|FOR CRYING OUT LOUD
Heard all the theories (including your mother's) about what ails a howling baby? Science has a new answer: It's no real problem — it may even be a good sign. Anne McIlroy reports on a breakthrough that could help to prevent shaken-baby syndrome
By Anne McIlroy
Saturday, March 27, 2004 Globe and Mail
Ron Barr isn't a masochist. But the University of British Columbia researcher wants to write an article that will prompt millions of parents to question his mental health. The title? "Why I hope my child has colic."
Dr. Barr has spent 25 years studying a cruel question for many parents: Why do some babies cry so much more than others? Whenever he tells people his field, he hears the war stories. Like the father who drove more than 200 kilometres a night to calm his infant daughter — she would start to cry again as soon as he pulled into the driveway and turned off the engine.
Or the mother who tried to throw a dinner party to thank the friends who helped to build her new house, only to have her two-month-old scream for four hours, while her guests bolted down dinner so they could leave as soon as possible. "It was Yorkshire pudding," she remembers sadly.
Then there was the couple who tried pacing the stairs with their newborn as they sang The Wheels on the Bus. "Some nights we went up and down for four or five hours," the father says.
One desperate mother would take her baby to the laundromat and put him on a moving dryer. Another couple took to holding their baby next to an open freezer in hopes the cold air would calm him. Still another would hold their baby under the roaring fan of the stove. It would quiet him till they paused to give their aching arms a break. Then he would go back to howling.
Two decades ago, Dr. Barr might have told them it was lactose intolerance. Now, he has a new answer to all the methods prescribed by parenting magazines and advice books such as The Happiest Baby on the Block, the recent bestseller that proposed "the five S's," which include swaddling, shushing and swinging.
"None of them work," he says. They might sometimes, but mostly not. "There is no magic bullet. "Why? This is inborn. This is something that has been adaptive for infants for generations and eons of evolutionary history. This increase and decrease in crying — and that includes these inconsolable crying bouts — is normal. We have to accept that they are, and not make ourselves uptight about it. And that is new."
Dr. Barr and other researchers studied the crying patterns of babies around the world and plotted the hours of fussing and bawling on a chart. To his own astonishment, they discovered something that could not only ease parents' frayed nerves — he hopes it might put an end to life-threatening shaken-baby syndrome.
They found that there's a universal pattern to infant tears — and not just in most human cultures, but in other mammals as well: Babies cry a lot shortly after birth, then crying time drops, and then it builds and peaks again four to six weeks later.
The height of that peak varies, along a common spectrum. Some babies cry only a few minutes a day, others — up to 20 per cent of all infants — might cry for almost six hours. But after 15 years of study, Dr. Barr began to think that, like personality differences later in life, "colic" was a natural variation of human behaviour.
"All kids have periods of inconsolable crying. Sure, it is exaggerated in kids with 'colic,' but they are not a unique, separate group. It is part of the normal continuum," he says. "And, no matter what you do, some of this crying is inconsolable. All infants at some time or another will have an inconsolable crying bout. This is a very important message for parents." In fact, intense crying may not be a signal that something is wrong, but a sign that the baby is robustly all right. He thinks inconsolable crying probably has to do with the reorganization of the many systems learning to interact with each other at this stage of life, such as digestion, learning, the visual system.
"I think — I don't know how to prove this — that it is the babies who don't have the peak period that are going to have difficulty in life." He says his article on the virtues of colic is something he hopes to be able to write before he dies. (Mind you, Dr. Barr's own children haven't been colicky.)
Over the years, parents have received conflicting advice about crying babies. Mothers in the 1950s and 1960s were told that you could spoil children if you were too attentive to their crying. That's definitely not true, Dr. Barr says. Parents should do what they can to soothe their infants without worrying about spoiling
But parents also shouldn't feel guilty or inadequate if they can't stop their baby's crying. The baby is doing what babies have done for thousands of years. And sometimes, he says, it is okay to put the infant down and walk away. The problem is, most people believe mothers and fathers should always be able to stop their infants from crying. When Dr. Barr began his research, the widespread scientific assumption was that colic had something to do with infants' digestive tracts. They appeared to be in pain, and their loud, angry cries could go on hour after hour, frustrating even the most patient of parents and leaving them feeling helpless and inadequate.
Like others in pediatric medicine, he began working on the idea that these babies were having trouble digesting lactose, the milk protein found in baby formula and mothers' breast milk. But he soon proved himself wrong: Lactose intolerance added gas to the intestine, but did not increase crying.
Dr. Barr, who worked at McGill for most of his career but recently moved to UBC, tested his hypothesis with the help of the exhausted parents of colicky babies. He and his American colleagues did home visits comparing 20 two-month-old infants with colic and 20 without it.
They defined colic as crying for three hours or more a day for three days straight. When they made their visits, the colicky babies cried twice as long and more intensely than their more peaceful counterparts, and were harder to console. But when they tested their heart rates and levels of cortisol — a stress hormone that usually accompanies distress or pain — they found no significant differences between the two groups of babies throughout the day. Perhaps colicky babies weren't in pain after all. That led to the discovery of the universal pattern.
Now, Dr. Barr's goal is to change public attitudes, from the business traveller giving a crying infant a dirty look on the plane to all parents trying to soothe new babies who refuse to be comforted. But most of all, he is hoping his research will eventually lead to a reduction in shaken-baby syndrome, which affects 25 to 40
babies out of every 100,000. The No. 1 reason parents or caregivers shake babies — causing death or severe disability — is inconsolable crying.
