies regarding how parent’s issues might contribute to or cause sleep difficulties in their child.
In 1954, Drs. Morris Wessel and R. S. Illingworth published the first modern studies trying to define colic. Dr. Wessel, in America, defined a colicky infant as “one who is otherwise healthy and well fed, had paroxysms of irritability, fussing or crying lasting for a total of more than three hours a day and occurring on more than three days in any one week [49% of infants] and that the paroxysms continued to recur for more than three weeks [26% of infants].” Dr. Illingworth, in England, defined colic as “violent rhythmical, screaming attacks which did not stop when the infants were picked up, [inconsolability] and for which no cause, such as underfeeding, could be found.”
The age of onset of these behaviors is characteristic. Both Dr. Wessel and Dr. Illingworth found that the attacks were absent during the first few days after birth but were present in 80 % of affected infants by 2 weeks and in about 100 % by 4 weeks. Premature babies also start their attacks shortly after the expected due date, independent of their gestational age at birth. The time of day when these behaviors occur is another characteristic. During the first month, crying appears at any time of the day or night, but later it occurs predominantly in the evening hours. In 80 % of infants, the attacks start between 5:00 and 8:00 p.m. and end by midnight. The age of termination of these spells is also characteristic. The attacks disappear by 2 months of age in 50 percent of infants, by 3 months of age in 30 percent, and by 4 months of age in 10 to 20 percent of infants. The infant’s behavioral state is associated with colicky behavior. Among colicky infants, 84 percent have crying spells that begin when they are awake, 8 percent have spells that start when they are asleep, and another 8 percent have spells under either condition. For 83 percent of infants, when the crying spells end, they fall asleep. These universal features suggest that there is a biologic component to colic.
Supporting the notion that colic is a within-the-child feature are the observations that:
A 2019 brain imaging study during the first 3 days of life examined responses to different olfactory stimuli using the odors of rotten cabbage, banana, and eucalyptus. Infants who showed a strong reaction to the cabbage odor were much more likely to develop colic at 5-6 weeks of age. They concluded. “Shortly after birth, the central nervous system of babies developing infant colic has already greater reactivity to sensory stimuli than that of their noncolicky peers.”
It is now known that persistent low-intensity fussing, rather than intense crying, characterizes infants diagnosed as having colic. In fact, to emphasize fussiness instead of crying, the title of the paper by Dr. Wessel was “Paroxysmal Fussing in Infants, Sometimes Called ‘Colic.’” Fussing is not a well-defined behavior, and although not defined in Dr. Wessel’s paper, it is usually described as an unsettled, agitated, wakeful state that would lead to crying if ignored by parents. Over a thirty-four-month period, at newborn visits in my office, I routinely asked every new parent who joined my general pediatric practice whether their child fulfilled Dr. Wessel’s exact diagnostic criteria for colic. All families had been followed by me since the child’s birth and received counseling regarding the normal development of crying or fussing. There were 118 colicky infants out of 747 (16 percent). However, the vast majority of infants had little or no crying. Instead, they fulfilled Dr. Wessel’s criteria for colic because they had long and frequent bouts of fussing, which did not lead to crying because of intensive parental intervention.
An alternative explanation, by Dr. Johanna Petzoldt, is that “infants of mothers with anxiety disorders prior to pregnancy were at higher risk for excessive crying [colic] than infants of mothers without any anxiety disorder prior to pregnancy.” Additionally, she speculated that “maternal anxiety might lead to intrusiveness that possibly intensifies infant crying.” Intrusiveness means unnecessary night feedings and attention at night. Fathers were not included in her study. My research shows that older fathers are less involved in helping children sleep well and this was a source of stress for the marriage and for parenting in general before the colic developed and infant colic was more likely among older fathers. Obviously, children’s sleep issues reflect not only the mother’s care for the baby but also the father’s care and how well the parents cooperate or agree on parenting [Blog Posts 17, 18, 39–42].
In short, colicky behavior (fussing, crying, sleep issues) might reflect features within the baby, the mother, the father, or any combination. Persistence of sleep issues within the child and/or persistence of features within the mother or father may cause sleep issues in the baby after the fussiness and crying ends at 2-4 months.
Based on parent diaries at 4.5 and 6 weeks of age and objective studies at 7 and 13 weeks of age, colicky infants had shorter durations of sleep, more difficulty falling asleep, and less deep or quiet sleep than infants without colic.
(To be continued.)