Colic

(Infantile Colic)

The Facts

It's appropriate that we should still call this condition by its medieval name "colic," since we know as much about its causes today as we knew 800 years ago.

A colicky baby is one who cries a lot and can't easily be pacified. Though there isn't a full agreement on the definition of colic, a common one is that if an otherwise healthy baby cries for more than 3 hours a day, more than 3 days a week for at least 3 weeks, it's colic. Colic affects boys and girls equally, and the incidence is also similar between breast and formula fed infants, as well as full term and preterm infants. It tends to appear in the first 6 weeks of life, up to the age of 3 to 4 months.

The Causes

There is no evidence that colic is caused by a disease. Colicky babies are typically healthy and full of energy. There has been much research to find what it is that makes colicky babies cry, but the answer remains elusive. Even after extensive testing, no medical causes have been found. One theory is that an underdeveloped digestive tract is responsible. Others blame abdominal gas, food allergies, or noise and distractions interfering with sleep. By looking at the various remedies that have been found to help, research suggests that some crying is just a matter of temperament or nervous system maturation. True abdominal issues, including being gassy, or acid reflux probably account for under 5% of cases. The best we can now say is that some babies just cry a lot at this age.

Other factors that have been found in some cases to have an influence on babies include:

swallowing air when feeding, especially if drinking from a bottle while lying down
an allergy to cow milk proteins found in formula or passed to the baby through breast milk (when mothers drink cow milk products, proteins from cow milk can be excreted into the breast milk)
an intolerance to certain foods eaten by the mother (and passed to the baby through breast milk)
overfeeding by parents who think the baby is crying due to hunger, rather than just needing to suckle (e.g., on a pacifier)

Symptoms And Complications

The crying of a colicky baby is often high-pitched, grating, and piercing, even compared to normal infant crying. Neither food nor attention can stop it. Your baby's face may be red, the fists may be clenched, and the knees may be tucked up into the abdomen.

The crying goes on for at least an hour, and sometimes as long as 4 hours. It often starts at the same time each day, usually late afternoon or early evening (unfortunately, when the parents are most tired). Sometimes, the baby passes gas or a stool shortly before or after calming down.

Colic is generally at its worst around the age of 4 to 6 weeks. If your baby is still colicky after 3 months, or cries nonstop for more than 3 or 4 hours, some other condition may be causing real discomfort and you should take the baby to the doctor. You may want to take your baby to the doctor when colic first appears, just for a checkup to ensure you are not overlooking something that can be effectively treated, especially if this is your first baby.

Always see the doctor if your baby has a fever, becomes lethargic, irritable, vomits more than 5 times a day (especially if vomit is green or bloody), has difficulty breathing, has poor weight gain, or has bloody stools.

Making A Diagnosis

You can't assume that a crying baby has no real problems until you've checked all possibilities. Any number of infections or other conditions could be causing your baby's pain. Diagnosing of colic requires eliminating these other possibilities. They include bowel obstruction; a scratched eye; a hernia; a hair or thread that has become tied around a finger or toe; or an infection of the bladder, brain, abdomen, or ear.

There's no chemical or physical test for colic. If the baby is crying more than 3 hours a day, more than 3 times a week, and for more than 3 weeks and is not physically sick, then your doctor may diagnose your baby with colic. The difficult part is figuring out how to remain calm and not let the colic interfere with the pleasure of raising your baby until the colic resolves itself at around the age of 3 to 4 months.

Treatment And Prevention

If you talk to other parents, you will hear dozens of ideas on preventing a colicky baby from crying. Your doctor may suggest some of the same techniques. Most behavioural interventions have not been proven to work but parents can try them anyway. They are generally not harmful and they do give the parent a feeling of "doing something." Trying to calm your child has been shown to lessen the total time spent crying, even if it doesn't seem like it. Keep a "cry diary" including descriptions of things like how the cry sounds, time of day it occurs, length of crying episode and what you tried to make the baby more comfortable.

The following methods have been used for centuries to calm babies with colic:

Swaddle the baby in a soft blanket.
Hold the baby more often during the day, even when the baby isn't crying.
Rock the baby gently.
Give the baby a warm bath.
Burp the baby more often.
Make sure the baby is sitting up when feeding. This reduces the amount of air swallowed.
Use the "colic carry" to hold your baby. Place the baby face down along your arm, with the chin in the palm of your hand and the legs straddling your inner elbow. Walk around the house a bit.
Take the baby out for a walk or a drive.
Try singing a lullaby to the baby.
If it all becomes overwhelming, take a break and leave the house. Let someone you can trust babysit for a few hours. If you're stressed or angry, the baby can sense it.
If you are breast-feeding, avoid stimulants such as caffeine and chocolate.
If you are breast-feeding, you may find that avoiding dairy products, broccoli, or cabbage is helpful.

Other options:

A pacifier may help, but make sure it's not held by a string around the neck.
Soothing music often helps both you and the baby relax.
Make sure the hole in the bottle nipple is not too large or too small. It should take about 15 to 20 minutes for the baby to drink a bottle. The nipple should release about one drop per second when held upside down. If it's too small, it can cause the baby to swallow air.
If feeding with a bottle, try using a curved bottle or a bottle with a collapsible bag to reduce air intake.

Many people find that rhythmic noise, white noise, and vibration help. For example, some mothers carry their baby in a chest pouch while vacuuming or put their baby in an infant swing which has a vibration setting. Cars provide vibration and a white-noise background, which explains why many colicky babies calm down during car rides. Washing machines, dishwashers, air conditioners, or the noise from a fan all provide a white-noise calming effect on some babies.

If none of these simple solutions seem to help much, ask your doctor about devices that attach to the crib that both gently vibrate it and provide a white-noise background. These devices are expensive, but for frazzled parents with a very colicky baby, they can be worth the price.

No medication has ever been proven to help colic (including those that claim to reduce "gas"). Never give your baby medications without talking to your doctor or pharmacist first. Breast-feeding mothers can also check with their pharmacist to find out if any of the medications they are taking may be part of the problem. Remember, the crying is not yours or the baby's fault! Never shake, grab, twist, or hit the baby. Take a break, get help, and stay calm.