Just as infants vary in their ability to communicate through crying, parents also vary in how they interpret the crying and in the parental behaviour they exhibit.11 All infants cry but inconsolable crying can be extremely stressful and disruptive125 to everyday life and parents search for help.12 Not only the amount of infant crying, but also to what extent the mothers perceive the cries as being cries of pain are decisive factors for whether or not they seek help.23
Wade et al126 found that mothers tried various activities to stop or diminish their infant’s irritability and searched desperately and creatively for effective activities to pacify the child. Coping mechanisms could be aimed towards the infant or towards themselves. Mothers tried to establish why the child was crying and tried to comfort it by feeding, changing nappies, rocking, singing and walking the child outdoors. If the interventions did not help, the mother acted by, for instance, putting on headphones, turning on the radio or walking out of the room and going out to have a cigarette.126 Mothers and fathers of colicky infants react cognitively by searching for tips in books or on the Internet and by seeking social support.3, 5, 126 If a mother does not have enough social support from family and friends, support can be non-traditional such as from a sponsor at Alcoholics Anonymous, a neighbour or a church member.126
Influence on parents and family dynamics
Having an infant with colic certainly causes a variety of parental feelings and emotions, with anger, guilt, self doubt, worry, frustration, fear of losing control, hopelessness, fatigue and disappointment being described by mothers of infants with colic.3, 7, 12, 120, 127 The few studies in which fathers were asked found similar experiences.5, 11, 120 Allowing the infant to cry aggravated negative feelings. Parents can react with crying, depression and resentment. This phenomenon has been described as “parental colic”.127
Siblings, other relatives, friends and health staff can also be included in the family system.128 When one person in the system has symptoms, the others will be affected, and the way in which they react will, in turn, affect how the rest of the system
Räihä et al compared the interaction between parents and baby in 32 families who had an infant with colic and 30 control families.4 They found that both parents of colicky infants had less than optimal parent-child interaction; this was most pronounced between the fathers and the infants in the severe colic group. These fathers’ voices were less expressive when they spoke to their infant, they had less visual contact, expressed fewer positive feelings towards the baby and were less responsive and sensitive in reading the infant´s cues. The colicky infants were less competent in communication with their mothers. In addition, interaction was more often dysfunctional between the parents in this group. Communication between parents was less efficient and less clear and the expression of feelings was more restricted in the colic group.
Self-efficacy refers to parents’ belief in their ability to effectively manage the varied tasks and situations of parenthood.129 When attempts to soothe an infant are met with failure, feelings of incompetence are likely to develop. Mothers of infants with colic rated themselves as significantly less competent as mothers than other mothers did.7,90 Parents described a delay in the development of “good” feelings for the baby, and were concerned about their lack of joy in the situation. It was difficult for them to establish contact with the crying infant, and some felt rejected by the infant120 or that they had perceived a loss of the baby.7 Stifter and Bono90 state that infants with colic are no more likely to develop insecure attachments, but if the mother’s self-efficacy is low, attachment may be affected. Yet the majority of the colicky infants developed secure attachments.90
Colic can result in tense relations and affect nearly every aspect of family life.64,120 It is considered to cause a crisis3 involving chaos and disruption in the families’ lives12 for its duration. Colic may affect mothers and families even after the colic has been resolved. Some studies show long-term problems with parental interaction in families with an infant that cries excessively. Four and six months after delivery, mothers of colicky infants scored significantly higher on a parental stress index and felt they received no positive feed-back from interaction with their infants, compared to mothers of non-colicky infants.130 Another prospective study found no residual effects on maternal distress once the colic had resolved.2 In a study elucidating fathers experiences the themes describe how fathers experienced colic as a feeling of first falling into a crying abyss, then hitting the bottom and weaving strands together in order to make a rope from the support they could find and finally, climbing out of the abyss together as a family.5 In this study the fathers experienced that their relationship with their partner became deeper and better as they saw each others’ handling of the colicky situation.
Maternal perception of temperament showed colicky infants being rated as intense, negatively reactive, and difficult to manage later in infancy and childhood, suggesting that colicky infants may continue to cause stress in the relationship well after the colic has ended.131 In families with an infant with severe colic, family problems persisted one year later,132 but had been normalised after three133 and four years respectively.31 When the children were three years old families who had had colicky infants still had
more distress compared to families who had had infants without colic.134 In this study, including 1200 families, the parents who had had infants with colic were less satisfied with the arrangements of daily family responsibilities and with the amount of leisure time and shared activities. There was no difference in the frequency of divorces between the groups but the children who had had colic three years earlier had significantly fewer younger siblings.
Increased risk of child abuse
In periods of heightened tension, colic can result in a fear of losing control and of non-accidentally injuring the infant.12, 120 Persistent crying is a major challenge that places caregivers, especially those with limited resources and support systems, at risk with regard to child abuse and neglect.126 Children who cry a lot are more likely to be exposed to child abuse and physical violence.8, 10 There is a correlation between infants being admitted to hospital for Shaken Baby Syndrom (SBS) and the crying curve, although a time lag exists.21 In one investigation 26 children under the age of one were identified with SBS in Estonia during a period of seven years.10 Prior to admission to the hospital with SBS or death, parents to 23 of the 26 children had contacted their doctor because of excessive crying.
Prognosis
Infantile colic often starts during the first three weeks of life. The prognosis is good.
Most infants with colic have recovered spontaneously by 3–4 months of age.23 However, a prospective study with 547 dyads found 35 infants (24%) with colic when the infants were six weeks old. At three months 18 infants who had had colic when they were six weeks old (14% of the infants who had had colic at 6 weeks) still fulfilled the colic criteria while 86% had remitted. Yet another 17 infants who did not have colic when they were six weeks old fulfilled the colic criteria at three months, indicating two types of colic: “persistent” and “latent”.2
Some differences have been found in follow-up studies that compare infants with and without colic. Kalliomäki et al found that fussing and colic-type crying preceded atopic disease in 116 high risk infants.135 Likewise Savino et al found an association between infantile colic and allergic disorders (allergic rhinitis, conjunctivitis, asthmatic bronchitis, pollenosis, atopic eczema and food allergy) in a study with 96 children at 10 years of age78 while Rautava et al found no difference in verified or suspected allergies or in special diets when comparing three year old children who had or had not had colic when they were infants.134 One prospective study that followed children from infancy up to 11 years of age found no association between infantile colic and asthma, atopy or allergic rhinitis and no differences in children’s weight and height at 11 years of age.77
years old78 as compared to control groups, and were also less likely to enjoy meals and to enjoy eating. They also refused certain foods more often.31 Children who had colic as infants had more frequently sleeping problems when they were three,134 four31 and ten years old.78 Children who had had colic as infants were in five follow-up studies 31, 78, 134, 136-137 perceived by their mothers to be more emotional and to have temper tantrums more often. This phenomenon was not found in two other studies.131, 138 One metaanalysis found an association between infant regulatory problems like excessive crying and later behavioural problems like attention-deficit/hyperactivity disorder (ADHD) problems in 1935 children, particularly in multi-problem families.139