BabycareAdvice.com Articles: Colic

Infant colic is NOT a specific condition RATHER a term used to describe "excessively long periods of inconsolable crying in a healthy, thriving baby". In other words "infant colic" describes how a baby behaves rather than what a baby has. In real terms, when a health care provider makes a diagnosis of infant colic, he/she is really saying "Your healthy baby is crying and I don't know why".

Infant colic affects 30% of all babies; with breastfed and formula fed babies affected equally. Infant colic occurs between the ages of 2 and 16 weeks, with the peak period of irritability occurring around 6 to 8 weeks.

Infant colic is NOT dangerous, although it can be frightening. The crying will cause NO serious problems for your baby.

Symptoms of infant colic

The main symptom of infant colic is NONSTOP inconsolable crying, which lasts for 3 hours or more. Although this type of crying can occur at any time, it's usually WORSE in the evenings. Colic can occur 3 or more days a week, and continues over a period of at least 3 weeks. (For some babies it may last for months.)

When your baby has colic NOTHING you do seems to comfort her OR stop her from crying. Beyond crying, she may look uncomfortable and appear to be in pain. She may lift her head or legs, become red in the face and pass wind. She may refuse to feed during episodes of colic or she may continue her screaming soon after feeding.

Many of the distressed behaviors displayed by a "colicky" baby are OFTEN thought to be due to physical discomfort or pain. However, there are many reasons for both inconsolable crying and other distressed behaviors that have NOTHING to do with physical discomfort/pain.

When crying is NOT colic

NOT all crying is colic. The term 'colicky' baby is often used incorrectly to describe normal crankiness that all babies experience from time to time. Some babies simply cry more than other babies. It's normal for babies to cry, sometimes 2 or more long crying times each day.

Babies cry to communicate when they need something. This could be something simply like a cuddle, rocking or feeding. Most of the time babies can be calmed once parents have worked out what they want, which is NOT always easy. (See Crying baby for more information on common reasons why babies cry.)

If your baby is able to be comforted it's NOT colic! The main difference between normal crying and infant colic is whether your baby can be comforted or not. A baby with infant colic cannot be comforted during crying episodes.

What causes infant colic?

NO ONE knows for certain, NOT even the experts can agree. No matter who you talk to, everyone will have DIFFERENT ideas about the cause and treatment of infant colic. It's very likely that colic is NOT due to a single cause but due to a COMBINATION of different reasons.

There are a number of common theories on why colic develops; as yet NONE have been proven. Some theories which have been put forward over the years include...

1. Swallowed air (wind or gas)

This theory suggests that infant colic is due to stomach pain, related to air swallowed during feeding OR while crying. The air passes into the baby's intestines (or bowel) and causes bloating, abdominal spasms or cramps. This is OFTEN referred to as a baby having "wind" or "gas".

This is perhaps the MOST popular theory on infant colic. However there has been NO evidence to support this theory. Studies have shown that although all babies may swallow air during feeding or crying, they generally DON'T all cry inconsolably for long-drawn-out periods because of swallowed air. Wind/gas alone RARELY causes the level of distress experienced by a 'colicky' baby. (See Infant gas for more information.)

Dispelling myths:
1. Failure to burp your baby does NOT cause infant colic.
2. Taking a baby outside on a windy day OR driving with the car window open does NOT cause a baby to swallow air.

2. Baby's diet

Breast OR formula fed, a baby's diet is OFTEN thought to be the reason for infant colic.

LACTOSE INTOLERANCE
Lactose intolerance is a condition that makes it difficult to digest milk. This is one of the first conditions parent worry about when faced with a distressed baby, because it is a common condition in older children and adults. However, lactose intolerance in babies is very RARE and is NOT a cause of infant colic. Symptoms of lactose intolerance in babies include: excessive gassiness, cramps, diarrhea and weight loss. A baby with lactose intolerance is extremely unwell.

