Evolving ideas in primary care.

The other day I saw a new mom with a 5-week-old baby who spent a good part of his day crying. The mom had done the things moms with babies who cry a lot often do: she had blamed something in her breast milk and stopped breastfeeding, then she had started working her way through the various infant formulas in the grocery store; still her baby would not stop crying. “He looks like he’s in pain. He scrunches up his little fists.” Findings of the baby’s examination were reassuring, and he was gaining weight appropriately. I told her everything pointed toward colic as the diagnosis. I explained that, with the notable exception of shaken baby syndrome, colic usually has a good outcome for babies, moms, and the baby-mom dyad.1-3 A family member had moved in for a time to help with the baby, and the mom was happy she had someone to whom she could hand him off when she felt herself becoming helpless or angry. She asked if she should continue with the probiotic drops she had been giving the baby; I said there was not much evidence it would help with her son’s crying4,5 but that there was likely no harm in trying. Usually my colic visits end around there, with reassurance and arrangements for follow-up. It can be a dissatisfying exchange for both patient and physician: simple reassurance that “nothing is wrong” can be mistaken for minimizing, and it also does not necessarily help a patient with her very real distress. On bad days, it feels intellectually fraudulent: if nothing is wrong, then what evidence do I have that it is “right”?