I (Dr. Sharp) have long held that many valuable lessons that I’ve learned came to me by way of my patients and their families. In the world of medicine, “taking a history” is listening to the patient (or their parent or representative) tell the personal story of their illness. The patient and their family may not know the name of the disease or problem, but they can describe it quite well, because they are living with it, just as you have been somehow surviving with your colicky baby. It takes time to take a proper history and that’s the way it should be, but in today’s rushed medical encounters, that is often difficult to accomplish.
During my years on the Secchia Center medical school faculty of Michigan State University, I taught medical students that contributors to a correct diagnosis were: history (70%), physical examination (20%) and laboratory or radiological studies (10%). This traditional approach comes down from noted Johns Hopkins medical educator Sir William Osler (1849-1919), who was one of the first to bring medical teaching out of the lecture hall and to the patient’s bedside. He advised students and residents:: “If you’ve taken a good history and don’t know what is ailing the patient, go back and take another history.” And that brings us to the first problem: In the rush of today’s medical care climate there is seldom adequate time for the health care professional to listen carefully to the patient’s story and perform a thorough examination. Too often technology supersedes careful listening and detailed examination.
And there’s a second problem: The “complete physical examination” that is performed on colicky babies is often incomplete in a crucial way. Investigation of a constipated patient (and isn’t that what your fussy baby with grunting and a red face and flailing arms and pulled up legs reminds you of?) should include checking the outlet of the gastrointestinal tract with a digital rectal examination (DRE), as Dr. Bouisson advised in 1851. Unfortunately, this is typically not done. We are reassured by the passage of any amount of meconium (green newborn poop). Modern textbooks recommend the use of a Q-tip to check the ano-rectal canal, but this will not diagnose or cure the two common causes of partial obstruction, which are easily detected by a careful finger examination. (Please see the CAUSE and CURE sections for further details.)
That brings us to a crucial third problem: There is no such thing as a “typical case of colic.” It’s highly variable. The anatomical status of the baby’s ano-rectal canal is individually determined by what happens during those crucial 5-9 weeks following conception. Modern researchers cite molecular influences like “Sonic Hedgehog,” the “Homobox Gene” and the “Para-Hox Cluster,” but the actual “why” of developmental variability remains unclear. Additionally, factors of temperament (both babies and parents!) are involved,, further contributing to the variability of the problem. It’s no wonder that such confusion exists! We will examine further details in the CAUSE and CURE sections.
In terms of more conventional “chronological history,” the oldest reliable colic information we’ve found comes from Frederic Etienne Bouisson, M.D.’s Thesis, published in French in 1851. We’ve recently produced an English version of the 168 page book. Dr. Bouisson covers every imaginable defect of the rectum and anus of infants, but clearly states that the internal anal sphincter (that’s the muscle that keeps stool from leaking out between poops), and variable “flaps” that form when the inside of the large intestine meets the outside skin dimple of the rectum in the developing embryo, cause all of the FIXABLE problems with babies having trouble pooping and then having belly pain secondary to that partial blockage. He lists many other problems with infants’ intestinal and pelvic problems, but those relate to newborns who have NOT passed green baby poop (“meconium”) after birth. The modern Krickenbeck Classification (2005) has codified these problems in a more orderly fashion. Again, please refer to the CAUSE section for more detailed explanations of how this partial stool blockage happens.
Here are two other examples of the chronologic colic history that we have documented:
- 1929 – Journal of the American Medical Association. Dr. Joseph Brennemann reported performing digital rectal exams (often abbreviated as DRE) on six babies suspected of having toxic megacolon. All six were “colicky babies,” and all six were cured by the DRE and did not require further surgery.
- 1950 – Journal of Pediatrics. Drs. Samuel Brown and Austin Schoen report their findings on 100 consecutive babies receiving a partial digital (finger) rectal examination (DRE) in their pediatric practice. Thirty-nine are found to have a partially obstructing membrane, and they observe that “some difficulty in expelling the stool is present in every case of stricture causing symptoms… such a history is very significant and in most instances is pathognomonic [highly indicative] of ano-rectal stricture. One can almost always predict the presence of this abnormality when such a history is obtained from the mother.”
- These findings hold true today, with colic affecting 15-40% of all newborns, worldwide.