LACTOSE OVERLOAD
Due to an immature digestive system some young babies may experience gastric symptoms SIMILAR to lactose intolerance, which are due to lactose overload (also known as 'functional lactase insufficiency'). The major difference to lactose intolerance being babies experiencing gastro-intestinal symptoms due to lactose overload are healthy and gain LARGE amounts of weight. (The management of lactose intolerance and lactose overload is very DIFFERENT.)

COW'S MILK PROTEIN ALLERGY OR INTOLERANCE
This is a possible cause of 'colicky behavior', especially where there is a strong family history of allergies. Gastro-intestinal symptoms that may indicate a milk allergy or intolerance include excessive gassiness, cramps, diarrhea (which may contain mucous or blood), vomiting may also be present, but not always. A formula fed baby with milk protein allergy or intolerance will loose weight, whereas a breastfed baby may struggle to gain weight. A baby with a allergy may also develop allergy-type symptoms, such as wheezing, nasal congestion, hives or eczema.

DIETARY IRON
Some people MISTAKENLY blame dietary iron for infant gas and/or constipation. However, the amount of iron in breast milk or iron-fortified formula is NOT enough to cause stomach ache. Iron is ESSENTIAL for growing babies. NEVER restrict iron in your baby's diet unless advised to do so by a doctor.

3. Breastfeeding mother's diet

Foods eaten by nursing mothers are OFTEN blamed (but are in reality RARELY the reason) for infant colic. There's NO real difference between the number of breastfed and formula fed babies who suffer with colic. If nursing mothers' diet was a major cause of infant colic, you would expect to see MORE breastfed babies with this problem than formula fed babies.

GAS PRODUCING FOODS
This theory suggests that gas producing foods such as cabbage, cauliflower, broccoli and onions, in the mother's diet will cause gassiness in her breastfed infant. Studies suggest that this is UNLIKELY.

BUBBLY SODAS (SOFT DRINKS)
Nursing mothers are often told that sodas that contain carbonate (which make the bubbles) will cause excessive gas in their infants. This theory has also not been proven to be a cause of colic. (However, it is wise for nursing mothers to drink plenty of water and restict colas or other drinks containing caffeine.)

CAFFEINE
Another theory relating to a mother's diet is that too much coffee, tea, chocolate or sodas that contain caffeine (such as colas) may make a baby lose sleep and become irritable. Caffeine is EASILY transferred in breast milk and in large amounts can cause agitation and irritability in breastfed infants. If you limit coffee (or equivalent amounts of caffeine) to 3 cups or less per day, this will NOT normally cause any problem for your breastfed baby.

FOOD ALLERGIES
Although RARE, it is possible for a breastfed baby to develop an allergy to a food eaten by her mother, this includes milk. Reactions to food allergens in breast milk will initially present in a similar way to infant colic. Babies with a true allergy will develop other allergic type symptoms within a few weeks. (See milk allergy & intolerance for more information.)

4. Gastro-intestinal problems

GASTRO-ESOPHAGEAL REFLUX (GER)
Spitting up some milk is NORMAL for babies. Approx 50-70% of healthy, thriving babies spit up occasionally (or even regularly). For the MAJORITY of babies spitting up does NOT cause heartburn or colic. (Just because a baby spits up does NOT mean they are immune to the many other reasons for infant colic.)

Gastro-esophageal reflux disease (GERD) CAN cause 'colicky' behavior in a TINY number of babies who spit up. These babies experience EXCESSIVE spitting up (sometimes projectile) which results in poor weight gain, even weight loss. Others may experience severe HEARTBURN as a result of continuous regurgitation of stomach acids which can occur with or without spitting up. Feeding difficulties and poor weight gain OFTEN develop as a result. These babies are EXTREMELY distressed and will cry inconsolably for long periods at anytime during the DAY and through the NIGHT (not only in the evenings).

