Colic vs. High Needs Babies - What is the Difference?

What are the Symptoms of Colic?

As all new parents quickly learn, the first few months of a baby’s life are filled with excitement, fear and, yes, frustration. Pregnant women await the day of their babies’ births with idyllic images of newborn life dancing in their minds. Their babies will snuggle them, sleep often and sometimes cry. But what happens when real life doesn’t match our imaginations? How can you handle a fussy baby that seems to cry all the time, despite your most ardent efforts at soothing? And how can you tell if your baby has colic or is simply a “high needs” baby?

These questions are not easy to answer because the diagnosis of colic is not clear-cut. Many experts believe that colic is simply the upper end of a spectrum of otherwise normal crying.¹ In other words, some babies cry a little and some babies cry a lot. Yet other experts believe that colic babies don’t simply cry more than other babies, they cry differently. Let’s look into this further.

Before we can decide if our fussy baby is a high needs baby or a colicky baby, we need to know more about “normal” babies. Newborn babies cry between 90 minutes and 2 hours a day. This crying is spread through the day with increased crying in the late afternoon. Crying time increases until age 6 weeks, when babies tend to cry about 3 hours a day. Crying then decreases gradually. By age 6 months, babies tend to cry about 1 hour a day.^2-4

Colic infants and high needs infants cry more than normal infants. But is there more to it than that? Exactly how does colic and high needs crying differ from normal crying, and from each other? It has taken doctors decades of research to begin to understand newborn behavior, such as crying and fussing, and the answer to these questions seems to come down to temperament. Temperament is described as the way a person experiences and responds to his/her environment.5 It can also be explained as a person’s natural predisposition, a combination of one’s mental, physical and emotional traits.6 And yes, even babies have temperaments!

View the Colic vs High Needs Baby Infographic

In the late 1950s, Drs. Thomas and Chess published The New York Longitudinal Study which showed that nine different life-long temperamental traits were present from birth. Using these traits, they were able to categorize babies into three basic groups: “Easy”, “Difficult” and “Slow to Warm Up”. Of course not all babies clearly fall into just one of these categories; many babies seem to contain mixtures of these temperament traits and fall into different categories at different times^7-11.

So how does temperament help you decide if your baby’s crying is colic or simply due to “high needs”? The term “high needs” is basically another way to describe the babies formerly called “difficult”. These babies tend to be fussy, hyperactive and demanding. They have irregular patterns to their eating and sleeping habits; they feed often and wake frequently throughout the night. Despite the irregularity of their habits, they have a hard time adjusting to changes in their environment and schedule. High needs babies also tend to be fearful of new people and have intense, negative reactions to strong stimuli such as noise and commotion.^3-7 While these babies cry more than normal babies, they rarely reach the crying levels of babies with colic.

While there is no clear-cut way to diagnose colic, most experts use “Wessel’s Criteria”, also known as the “Rule of 3s”. Colic babies are otherwise healthy, well-fed babies with crying episodes that last at least 3 hours a day, occur more than 3 times a week for more than 3 weeks.^{4, 11, 12} Colic babies, like normal and high needs babies, cry more often in the late afternoon and early evening hours. Colic is seen in about 20% of infants born in the United States and is not associated with parental age or the child’s birth order.¹³ Colic presents around 2 weeks of age and resolves by 3 or 4 months of age. In contrast, the crying of a high needs baby starts at birth and the increased intensity in reaction tends to remain throughout life.

Colic babies have significantly increased crying time but do not exhibit the other behaviors seen in high needs babies. They are not as hyperactive, have regular sleeping and feeding habits, and are not as fearful of new people. Unlike high needs babies, colic babies’ crying episodes seem to be unrelated to external stimuli such as loud noises.¹ Colic babies’ crying episodes may seem to come out of the blue, but when they do get riled up, they have a difficult time calming down. In other words, they don’t cry more often than normal babies, but once they start crying, they cry for significantly longer periods of time.^{1, 11} In one study, the colic babies’ crying episodes lasted an average of 38 minutes; crying episodes of both the high needs babies and normal babies lasted an average of only 20 minutes.¹¹ During crying episodes, babies with colic will often clench their fists, flex their legs and arch their backs. Their faces turn red, their stomachs appear hard and distended, their faces often grimace and they may pass gas^{1, 14, 15}. These babies are very difficult to soothe; feeding, holding and rocking often fail to relieve their crying.^{1, 15}

Colic Babies vs. High Needs Babies Differences Chart

There are no strict criteria to tell you if your child has colic or is high needs because neither entity has a clear definition. However, there are some distinguishing characteristics of each as seen in Figure 1. In truth, the distinction may not be that important. The fact is that neither represents a disease or an illness, and both are treated the same way. Once medical causes are ruled out, spend some time trying to “read” your baby’s needs. Watch how your baby responds to different stimuli. If your baby starts to cry every time there is a loud noise, try to minimize noise. If your baby isn’t bothered by loud noise then there is no need to keep the house silent. The key is to accommodate your baby’s temperament as you cannot change it. Trying to make your colic or high needs infant conform to your preferred schedule or environment will only lead to more stress and failure.^{5, 16}

Try soothing techniques that help in some situations. Gentle, tactile stimulation, swaddling tightly in a blanket or placing the baby face down with his/her stomach on your knees as you rock side to side may abate the crying. Some babies respond well to pacifiers while others like to be carried around and bounced. Remember, high needs babies react poorly to stimulation so don’t try too many maneuvers in quick succession.¹⁷ And when nothing will stop the crying, take a break. If possible, let somebody else try. If that is not an option, swaddle the baby tightly, put him in his crib, whisper some reassuring words and then walk away. Give yourself time to calm down and recharge before returning. Who knows? He may stop crying on his own after a few minutes. If not, you can try again when you are feeling better.¹³

The bottom line is that babies cry, some more than others. And while it can be extremely frustrating and exhausting, it is important to realize that this behavior is not abnormal. Even more important is the fact that these behavioral tendencies are inborn and are not due to poor parenting. You aren’t doing anything wrong! Even the best parents have colicky or high needs babies. It is not a reflection on you. Try not to compare your baby to others. Every child (and adult) is unique with both strengths and flaws. Ignore the “If Only’s”. Well-meaning friends and family members may offer advice (that often feels like criticism) by saying, “If only you would (insert useless tip here), he wouldn’t cry”. Remember, the crying isn’t caused by anything you are or are not doing. So smile and thank them and move on.¹⁰ And recognize that it is normal to feel disappointment, frustration and even anger. It isn’t easy when our dreams of motherly bliss come crashing down. Allow yourself to feel your feelings; they are normal and do not make you a bad mother. They simply make you human. Just like your crying baby.