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FOR IMMEDIATE RELEASE
by Ralph K. Campbell, MD
(OMNS Apr 18 2018) An infant with colic not only is suffering from pain, but is causing great concern in parents attempting to render loving care. We can't ask the infant to rate the pain on a scale from 1 to 10, but we know that only pain could produce such an agonizing cry that borders on screaming. We may infer that it is a bellyache by observing the way the infant's legs are drawn up and the way the pain comes in waves as the crying intensifies.
The crying seems relentless. A procedure that often brings relief from swallowed air due to crying while eating, is to burp the infant by holding it upright and gently patting on the back. However, this provides little relief when colicky pain gets under way. It is terribly frustrating for a parent who is attempting to do everything possible to comfort the little one but with little positive effect.
For frazzled parents, this is particularly exhausting and can even provoke anger: "I feel exhausted, mentally and physically, and I am doing my best to take care of you, but yet you continue to scream. I've had it with you!" The next almost uncontrollable exhibit of anger is to exaggerate the comforting jiggling that is commonly done, probably because we can't think of anything better to do than shaking the infant, serving like a slap in the face to bring around one out of control. Unfortunately, shaking can cause a big problem: what is called the "shaken baby syndrome."
Ending up in court?
An infant's neck muscles are not strong enough to hold the head steady when being shaken. This whiplash-like motion can cause rupture of blood vessels in the brain resulting in cerebral edema. The damage may be detected by examining the eye with an ophthalmoscope that can show swelling around the area where the optic nerve exits the eye. If this is brought to a doctor's attention, or if there are other signs of injury, such as bruises on the extremities or body, the immediate thought is abuse, with the abuser being anyone who attended to the infant. The doctor is directed by law to refer the case to the social service authorities. This can progress to a point where the baby is taken from its parents and put into a child custody program until court proceedings can take place.
In such a proceeding, years ago, expert testimony for the defense from an expert with a background in orthomolecular medicine, pointed out the similarity of this syndrome to scurvy (severe vitamin C deficiency).[1-4] Doctors are familiar with scurvy and its bleeding gums, bruises evident on the body, or elsewhere, following the lightest of trauma; so it made sense that this same capillary fragility would take hold in the brain. Next was the need to look at case histories of the mother's nutrition history during the pregnancy. Surely during the nausea of pregnancy that many prospective mothers suffer, both mother and fetus have nutritional deficiencies. Even the small amount of vitamin C needed to prevent scurvy could be lacking. It becomes a tragic situation for the parents when this diagnosis of scurvy is not accepted. To enhance health, infants can be given buffered vitamin C. Dip your clean finger in water and then in sodium ascorbate powder, then feed your finger to the infant. Give this dose several times daily for best health. However, adequate vitamin C in the diet of the breast-feeding mother may obviate any need to provide supplemental vitamin C for the infant.
There is a vicious cycle with colic. Uncontrolled crying, bordering on screaming, results from the pain of a distended colon which becomes further distended from air swallowed during the frantic crying. Somehow, we must find a way to calm the baby. I started my pediatric career by joining the pediatric practice of John C. Wilcox. Dr. Wilcox was not only a well-qualified pediatrician, but somewhat of a philosopher as well. While the idea that kids just starting school often were too "hyper" and distracted and disruptive to be able to learn, Dr. Wilcox recognized the need for children to develop composure. In 1980, he published a book, "Growing-With-Toward-Into Composure," designed for pediatricians and mothers. He had described a method of swaddling the infant that was published in a pediatric journal, and was later adopted by many newborn nurseries in some of the top hospitals in the country. Here is how it was done: Lay out a light-weight receiving blanket like a baseball field. Fold down the top corner so that when you place the infant in the supine position on the blanket, its head will remain free. With arms at about a 45 degree angle with the body, take an east-west corner and cover an arm with the material lying between the head and further down. Pull the corner over the arm and tuck it in under the other side. Do the same with the other arm, and secure with a large safety pin, the corner to the blanket on the backside. Next, hold the infant with its back to the holder's chest with its legs drawn up. When the infant calms down, it might pass some gas (swallowed air) or burp. Then transfer the infant, in this position, to an infant seat that is set at about a 45 degree angle.
It is hard to believe that the accepted medical treatment for colic, as recently as the '60s, was in the form of paregoric, a tincture of opium. Not until 1970 was a prescription required for paregoric, while prior to that it could be purchased over the counter at a pharmacy. All sorts of exceptions were made because its content of opium was small, as if a little bit won't hurt you. I know of no medicine that really helps. I did find that food allergy, often cow's milk, could get the bowel in an uproar. If that is suspected, then switch to a goat's milk or soybean formula. Within just a couple of days, things would calm down if we were on the right trail. If so, continue; if not, look for another allergen. Wheat sensitivity would be next in line. Milk altered by good bacteria, such as yogurt or buttermilk, is often well tolerated by milk allergic individuals. And, since food allergies are often outgrown, one can cautiously re-introduce cow's milk periodically. I even had a case of a conscientious nursing mother who herself had developed milk allergy that was creating colic in her infant.
When I think of the effectiveness of keeping calm and composed, I see the importance of this in the "irritable bowel syndrome." The adult gut activity is greatly influenced by stress, and medical treatment attempts to reduce the activity of the bowel. Any drug used to calm the mind is fraught with side-effects. Swaddling an adult as we might an infant with a blanket, would not help, leaving us with few choices other than either avoiding stressful situations or learning how to deal with them. We might not be able to help ourselves, but I am certain we may help the colicky infant. Make sure the mother and infant are both getting adequate vitamin C.
1. Fung EL, Nelson EA. Could Vitamin C deficiency have a role in shaken baby syndrome? Pediatr Int. 2004 Dec;46(6):753-5. https://www.ncbi.nlm.nih.gov/pubmed/15660885 . https://listserv.brown.edu/archives/cgi-bin/wa?A3=ind1004&L=PED-EM-L&E=base64&P=125225&B=--%3D_mixed+007A1DB3852576FB_%3D&T=application%2Fpdf
2. Innis MD. Tissue Scurvy Misdiagnosed as Shaken Baby Syndrome Homicide Clin Med Res, Jan 2014, 3:6-8. http://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20140301.12.pdf
3. Kalokerinos A. Shaken Babies. http://www.whale.to/a/kalokerinos_sbs.html
4. Kalokerinos A. Shaken Baby Syndrome: An Abusive Diagnosis. 2008. https://pdfs.semanticscholar.org/bb7e/8347403638ac98691c58f32f40ea3f4ba678.pdf
5. Wilcox JC. Growing With-Toward-Into Composure. Dorrance & Co (1980). ISBN-13: 978-0805927177.
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