GASTRO-COLIC REFLEX
When a baby sharply pulls away from the breast or bottle, fidgets, grunts, passes some gas or a poop and then returns to feeding, this is due to the gastro-colic reflex. This is normal infant behavior! Feeding stimulates the gastro-colic reflex, which triggers an urge to poop (sometimes passing only gas). The gastro-colic reflex compliments the defecation reflex, which is triggered in response to expansion or filling of the baby's large bowel. Both of these reflex actions which can appear like a baby is straining. (See infant reflexes for more information.)

Another theory is that infant colic is the result of an exaggerated gastro-colic reflex, which presents as frequent abdominal spasms which cause physical discomfort for the baby. These spasms occur in waves that can continue for hours, during which time the baby is terribly upset. The pain is relieved by passing gas (flatus) or a poop (stool).

CONSTIPATION
Constipation is OFTEN blamed for a baby's distressed behavior. However, constipation is NOT a reason for infant colic. What can appear like straining, i.e. drawing up legs, grunting, groaning, going red in the face, FREQUENTLY occurs as a result of the gastro-colic and defecation reflexes (above) and is often MISTAKEN as a sign of constipation.

IMMATURE DIGESTIVE SYSTEM
Many people believe that babies' immature digestive systems is the major reason for infant colic. Indeed, we know that young babies' digestive tract does NOT produce all the enzymes and digestive juices needed for breaking down food until 4 months of age (or older). An immature digestive system is suspected of being the reason why a small number of babies experience gastric symptoms due to cow's milk protein intolerance or lactose overload (which is often MISTAKEN as lactose intolerance).

5. Parental stress

For years it was thought that infant colic was a result of a baby's stress from being handled and cared for by inexperienced parents. There is absolutely NO evidence to support this theory. First born babies do NOT cry any more than later born babies, which would be expected if parental inexperience was the cause.

6. Baby's temperament

Many health professionals believe infant colic is NOT due to a condition at all. They believe that prolonged crying is an extension of crying that's normal for all babies under the age of 4 months. The theory is that a baby's temperament may mean some babies simply cry more than other babies. Parents are offered reassurance such as "It's normal" or "She'll outgrow it".

7. Neurological development

It has been observed that babies with colic are more easily over-stimulated than other babies. Some studies suggest that colic has NOTHING to do with stomach pain at all, but instead is due to a baby's inability to remain calm when dealing with the stimulation of their new world. Once worked up, many babies (particularly those under 3 months) have a hard time calming down.

8. Sleep deprivation

Others believe the distressed behavior displayed by 'colicky' babies is NOT due to physical pain, which leads to lack of sleep, RATHER lack of sleep leads to distressed behavior, which can APPEAR as if the baby is experiencing physical pain. This theory is based on the belief that a baby's dependence on parental help to fall asleep leads to a disruption in infant sleep patterns, resulting is shorter naps and less sleep. The baby then cries due to the distress of over-tiredness, until he/she eventually falls asleep exhausted.

9. Spinal functional disturbance

Many chiropractors believe that infant colic may be linked with incorrect positioning of the spine, which can arise from the physical stress to a baby's body during birth. It is suggested that a baby's colic can be reduced by visiting a chiropractor, who will apply slight pressure to correct the spine's alignment.

This should NOT be confused with 'cranio-sacral therapy', which is practiced by osteopaths. Some osteopaths believe infant colic is due to compression at the base of the skull, which can in turn affect the spine and pelvis. Osteopaths use gentle rhythmic movement of the head to treat infant colic.

10. Other conditions

There are ALSO a number of other conditions that affect babies that are sometimes blamed for long period of inconsolable crying in healthy babies.

THRUSH
An overgrowth of the yeast fungus called 'Candida Albicans' can cause a thrush infection in a baby's mouth or diaper area. Sometimes a "sore mouth" is blamed for a baby's inconsolable crying or feeding difficulties. However, even if a thrush infection remained untreated, it is very RARE for it to reach the level where it will cause distress for a baby (i.e. ulcerations in the mouth.)

