About one in ten babies cries excessively and violently in the first three months of life. If the infant exhibits a regulation disorder, a great deal of nerve, perseverance and inner calm are required of the parents in any case. An outdated term for this disorder is three-month colic.
What are regulation disorders?
Infants who cry an unusual amount and are difficult to calm are colloquially referred to as “cry babies.” Today’s medical term for the difficult behavior is regulatory disorders. The term three-month colic is considered outdated. Originally, it was assumed that air in the infant’s stomach caused abdominal pain and flatulence, and that excessive crying was an expression of discomfort. However, it is now known that air in the abdomen is a consequence of crying, during which the infant also swallows a lot of air. An infant is considered a cry baby if he or she cries unusually much and apparently without reason for more than three hours on at least three days a week and is difficult to calm down. This condition must last for at least three weeks to be considered a regulatory disorder.
Causes
Excessive crying is a result of delayed behavioral regulation in the infant. Babies must learn to regulate their behavior appropriately in the particular, often interactive, situation, such as feeding, sleeping, seeking attention, or self-soothing. Spelling babies have great difficulty in correctly assessing different situations and reacting appropriately. In many cases, parents are not “to blame” for the baby’s regulation disorder and they can have little influence on it: The infant must ultimately learn regulation on his or her own. However, since babies are heavily dependent on their parents and cannot yet satisfy needs such as food on their own, regulatory disorders often occur in connection with disturbances in the mother-child relationship. Reasons for this can include, for example, a high stress factor before, during, and after birth, conflicts of the parent couple or the family of origin, and mental illness of one or both parents.
Symptoms, complaints and signs
The main symptom of regulatory disorders is excessive crying. Excessive crying is when the average age-appropriate crying duration per day is significantly exceeded. In an infant, this is about one to two hours within the first six weeks of life. From the sixth to the twelfth week of life, it increases to two to three hours. After that, it usually decreases again in healthy children. The complaints occur at least three days a week in the case of regulation disorders. In many cases, there are several episodes of crying every day. Usually, the symptoms last for at least three weeks. They may also recur in episodes. What is striking about regulation disorders is that the affected infants otherwise make a completely healthy impression. The crying occurs in fits and starts, usually in the early evening or after meals. The affected babies suddenly experience severe abdominal pain and, in many cases, flatulence. They often have a distended abdomen and hunch over. Their skin may turn red. The muscles often seem tense. Other symptoms may include irritability and jumpiness. There may also be difficulty swallowing or sucking. Most infants with regulation disorders also have sleep disturbances and difficulty falling asleep. In a few cases, failure to thrive occurs.
Diagnosis and course
The main symptom of regulatory disorders is excessive, seemingly unprovoked crying and lack of response to appropriate reassurance. The infant may have been content and calm one moment and then burst into a screaming fit the next. The seizures occur predominantly in the evening. The baby has severe problems falling asleep and rarely sleeps for more than 30 minutes at a time during the day. The child also wakes up frequently at night. A generally pronounced jumpiness and irritability are typical of crying babies. Accompanying symptoms during crying spells may include an intense red skin color and tense muscles. Due to the air swallowed during crying, the abdomen may be somewhat distended. In order to make the diagnosis, physical illnesses or damage to the brain must first be ruled out.Child abuse is also considered a diagnosis of exclusion for a regulation disorder. Special attention is paid to the interaction between mother and child. The parents’ own childhood experiences, the quality of the parents’ relationship and other psychosocial problems of the parents are taken into account. A detailed medical history and possibly diaries will help to identify and improve difficult situations in the daily routine. Furthermore, an investigation of a possible developmental delay of the infant is performed.
Complications
Occasionally, three-month colic has an impact on the psychological state of the parents. Due to stress and lack of sleep, an aggressive attitude toward the child and partner may develop, which in turn leads to quarrels and neglect of the child’s well-being. Sometimes desperate parents shake the child, which can quickly lead to serious damage to the child’s health and even death. If mental suffering is already present, regulation disorders can intensify it and in the worst case lead to depression. For the baby itself, regulation disorders are not problematic. However, if other illnesses are present, the three-month colic can intensify them. In children with gastrointestinal or cardiovascular disorders, sudden abdominal pain and the associated stress can cause serious complications such as circulatory problems or diarrhea and constipation. No major complications usually occur during treatment. Occasionally, the pediatrician prescribes mild sedatives, which may cause temporary physical discomfort. Complications can also arise if three-month colic is mistaken for another condition. If this is recognized too late due to a misdiagnosis, physical discomfort and late complications are conceivable.
