It’s 6 p.m. and the wailing begins. You’re holding your 2-week-old baby -- the model of a thriving infant, apparently without a care in the world. Suddenly and unexpectedly he stiffens his limbs, arches his back, clenches his fists, draws up his flailing limbs against a bloated, tense abdomen and lets out ear-piercing shrieks. If he could speak, he would yell, "I hurt and I’m mad." As the intensity of Baby’s cries mount, your frustration escalates, and you feel helpless in determining the cause of his distress and alleviating your baby’s pain. He’s inconsolable, and you’re both in tears. You hurt together.

You try to cuddle, Baby stiffens in protest; you try to nurse, Baby arches and pulls away; you rock, sing and ride. The soothing techniques that worked yesterday aren’t working today. And inside your head the familiar refrain, "What’s wrong with my baby; what’s wrong with me?" plays over and over again.

By the time you go through all of Aunt Nancy’s herbal teas, the doctor-advised feeding changes and every conceivable holding pattern, as mysteriously as the fight began, around 3 to 4 months of age, it stops, and life goes on. Your baby seems none the worse for wear, and you close one of the most difficult chapters in life with your new baby. That’s colic.

What’s in a name? Even though no one completely understands colic, let’s make two assumptions: first, the baby has pain in the gut. (The term "colic" comes from the Greek kolikos, meaning "suffering in the colon.") And second, the whole baby is upset as a result. My perspective on colic changed years ago when a mother brought her baby in and wanted me to find out why he was crying so much. After I diagnosed the baby with colic, she challenged me. "Do pediatricians call it colic when they don’t know why a baby is hurting?" she asked bluntly. She was right. A gastroenterologist I often work with once confided to me: "Colic is a five-letter word for ‘I don’t know.’"

When an adult hurts, the doctor and patient do some detective work to track down the cause of the pain and fix it. So I started approaching my evaluation of colicky babies the same way. First, I dropped the term "colic" from my diagnosis list and adopted the term "the hurting baby." Besides being more accurate, this motivated my patients’ parents and me to keep searching for a cause and to keep working at ways of fixing it. Labels can be therapeutic. By viewing your baby as "hurting" instead of "crying," you’re more likely to show the same empathy that you would a baby who was hurting because of an ear infection, instead of regarding crying as an annoying tool babies use to manipulate their parents into holding them a lot, which tops the list of colic myths. Here’s a step-by-step approach to tracking down why your baby hurts and learning what to do about it:

Step 1: Keep a Colic Diary
A diary is helpful for two reasons: you may uncover clues that help your baby’s doctor diagnose a hidden medical cause of colic, and you may be surprised by the correlations you find. As one mother noticed, "On days that I wear my baby in a sling most of the time, he fusses less."

Step 2: Get a Medical Evaluation
Don’t settle for a five minute squeeze-in appointment. To thoroughly evaluate a hurting baby and the effects on his exhausted parents, a doctor needs time. Request an extended office visit, preferably when the doctor usually schedules consultations. Prior to your visit, it’s a good idea to send the doctor a letter describing your baby’s crying episodes. If possible, both mother and father should attend the appointment. While some mothers tend to downplay the magnitude of the problem, dads usually tell it like it is. I didn’t fully appreciate the toll a colicky baby was taking on his family until his father volunteered, "I had a vasectomy last week. We’ll never go through this again!"

Make a distress tape. To help your doctor appreciate how devastating these bouts of colic are, videotape one of your baby’s crying jags and ask her to view it, preferably before your appointment. I’ve found that watching such a tape helps me appreciate whether baby is just crying or is really hurting. And the type of cry often gives a clue to the root of the problem. Besides being helpful to the doctor, these tapes are therapeutic for parents, who at last have solid evidence of the torture they’re subjected to each evening. Before their scheduled appointment, for instance, frazzled parents of a fussy baby recorded one of their baby’s crying jags and mailed it to me. When I viewed the tape, I realized how much pain this baby was in and how frustrated his parents were by not knowing how to help him. Don’t hold back about how much your baby’s crying bothers you. As one exhausted mother told her doctor, "I’m not leaving this office until you find out why my baby’s crying."

Step 3: Search For Medical Causes
In general, a medical cause is likely if the so-called colic isn’t getting better by four months and your intuition tells you that your baby is in pain.