TEETHING
Parents often start to worry about the possibility of "sore gums" due to teething when there is NO obvious reason for their baby's distress. Teething is NOT a cause of infant colic because apart from the RARE occurrence where babies are born with a tooth, it is very UNCOMMON for the first tooth to appear before the age of 3.5 months, a time when infant colic generally disappears.

DIAPER RASH
Understandably a severe diaper rash could cause discomfort for a baby due to a "sore bottom", and she may cry due to the stinging or burning effects of urine (pee) or stools (poop) on tender raw skin, that has occurred as the result of a diaper rash.

When to see a doctor

Although colic is RARELY due to a medical problem, its is important when a baby cries for long period of time and is NOT able to be calmed by soothing methods, that she is examined by her doctor to rule out any underlying medical problem.

Infant colic treatments

Since colic is most likely NOT one condition, but a set of symptoms with a variety of DIFFERENT causes (or even a COMBINATION of causes) each baby may respond differently to different treatments.

Soothing methods

A baby with colic can often NOT be comforted, but it may be well worth your while to try some of the MANY soothing methods to see if they help. Use soothing methods that aim to REDUCE the amount of stimulation your baby is experiencing.

Medications

Colic mixtures, gripe water etc. are of NO proven benefit. Comparison studies of different mixtures found that these products were less useful than the same amount of sugar water.

Antacid medications may be helpful in reducing heartburn caused by gastro-esophageal reflux disease (GERD) but are of little or NO benefit to babies with gastro-esophageal reflux (GER), who do NOT experience heartburn (which is the majority of babies who spit up).

There are also medically prescribed medications that aim to minimize abnormal spasms related to the gastro-colic reflux. However, many of these contain alcohol or sedatives and it remains unclear whether they relieve any pain OR simply sedate the child. (See anti-colic medications for more details.)

Natural remedies

Herbs such as chamomile, dill, peppermint, ginger, fennel, caraway and aniseed, given fresh or dried in the form of a tea are often recommended as 'natural remedies' for colic, but their effects, if any, are often temporary.

Starting solids

Parents often wonder whether it would help to start their baby on solid food. Solids will NOT relieve colic and may further complicate the situation.

Understanding your baby

Perhaps the MOST effective treatment for colic is PREVENTION. In MOST situations the incidence of colic can be reduced significantly by understanding your baby's temperament. By working with your child's temperament RATHER than unknowingly working against it you may find the prolonged periods of crying can be REDUCED.

What to do when at the end of your rope!

It's natural to feel anxious and upset when your baby cries and it can be extremely exhausting trying to comfort a distressed baby. First of all it's important to accept that all babies cry... it's NOT your fault!

Babies with colic will cry whether they are being held or NOT, so it's OK to put your baby gently into her crib. She will not be harmed by spending time alone in a safe spot, especially if you need a break.

Have something to eat and drink. If someone is available to watch over your baby, take a walk, bath or shower, or anything else you find works best to reduce your level of stress. If no other adult is with you, call a friend or family member and ask them to come over. If they can't come over, talk to them over the telephone until you feel calmer.

NEVER SHAKE YOUR BABY! This can cause serious and permanent brain injury OR death. Many infants are killed in this way (mostly unintentionally) every year.

We value your feedback!

If you would like to comment on this article or if you have a question regarding infant colic that has not been covered in this article, feel fee to email us at info@babycareadvice.com.

How we can help!

At BabycareAdvice.com we don't have fixed ideas about what causes colic. We DON'T make a snap diagnosis on why your individual baby is crying. For each baby the reasons could be different. Our specialty lies in carefully examining all possible causes.

A consultation with one of our qualified and experienced consultants can help you to pinpoint the reason or reasons for your baby's distress. We can't promise to help you to make your "colicky" baby into a "perfect" baby but we can help by explaining ways to reduce her distress and encourage her contentment.

If you would like more information about our consultation service click here.

Colic

What is infant colic?