CHALLENGING CASE: BEHAVIORAL CHANGES Beyond Infant Colic*

Some of the most interesting cases in pediatric practice evolve through time. What may begin as a clear, well defined problem with a predictable natural history and an accepted intervention strategy may develop into a more complex, multi-faceted set of problems. It is these children who potentially provide clinicians with new insights into behaviors. This case of a colicky infant illustrates the wide spectrum of behavioral and physiological symptoms that emerge from a specific underlying behavioral phenomenon. It also emphasizes the significant benefit derived from a longitudinal perspective of developmental events. Editor’s Note: In this Challenging Case, the case is presented in stages (boldface type), and Dr. Martin Stein responds to the information, sharing his reasoning with the reader (regular type). Two commentaries, by Drs. Esther Wender and William Carey, follow the presentation. Luke was a planned child conceived by a couple in their 30s who had active careers before marriage. The 40-week pregnancy was complicated by mild, first trimester bleeding and pregnancy-induced hypertension. Medication was limited to acetaminophen. Labor was spontaneous but prolonged, resulting in a Caesarean section with epidural anesthesia. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Luke was a robust, 9-pound, 8-ounce boy who breastfed vigorously in the delivery room. His father was present throughout the labor and delivery.