In Practice: Reflections from NPs and PAs

Emily F. Moore, RN, MSN, CPNP-PC, CCRN practices pediatric cardiovascular care across the Pacific Northwest.

 

After my first baby, I always said that my second one was bound to be clingy, colicky, and skinny, as my first daughter was fat and happy. Aside from a few bursts of crying between 4 and 6 weeks of age, she was the perfect baby.

My second daughter is now 3.5 months old. When she was about 3 weeks old, I first noticed that no matter what I did, she cried, unless she was sleeping. Initially I had a pretty good attitude about it. I kept thinking she would outgrow it and life would move on. But then she started screaming herself hoarse and arching her back. I found myself getting nutty. I was very frustrated and doubting myself as a mom. I kept asking myself: What is going on? What am I doing wrong? Why won’t my baby stop crying? To make matters worse, she needed me so much that I felt like I was ignoring my two-year-old, who said to me more than once, “Baby sister is okay, Mama, I need you right now.” Or, “Baby sister cries all the time, Mama, what is wrong? When can I have you?” To say that I felt guilty is an understatement. There I sat — hormonal, postpartum, and torn, finding myself needing to choose between an infant and a toddler. That’s when I realized that this is how postpartum depression develops and, worse, how shaken baby syndrome happens. (Disclaimer: I never felt like shaking my baby).

Multiple people offered their advice. My dad said to lay her tummy on my tummy, my sister said to sing to her, a friend said to let her cry and to walk away to get relief. My mom said to just hold her and rock or bounce her. I tried it all and nothing helped. I started her on over-the-counter anti-gas drops hoping that would do the trick. Nothing. She was relentless in her crying. Thankfully, my husband shared a lot of the care responsibilities with me.

At our two-month well-child checkup, my provider asked about crying. I said, yes, my baby cries. ALL. THE. TIME. She asked when, and I said all day every day. I explained that we really don’t get relief unless she is sleeping, that even when I hold her, she is fussy and crying. Our pediatrician suggested that we start ranitidine for reflux. I instantly said no, arguing that reflux is over-diagnosed and that I didn’t want to be ‘that’ mom whose infant with colic was being treated for reflux. I also argued that as a relatively big baby, she didn’t seem to meet the criteria for reflux. Shouldn’t she be failing to thrive if she had reflux? The pediatrician laughed and explained that infant colic follows the rule of threes: crying for 3 hours a day, 3 days a week, and for more than 3 weeks. She also explained that a lot of big babies have reflux and keep eating to soothe the pain, causing a vicious cycle of eating and crying. Reluctantly, I started the meds. Within days, her periods of crying lessened and she stopped arching her back. I felt horrible that I didn’t address the issue sooner. Now she still cries, but not nearly as much, and my mental health has improved.

There is nothing more frustrating to a new mom than a baby who cries ALL the time. Moms need assurance that this is normal (and fairly common, affecting 10%–40% of children), empathy that it sucks, and validation that they are doing nothing wrong. My pediatrician knew I was at my wit’s end and needed a solution. I am so grateful that she took the time to ask, listen, and counsel me. Not once did she make me feel like a bad mom.

Being a pediatric provider, this experience opened my eyes to a few things. First, I am guilty of dismissing a baby with colic. This showed me how wrong I was. I know now that from my experiences as both a mom and a provider, I must take the extra time to sit with parents of newborn patients and listen to what is going on. I will provide the support needed to assure a mother that she is doing everything right. I will sympathize that hearing your baby cry all day every day is hard. Validating a mother and/or father is so important and can be incredibly therapeutic. I urge my colleagues to do the same. The time we spend on therapeutic communication might prevent or lessen colic-associated short-term depression and anxiety in stressed or exhausted parents, and might even save a parent from causing harm such as shaken baby syndrome.