Suspect a medical cause for colic if baby is:

• getting worse or not gradually getting better
• awakening frequently with painful cries
• unable to be consoled
• not thriving: poor weight gain, frequent respiratory or intestinal illnesses

Among the possible underlying causes for colic are:

1. Gastroesophageal reflux (GER), a newcomer to the hidden causes of colicky and nightwaking behavior, occurs when the muscular tissue at the junction of the esophagus and the stomach doesn’t function like a one-way valve and allows irritating stomach acids to be regurgitated into the esophagus, causing pain similar to what adults call heartburn. Clues that your baby suffers from reflux are many, but not necessarily all, of the following: wails and shrieks in pain, causing you to feel that he’s not just crying but truly hurting; spits up after feedings; experiences painful bursts of nightwaking; most painful cries occur after eating; draws up his legs, knees to his chest, and arches his back as if writhing in pain; has frequent, unexplained colds, wheezing and chest infections; often seems happier when he’s upright rather than lying flat. Your doctor may suspect GER based on the information from your colic diary and the way you describe baby’s crying episodes. GER can be confirmed by placing a tiny tube into the baby’s esophagus and leaving it in place for 12 to 24 hours while continuously recording the amount of stomach acids regurgitated into the esophagus. About one-third of infants have some degree of reflux, so simply measuring the stomach acids doesn’t prove that GER is why baby is hurting. For this reason, a parent or trained observer records the timing of baby’s colicky episodes. If these coincide with the time the baby refluxes, the hidden cause of colic has been found.

If your doctor suspects severe GER, the doctor may suggest an esophagoscopy: under anesthesia placing a thin flexible tube into baby’s esophagus to see if there is any damage to the lining of the esophagus from the regurgitation of stomach acids. Your doctor may choose to begin treatment without subjecting baby to these studies and instead do a less invasive test, called an upper G.I. series, where baby swallows some formula-like fluid to be sure there isn’t a blockage in the intestines causing the reflux.

Your doctor may prescribe medications that lessen the amount of stomach acid produced and accelerate the emptying of the stomach which, along with the comforting measures listed later, will diminish the reflux and alleviate the baby’s discomfort. Holding your baby upright for 20 to 30 minutes after a feeding, in addition to feeding him smaller amounts more frequently, will often reduce reflux as well.

2. Food sensitivities. Do gassy foods ingested by a breastfeeding mother cause gassy babies? Nursing mothers have long noticed a correlation between what they eat and how colicky their baby gets, and they have compiled their own fussy foods list. Suspects include: dairy products, caffeine-containing foods and beverages (soft drinks, chocolate, coffee, tea and certain cold remedies), cruciferous vegetables (cabbage, green peppers, broccoli, cauliflower, brussel sprouts and onions), spicy foods (such as garlic or curry), wheat and corn.

3. The colic-cow’s milk connection. New research supports what old wives have long suspected: some breastfed babies become colicky if their mothers drink cow’s milk. That’s because potentially allergenic protein called beta-lactoglobulin in cow’s milk is transferred to the baby through the breastmilk. This allergen upsets the intestines just as if the baby had directly ingested the cow’s milk.

4. Formula allergies. Babies fed a cow’s-milk-based formula may become colicky if they’re allergic to the protein or can’t tolerate the lactose in cow’s milk. If a formula allergy is suspected, a hypoallergenic formula (Alimentum, Nutramigen or Pregestamil) or a lactose-free formula may be recommended by your doctor. The American Academy of Pediatrics Committee on Nutrition does not recommend changing to soy formula as the first formula switch, since studies have shown that colicky infants do not improve when switching from cow’s milk to soy formulas.

When will it stop?
Colic begins around 2 weeks of age and reaches peak severity around 6 to 8 weeks. Seldom do the violent outbursts continue longer than four months of age, but fussy behavior may last throughout the first year and mellow between one to two years of age. In one study of 50 colicky babies, the evening colic disappeared by four months in all of the babies studied. What’s magic about three to four months? Around that time babies develop more internal organization of their sleeping patterns. Exciting developmental changes occur that lead babies to the promised land of fuss-free living. They can see clearly across the room. Babies are so delighted by the visual attractions that they forget to fuss. Next, they can play with their hands and engage in self-soothing finger sucking. Babies can enjoy more freedom to wave their limbs freestyle and blow off steam. Also, during the second half of the first year baby’s intestine is more mature, and perhaps milk allergies subside. Or by this time the cause has been found or comforting techniques perfected. Like pregnancy and labor, colic too will pass.