Colic

What is colic?

Colic is a term used when a baby cries frequently and intensely, and is difficult or impossible to soothe. There is disagreement among experts about a definition for colic, or if the term colic should even be used. Colic is sometimes diagnosed by the “rule of three”: crying about three hours per day, at least three times per week, for at least three weeks straight. The excessive crying typically begins in the second week of life and continues toward the end of the second month. After that, the colicky behaviour tapers off, usually ending by three or four months of age.

Some babies with colic may appear as if they are in pain. They may tend to stretch out their arms and legs, stiffen, and then draw in their arms and legs tightly to their bodies. Their stomach may be swollen and tight.

Causes of colic

Although colic was first described by the ancient Greeks, the cause of colic remains unknown. Many scientists believe that babies who are described as colicky do not have any condition, but are simply at one extreme of a normal pattern of infant crying in the first few months of life. Some have even asserted that excessive crying is a sign of physical health and vigour.

Some experts believe that more than one factor contributes to colic. There is growing evidence that individual differences in crying are related to development of the brain rather than development of the digestive system. There is no evidence to support psychosocial causes such as poor parenting. In a very few cases, less than 5%, there can be organic causes. There is some evidence linking maternal smoking to an increased risk of excessive crying and infant colic.

Facts about colic

  • Estimates of the occurrence of colic vary greatly, but most range from 5% to 25% of babies.

  • Crying is most frequent in the late afternoon or evening.

  • Any baby can become colicky. It does not mean there is anything wrong with your baby.

  • The cause of colic is unknown, but many doctors believe it is part of normal development for some babies.

  • Colic goes away by three or four months of age in most cases.

  • If your baby cries too much, see your doctor to make sure the crying is not a sign of a health problem.

  • Colic can be very stressful for parents. If you feel tired or upset, ask someone else to take care of your baby for a while. If you can’t find someone to help, leave your baby in a safe place, like a crib, in another room for a while to get a break. It is okay to let your baby cry for a while. What matters is that most of the time, when your baby cries, you try to comfort her.

  • Babies who have colic grow up normally.

  • Colic is equally likely to occur in bottle fed and breastfed infants, so if you are breastfeeding a colicky baby, do not stop.

  • Holding or rocking your baby and offering a pacifier might help.

  • There is no evidence that medicines really help with colic.

What should you do if your baby is crying excessively?

Contact your doctor if your baby is crying frequently, intensely, and cannot be soothed. This way you can make sure that your baby does not have a health problem. In most cases, the doctor will be able to offer you reassurances that this period of intense crying will pass, that it is very difficult, and that you are doing all you can to soothe your baby. However, your doctor will not be able to offer any specific medication.

It could also be helpful to visit with a lactation consultant or other breastfeeding specialist to rule out any breastfeeding problems. If your baby is hungry from not getting enough milk, there may be ways to improve the latch and thus the milk supply. Continue to try to soothe your baby in the ways that have worked best in the past, by offering feeding, close physical contact, holding and rocking, gentle singing or talking, or offering a pacifier. In some cases, these strategies may help.

What does current research say about how to treat colic?

  • There is evidence that eliminating milk products, eggs, wheat, and nuts from the diets of breastfeeding mothers can provide some relief from colic.

  • When mothers have taken herbal teas containing chamomile, vervain, licorice, fennel, and lemon balm used up to three times per day (150 mL per dose), it has been shown to decrease crying in colicky babies. Because herbal products do not come in standard strengths or formulas, be sure to consult your doctor before trying this.

  • Carrying your baby more can reduce normal crying; however, it will not decrease crying once your colicky baby has started crying.

  • There is some evidence to support trying a hypoallergenic formula in bottle fed babies with a family history of allergies or for babies who are intolerant of cow’s milk.

  • Although there is some evidence showing improvement in symptoms when bottle fed babies were switched to soy-based formulas, not all doctors recommend switching to soy-based formulas. Soy allergies could develop.

  • Babies who were breastfed and given the probiotic, L. reuteri DSM 17938, experienced improved symptoms of infantile colic. The probiotic was well tolerated and safe.

What not to do when treating colic

  • Do not stop breastfeeding. Colic is equally likely to occur in bottle fed and breastfed babies.

  • Chiropractic treatment has shown no benefit in treatment of colic.

  • Baby massage does not significantly improve colic symptoms.

  • Fibre-enriched formulas do not decrease crying in bottle-fed babies.

  • There is no evidence that simethicone, an over-the-counter drug, reduces colicky episodes.

  • The use of the drug dicyclomine is not recommended for use with babies.

  • Placing babies in car-ride simulators does not improve symptoms of colic.

  • Crib vibrators do not reduce crying in colicky babies.

Are there other ways of treating colic?

Other methods to reduce a colicky baby’s crying have been proposed, but have not been scientifically tested. These include:

  • Putting a colicky baby near a vacuum cleaner. The white noise is supposed to soothe the baby.

  • Specific ways of holding the baby that put pressure on the babies’ stomach – “colic holds.”

  • Taking the baby for a ride in the car or a walk in the stroller.

  • Use of gripewater. These herbal preparations are available online and in health food stores. Use is not without risk. If you decide to try one of these preparations, make sure it is free from alcohol and sugar and that it is manufactured by a reputable company.

 
9/22/2009

​Roberts DM, Ostapchuk M, O’Brien, JG.  Infantile colic.  American Family Physician 2004; 70: 735-740.

Shenassa ED, Brown M-J  Maternal smoking and infantile gastrointestinal dysregulation: The case of colic.  Pediatrics 2004; 114: 497-505

Rogovik AL, Goldman RD, Treating infants’ colic.  Canadian Family Physician 2005; 51: 1209-1211.

Barr RG,. Colic and crying syndromes in infants.  Pediatrics 1998; 102(5) supplement: 1282-1286.

Ellet MLC, What is known about infant colic?  Gastroenterology Nursing 2002; 26: 60-67.

Soltis J, The signal functions of early infant crying.  Behavioral and Brain Research 2004; 27: 442-490.

Barr RG, St. James-Roberts I, Keefe M (Eds) New Evidence on Unexplained Early Infant Crying 2001: Johnson & Johnson Pediatric Institute, L.L.C.

Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: A randomized, double-blind, placebo-controlled trial. Pediatrics 2010;126:e526-533.

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