When should you go to the doctor?
Regulation disorders should be discussed with a doctor. As a rule, these disorders do not disappear again on their own, so medical treatment is definitely necessary. Only early diagnosis and treatment of the regulatory disorders can prevent further complications. A doctor should be consulted if the affected person cries very often and for a long time every day and can no longer control his anger himself. Especially children or adolescents can be affected by these regulation disorders. Often, outsiders have to point out these disorders to the person and persuade them to undergo an examination or treatment. In some cases, regulation disorders can also lead to severe flatulence or abdominal pain. If these complaints occur over a longer period of time, a doctor should be consulted in any case. First and foremost, the general practitioner can be visited. In most cases, this also leads to a positive course of the disease and not to a reduced life expectancy of the affected person.
Treatment and therapy
Treatment of regulatory disorders initially involves reassurance measures by parents, such as physical contact, baby massages and soothing baths, moving the baby to a different position, gently repeating sounds or movements, providing consistent and soothing background sounds, and introducing bedtime rituals. The infant should be carried around more often by parents when calm; this has been shown in studies to be more effective than carrying around as a calming measure during a crying episode. Overall, parents should try to remain calm, possibly seek serious help, and ensure a regular and calm daily routine. Furthermore, various therapeutic approaches can help parents better understand their child’s needs and respond appropriately. Common methods include relationship analysis with video feedback or parent-child psychotherapy.
Prevention
To prevent regulation disorders, a balanced interaction between parent and child is important. The measures mentioned above, such as a regular daily routine, quiet background noise, minimal bustle and overstimulation of the infant, and a loving bond, are the most important factors in preventing regulatory disorder. In case of problems and uncertainties, professional help should be sought as soon as possible.
Aftercare
Acute treatment and follow-up care of early childhood regulatory disorders are intertwined, as there are usually several aspects of early childhood development that cause difficulties for the infant. Not all symptoms of regulation disorder will be treatable at the same time, nor will they all resolve at one time. Close observation of the infant and the symptoms that occur is important. Regulatory disorders are not uncommon in newborns and do not require further follow-up in every case, as they gradually resolve with age. In cases of severe early childhood regulation disorders, a pediatrician will treat according to the effects and counsel and educate parents regarding feeding and supportive behaviors. Further follow-up is usually not expected in a healthy child. The pediatrician will have an appropriate focus on the regulation disorder at follow-up appointments or at the U examinations. In addition, the further development of the child is closely monitored in order to exclude any illnesses that may have caused the regulation disorder or to be able to treat them as soon as possible. In the case of the regulation disorder itself, no further follow-up is required if the child is healthy and the symptoms have completely subsided.
Here’s what you can do yourself
Regulation disorder is considered a temporary phenomenon. In the context of self-help, parents and relatives of a newborn, in collaboration with doctors but also experienced parents, can try different methods to achieve relief from the symptoms. Ultimately, by testing different approaches, individual ways are found to soothe the offspring. The baby should be placed in different physical positions so that changes can be noticed. Physical contact, warmth as well as affection help in most cases. In addition, warming baths or soothing background sounds can help the infant find inner peace. Often, care must be taken to ensure that the parents or people caring for the infant have adequate relief. They need sufficient sleep as well as breaks in caring for the newborn to be able to regenerate themselves. It is important to minimize any stressors overall in the offspring as well as the parents. Loud noises, conflict situations or noise should be avoided. Sufficient exercise in fresh air, a healthy diet as well as refraining from spreading agitation help to improve the overall situation. Playful activities, encouragement as well as maintaining aplomb are advised during the crying episodes of the offspring. In situations of overwhelm, another supervisor should be asked to help.
