When he was only three days old, Nick Blauwkamp started crying and didn’t stop. His sharp, loud cries got worse and worse in the weeks that followed. He cried — inconsolable — for several hours nearly every night.

His parents, Bend residents Nancy Green and Dave Blauwkamp, didn’t know what else to do. Nick wasn’t hungry. He didn’t need his diaper changed. He wasn’t sick.

The couple spent hours upon hours trying to soothe their infant. They bounced. They rocked. They held. “We were trying. No stone was unturned,” Green said.

They tried swaddling. They studied a technique on deciphering baby cries.

“Really, honestly, none of it worked,” Green said. After weeks spent trying to soothe a baby who cried inconsolably, Green remembers thinking: “Holy crap. What did we sign up for?”

Even when their baby wasn’t crying, the couple struggled to relax. Green remembers Blauwkamp couldn’t sleep because he was too tense — always anticipating another crying bout. Green likened the experience to smelling a bad odor — even when the smell is gone, it lingers in your nose. The sound of their baby wailing never really left their heads.

Then, just like that, Nick turned 3 months old and basically stopped crying.

Green says her son, now 16 months, is a happy, healthy boy who sleeps and eats like a champ.

Green says, looking back, she knows Nick was probably colicky. Colic is a term sometimes used to describe otherwise healthy babies who cry for long durations of time and then generally stop crying around 3 to 5 months of age.

Researchers believe this kind of behavior, also called high crying, was once beneficial to babies. But now the effects are mostly negative. The intense crying can affect parents, fraying their nerves and sometimes affecting their ability to bond with their babies.

Parents of high criers can feel isolated and alarmed. Many parents say they didn’t know a baby could cry so intensely for a long period and that this could be completely normal.

Marilyn Barr is currently working on a colic awareness campaign called the Period of PURPLE Crying, (see “Resources”) as part of her work as the executive director of the National Center on Shaken Baby Syndrome. The group believes there is a connection between colic and shaken baby syndrome. Barr says the goal of the campaign is for parents to understand that high crying is a “normal developmental stage” that about 20 percent of infants experience. Barr also hopes the campaign will help parents have reasonable expectations and assurances that an end is in sight.

Green remembers hearing from people that the crying would get better, “but I didn’t know that in my heart…. It was hard for me to see the future and be hopeful.”

What is it?

Colic has long been defined by the “rule of threes.” A baby with colic cries for three hours a day or more, for three days a week or more, and for more than three weeks in a row. The baby is otherwise healthy. But this definition can be frustrating. It is arbitrary — a baby who cries for two hours a day, seven days a week may be challenging, yet not “colicky” according to the definition.

Dr. Ronald Barr, a developmental pediatrician and a professor at the University of British Columbia, has been studying crying and colic for about 25 years and has conducted numerous studies on them. Barr says all babies go through an increase and decrease in crying. It is part of a natural, normal crying curve. Crying frequency increases beginning around 2 weeks of age, peaks at 2 months of age and usually declines around 3 or 4 months. Colic, Barr said, “is not something infants have, it’s something infants do.” This so-called crying curve can also be found in a lot of animals, says Barr.

While all babies experience the crying curve, the big difference is how much crying they do during the peak and whether they experience inconsolable crying. About 5 to 10 percent of crying that colicky babies do is inconsolable, according to Barr, which can be frustrating for parents. Barr encourages parents to try to soothe their babies, but to understand that sometimes “nothing is going to work.” And this too, he says, is normal. “That’s OK. That’s not you, and it’s not because you’ve got a bad baby.”

Saying an infant has colic also doesn’t give the parents a prescription.

Dr. Dana Perryman, a pediatrician with Central Oregon Pediatric Associates in Bend, is reluctant to issue such a label because, unlike a diagnosis of asthma or pneumonia, the label doesn’t come with any treatment.

“My tactic is to normalize it,” said Perryman.

Green said calling Nick colicky felt odd. “I don’t want people looking at him and thinking something is wrong with him.”

Perryman tries to acknowledge how hard it is for parents. Listening to a crying baby is “probably one of the most challenging things you can do.” It is grating, frustrating and stressful.

Parents come in to her doctor’s office and want help to stop the crying. First, Perryman checks that the baby is gaining weight and growing as expected. She wants to ensure the baby is healthy. If Perryman suspects the child is simply a high crier, she talks about how this stage will end. Three months “sounds like forever,” but it “is also finite.” Perryman also talks to parents about how a newborn, on average, cries for 42 minutes to two hours every day. “I don’t think that’s information that people talk about very much.”

The prescribed response — to simply wait until it gets better — can be hard to take. “Waiting isn’t very tolerable in our society,” said Perryman.

Why does this happen?

“Crying is one of the most effective stimuli babies have to get caregivers to invest in them,” said Ronald Barr. He says crying causes parents to rock, hold, talk to and nurse babies.