Aimee Quaife, a mother in Victoria, remembers that when her son, Dallen, was born 10 years ago, he cried a lot. On more than one occasion, when she was out of the house, he was shaken by his father, who served time in jail for the child abuse that marked his son for life. Dallen suffered such severe brain damage that the doctors didn't think he would live, let alone walk. He defied the odds, but has cerebral palsy, autistic tendencies and major behavioural challenges. He can't be left alone, even for a moment.
His mother was devastated when police charged her former partner for shaking Dallen in a moment of uncontrolled rage. She'd had no idea. Maybe the man she had once loved and trusted wouldn't have done it if he had known that long hours of crying were normal in babies. Maybe he wouldn't have shaken his son so violently that he fractured his skull and broke almost a dozen bones.
How to get the message across? Dr. Barr came up with a device in a Montreal diner: Call it "PURPLE crying," with each letter in the acronym corresponding to a characteristic peculiar to the first four months of bawling he believes is part of our evolutionary heritage:
P: Peaks around two months.
U: Unpredictable, often happening for no apparent reason.
R: Resistant to soothing.
P: Pain-like expression on the baby's face, even without any source of pain.
L: Long bouts, lasting 30 to 40 minutes or more.
E: Evening crying is common — what many parents know as the "witching hour" is now a scientifically proven fact.
Dr. Barr is now launching a randomized trial in British Columbia and Washington State to see if a public-education campaign on PURPLE crying will change caregivers' perspectives. These kinds of campaigns have worked before, especially in getting parents to put their babies to sleep on their backs to reduce the risk of sudden infant death syndrome, or SIDS.
The new campaign has several messages. If your baby cries, increase the amount of contact, through carrying, comforting, walking or talking. This can reduce crying by 50 per cent. But if you can't take it, put the baby down and take a break. And never shake a baby.
It's not only in the case of colic that crying has confused the medical profession. It is an inefficient form of communication that has often led to drastic misunderstandings. Although parents can become very adept at distinguishing between cries of distress and crying for crying's sake with their own children's, the interpretation is too difficult for health-care professionals.
Two decades ago, science misconstrued infant pain so badly that heart surgery would be performed with only a muscle-paralyzing agent but no anesthetic. Physicians believed that infants' nervous systems were too immature to feel pain. Even adults have trouble verbally describing pain to doctors and nurses and rely on metaphors — it feels like their arm is on fire, or like someone has stabbed an ice pick into their brain. Infants who can't speak have even more difficulty. "Pain is abstract, ephemeral. But you can't control it unless you can measure it," says Ken Craig, another UBC researcher.
Then, in 1985, came the first of several ground-breaking studies by Oxford University researcher Kanwal Anand and his colleagues. They found infants who underwent heart surgery were more likely to survive if they were given pain relief during the procedure.
Parents such as Jill Lawson in the United States began speaking out. Her premature baby, Jeffrey, had major surgery to tie off an extra artery near his heart. She found that he hadn't received an anesthetic. She and other parents began telling their story to reporters, launching a public crusade that changed the way doctors performed surgery on infants.
Around the same time, Dr. Craig and his colleague Ruth Grunau began videotaping dozens of infants as they were vaccinated. Their goal was to figure out a reliable way for medical professionals and other researchers to assess how much pain a baby was experiencing. Their hope was that finding a way to measure pain in babies would make it easier for doctors to relieve it.
It is hard to watch even one of these tapes. The baby looks content or happy, then in comes the needle. His face crumples, and he starts to wail. By going over every frame, Drs. Grunau and Craig were able describe a distinctive facial grimace that is a reliable indication of pain — the look that says "Ouch!"
The more extreme the grimace, the more pain the baby is in. They lower their brows, squeeze their eyes shut and raise their upper lip. The fold of skin between their nose and mouth deepens.
The scale they devised in 1987 is now used worldwide by doctors, nurses and researchers who work with babies. This scientific approach to infant pain has made it possible for researchers to study controversial issues, such as the effect of circumcision on babies. They found that not only does circumcision cause intense pain and behavioural changes that can last up to a day, but that it may have longer-lasting effects.
Scientists at Toronto's Hospital for Sick Children found circumcised boys cried longer after routine vaccinations at four to six months than girls, and appeared to experience more pain. They concluded the boys recalled the pain of circumcision six months later.
Infants aren't the only people who have trouble telling doctors how they feel. Dr. Craig has now extended the use of the facial-grimace scale to other groups that have trouble communicating verbally — toddlers, seniors with dementia and people with developmental disabilities such as autism. "They suffer from pain just as anybody else does. One has to have different measuring instruments."
It is not the first time researchers have found a broader application for discoveries they have made about babies. Scientists are drawn to infants because they offer a chance to learn something universal about human nature, Dr. Barr says — to find a pattern in seemingly random behaviour and help to make sense of something that to parents around the world seems so individual and unpredictable, the cry of a newborn baby.
Anne McIlroy is The Globe and Mail's science reporter.
Ooh, baby! Who kids find cute
Researchers have found that as children mature, they find different kinds of faces attractive. The facial types they favour seem to relate to the physical perspective from which they view the people around them.
At five months, babies looking at pictures prefer faces with big chins and small foreheads, perhaps like Jay Leno's. Daphne Maurer and her colleagues at McMaster University reasoned that babies are always looking up at faces, and so find a prominent chin a familiar, comforting feature.
For toddlers, the image is reversed: Three-year-olds in daycare prefer more babyish features, with the large forehead and small chin of someone like Drew Barrymore. This is when they start to have a lot of eye-to-eye contact with their peers for the first time. But when tested at home, toddlers still prefer the same big-chinned faces as babies.
It is not until puberty that they join adults in finding faces with even, symmetrical features, such as screen star George Clooney's, the most attractive — nine-year-olds, for example, still prefer the babyish faces. Dr. Maurer is now doing an experiment to see if she can change adults' preferences by having them look at many pictures of less attractive faces.