The "fourth trimester": a framework and strategy for understanding and resolving colic: one pediatrician's quest to find the answer to colic leads to a hypothesis about the condition and a five-step technique pediatricians can teach parents to calm their crying baby

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Author: Harvey Karp
Date: Feb. 2004
From: Contemporary Pediatrics(Vol. 21, Issue 2)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 7,146 words

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"There is a reason behind everything in nature."


One of the most frustrating problems parents and physicians face is a baby who won't stop crying. It is not a rare event: Approximately 15% to 20% of infants younger than 3 months old cry or fuss for more than three hours a day, and 50% of infants cry or fuss for two hours a day. (1)

Why are these babies crying? What can we do to help them and their families? These questions have remained mysteries for thousands of years.

During my training as a physician in the early 1970s, I was taught that colic was short-lived and self-limited and that its cause was unknown. I was instructed to recommend simple calming measures (rocking, walking, car rides, etc.) and to prescribe a sedative or an anticholinergic or paregoric (a mixture of opium and ethanol). Then, in 1980, during a fellowship in child development at UCLA, I attended a lecture that challenged my understanding of colic. I was astounded to learn that the !Kung San tribe of Southern Africa was "colic free." Ninety percent of the time, !Kung parents could calm their crying baby within 30 seconds. (2)

For the next 20 years, I sought to discover how these parents were able to soothe their babies so quickly, to clarify the biologic basis for their methods, and to adapt and refine them into techniques that my patients could employ. In 2002, the results of my research were released in a book, The Happiest Baby on the Block (Bantam Books), and a video of the same name.

In this article, I present a hypothesis to explain colic (what I call the missing fourth trimester); explain a previously unreported neonatal response (the calming reflex) that is a virtual "off switch" for crying in infants younger than 3 months; and describe five simple techniques that activate this reflex (the five S's).

First, let's take a step back and discuss crying and how it affects caregivers, and critically review the four major contemporary theories of the cause of colic.

The crying reflex

Crying isn't all bad. It was a brilliant way of getting a cave mother's attention, and it remains a brilliant way of getting a 21st century mothers (or father's) attention. It is one of the most important of the 70 neonatal reflexes that babies are born with. Like an acoustic umbilical cord, crying is a powerful, long-distance connection between a baby and caregiver. This alarm system consists of a newborn emitting a 80 to 100 dB sound for prolonged periods (an extraordinary ability far exceeding the fortitude of most adults). (3)

Unfortunately, this reflex sometimes goes awry, and the summoning cry turns into a persistent scream. In 1962, T. Berry Brazelton reported that among 80 infants in his practice, 25% cried and fussed for more than 3.4 hours a day. (4) This confirmed the landmark 1954 article by Wessel and colleagues, who codified our current definition of colic in the "rule of 3's"--crying...

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Gale Document Number: GALE|A113893790