From an evolutionary point of view, this behavior makes sense. Barr says babies who cried most were most likely to get the most attention from their caregivers. This was proven during a series of studies in Africa in the late 1960s, says Barr. At that time, infants in the United States were commonly classified with one of three temperaments: normal, slow to warm, or difficult (high criers). A researcher went to the Maasai tribe in Kenya to classify babies in order to see if the percentage of each temperament was about the same in each culture. It was. However, that winter, Kenya experienced a famine and many people died. Barr says the researcher returned in the summer and discovered that the “difficult,” high-crying infants were the ones who were most likely to have survived the famine. Barr says the idea is the “squeaky wheel gets the grease.”

These infants were more likely to get food, be kept warm and carried. But, Barr says, “not necessarily because the mother had an affectionate bond with them.”

Repercussions

In the past, crying a lot may have helped infants survive, but Barr says it doesn’t serve babies well now. In fact, attachment between parents and infants can be delayed when a baby is a high crier.

Green remembers telling Blauwkamp, “I don’t know if the baby likes us.” Although she feels close with Nick now, it wasn’t always the case. In the months right after Green gave birth, she says she wasn’t feeling like herself, she wasn’t looking like herself, and then she had a hard time feeling close to her baby. It was tough. “I really think it proved to be more of a challenge,” said Green.

Perryman says she thinks about how colic can affect parents’ bond with their babies. It is not something she brings up when parents are in the middle of it, as that would just be one more thing to worry about. Instead, she usually checks in during a follow-up visit. She also wants to help parents know that just because they didn’t connect during that tough time, doesn’t mean they missed their opportunity.

Ronald Barr and wife, Marilyn Barr, are working to raise awareness about colic to help parents understand what normal behavior is and to prevent caregivers from shaking babies. Marilyn Barr says 90 percent of shaken baby cases take place in the first six months of life and most take place in the second month, when crying is typically the highest. Ronald Barr says it is crucial for parents to not get so frustrated they end up shaking their baby. “The only long-term negative effect of colic is if you shake your baby,” said Ronald Barr.

The Period of PURPLE Crying program developed by the Barrs is in place in Deschutes, Crook and Jefferson counties through each county’s Healthy Start or Health Families of the High Desert program (see “Resources”). PURPLE is an acronym designed to help parents remember the symptoms of high crying.

These symptoms all held true for Green’s baby Nick, who looked as if he were in pain.

Marilyn Barr understands firsthand, having raised a son who cried for five hours a day. Barr hopes the campaign will help ease parents’ frustration a bit. “You can put up with a lot if you know it’s going to come to an end.”

‘Good babies’

Bend mom Angela Reid says her son, who is now 4, cried for most of his first two and a half months. She dealt with it by doing whatever worked.

“I pretty much nursed him all the time,” she said.

She remembers taking shifts with her husband — one would sleep the first four hours of the night, the other would sleep the next four. And that is all the sleep they got for at least the first two months. Going into it, she had no idea how hard it would be. “There is some secret code. None of us can talk about how hard it is.” She says it would have been helpful to know her son was not the only baby that cried so much.

Green also felt isolated. This was the couple’s first child and they didn’t know what to expect. Several of their friends also had babies around the same time, but none of them had high criers. She felt as if she couldn’t talk to them. “Their babies weren’t doing that,” she said.

“We both felt pretty isolated,” said Green.

Reid says the memories are mostly a blur. She now also has a daughter, age 5 months, who has been mellow and is not a high crier.

Reid struggles because sometimes people want to call her daughter a “good” baby. But she doesn’t like the implication that then her son must have been be a “bad” baby.

Other causes?

Sometimes parents wonder whether their crying newborn really has a problem with reflux. Reflux basically means spitting up or regurgitating milk. “All babies reflux — it’s a matter of degree,” said Perryman.

Perryman says it is a problem when the child is arching his or her back and turning to the side as if to get away from his or her belly. Perryman, however, wonders if this condition is over-diagnosed.

Ronald Barr studied intestinal gas for more than 10 years, specifically conducting research about whether or not this gas is what could be causing colic. He found no correlation.

A study in Pediatrics, a journal from the American Academy of Pediatrics, showed a possible connection between probiotics and crying. Half of the infants in the study were given probiotics and half were given a medication to reduce gas. The infants who took probiotics reduced their crying time from 159 minutes per day to 51 minutes per day on average (the babies taking the gas medicine went from 177 to 145 minutes a day).

Perryman says some mothers also ask about whether the baby is reacting to something she is eating, which is passed on through her breast milk. Perryman says this is hard to evaluate and sometimes suggests the mother try to eliminate cow’s milk as well as caffeine and chocolate from her diet and see how that works.

Ronald Barr says parents should consider whether the child has any symptoms beyond crying — such as diarrhea, fever or rash. Children experiencing food intolerance “typically don’t have just crying,” said Barr.

Ultimately, Barr hopes parents will understand that intense, even inconsolable, crying can be part of a typical, healthy infancy. And there should be no lingering effects of colic once they have weathered the storm.

— Reporter: 541-617-7860, ajohnson@bendbulletin.com