If you suspect your baby has colic, you’re going to reach out for anything that will make help her feel better. This article describes the various medications used as a treatment for infant colic, how they work and potential side effects.
Colic medications categories
During your desperate search for solutions for your distressed baby's crying, no doubt many different types of remedies, mixtures and medications - some of which will be harmless, some potentially dangerous - have been recommended. Most of these will fit in at least one of the following categories...
- Anti-gas medications
- Herbal remedies
- Other medications
Anti-gas medications include:
- Simethicone (e.g. Mylicon Drops®, Infacol Wind Drops®, Phazyme Drops®)
- Many antacid medications also contain simethicone.
How do anti-gas medications work?
Simethicone reduces the amount of gas in a baby's stomach by dispersing the foam that forms when air is swallowed during feeding. The active ingredient encourages the tiny bubbles to join together to form larger bubbles, thereby making the gas easier to be brought up with a burp.
Simethicone can assist in removing some air from the stomach but it has no significant effect on gas in the intestines. Intestinal gas will either be absorbed into the blood stream or be pushed through as flatus. Simethicone also has no effect on the production of excessive gas in the intestines, which can occur during the normal digestive process. (See Infant gas for more details.)
Is simethicone effective in treating infant colic?
The use of medications containing simethicone is based on the assumption that infant colic is due to swallowed air; however, numerous studies have shown that swallowed air does not cause infant colic.
In several studies on the various anti-colic treatments available, simethicone worked no better than a placebo* in reducing the level of distress experienced by a colicky baby.
Is simethicone safe to be used to treat infant colic?
Although no medication can claim to be completely safe, simethicone has been shown to be relatively safe. Simethicone is non-sedating and side effects are rare. However, as studies have shown that simethicone works no better than the same amount of sugar water, you may want to save your money. [Please note: Similar to simethicone, giving sugar water does not help in the treatment of infant colic.]
* Placebos are sugar pills or sugar water, which are used as a comparison when testing the effectiveness of medications in clinical studies. A placebo effect is when a person reports an improvement in symptoms because they believe the medication was helpful, but in reality they received a sugar pill or mixture that offered no medicinal value. The placebo effect works on the parent rather than the baby.
For centuries herbal remedies have been used to treat infant colic. Some herbal remedies offered to infants are based on an assumption that infant colic is due to indigestion. Other are offered because it is believed they have a calming or tranquilizing effect.
Single herbs or a combination of different herbs may be used; given in the form of a tea or commercially produced mixtures.
- lemon balm
- Californian poppy
- lime blossom
Herbal colic mixtures
Many different herbs (listed above) can be used together. The various combinations of different herbs are huge. There are also hundreds of commercially produced 'natural infant colic remedies' available on the market today, which claim to soothe the discomfort of infant colic. (The list of individual brands is too huge to mention.)
How do herbal remedies work?
Different herbs work in different ways. There are many herbs that are used to aid digestion; reduce inflammation of the bowel; lessen gas production; and/or calm and tranquilize. There have not been enough studies done to understand exactly how each herb works, yet alone to understand how they work when combined.
Are herbal remedies effective in treating colic?
Many parents have faith in the benefits of herbal remedies to relieve the distress of a colicky baby. While some healthcare professionals also believe herbal remedies may help, others believe they offer no more than a placebo effect. There have been very few studies on the effectiveness of herbal remedies in the treatment of infant colic, so the jury is still out.
Are herbal remedies safe to be used to treat infant colic?
Many people believe herbal remedies are "natural" and therefore they must be safe; however, this is not always the case. Some of the most potent medicines available today originate from herbs. When taken in large quantities a herbal remedy can be harmful. Infants have died from the inappropriate use of herbal remedies.
Many herbal remedies are not recommended to be given to children. Be aware that some so called 'natural infant colic remedies' used in the past contained ethanol (alcohol). In most countries these products have been removed from the market, but it will pay to check labels carefully.
The same care should be taken when using herbal remedies as it is with medications. Always talk to a herbalist in person before giving herbal teas or mixtures to babies or children.
Many different medications contain antihistamines. The most commonly suggested to parents to treat infant colic are often those that have greater sedative properties, these include…
- Promethazine (Phenergan®)
- Diphenhydramine (Benadryl®, Banophen®)
- Dimenthdrinate (Dramamine®, Gavol®)
- Brompheniramine (Dimetap®)
How do antihistamines work?
Antihistamines are designed to relieve the discomfort of nasal congestion and red, inflamed eyes which are caused by hay fever and other allergies. They also help to reduce feelings of nausea and vertigo (dizziness and loss of balance) associated with motion sickness.
Antihistamines work by restricting our body's production of histamine, which is responsible for producing allergic symptoms. Histamine is one of our body's natural defenses against foreign bodies i.e. microorganisms or allergens, which can enter our body and cause illness.
Many antihistamines have a tranquilizing (sedating) effect, which will make a baby feel drowsy and 'out of touch'. Alternatively, some babies will experience the opposite effect and become extremely excited and irritated.
Are antihistamines effective in the treatment of infant colic?
Using these medications generally results in a decrease in the amount of time a baby spends crying and an increase in the amount of time a baby spends sleeping. However, apart from providing a sedating effect they offer nothing more in the treatment of infant colic.
In a small number of cases, where infant colic is thought to be caused by food or milk allergy antihistamines may be used to reduce allergic symptoms, such as wheezing, rash, and runny nose. However, dietary changes are far more effective in the long term management of food allergies.
Are antihistamines safe in the treatment of infant colic?
Unfortunately, because these medications are available over-the-counter this provides a false sense of security regarding their safety. Alarmingly, manufacturers warnings that these medications are not recommended for the use in children under the age of 2 years (due to the danger of impaired breathing) are often ignored, with some parents being advised to give these potentially harmful medications to infants as young as 1 month of age.
Any medication has the potential for unwanted side effects. When an antihistamine is given for the purpose it was intended, and that is to relieve the discomfort of allergic symptoms, the benefits often outweigh the risk of side effects. However, when antihistamines are given solely for their sedating effect, such as in the treatment of infant colic, then the potential risk of side effects generally outweigh any perceived benefits.
Side effects from sedating antihistamines in particular are; headaches, difficulty passing urine, dry mouth, blurred vision, nausea, vomiting, constipation or diarrhea. Rarely, some antihistamines can also cause palpitations and abnormal heart rhythms, high blood pressure, allergic reactions (such as swelling, rash and breathing difficulties) dizziness, confusion, depression, disturbed sleep, tremor, convulsions, blood and liver disorders and over-excitement in children.
Phenergan® which has a similar chemical structure to phenothiazine (a potent anti-psychotic medication) have been linked with an increased incidence of Sudden Infant Death Syndrome. Although very rare, Phenergan can also cause a potentially fatal condition called Neuroleptic Malignant Syndrome. Symptoms include high fever, rigid muscles, sweating, and rapid or irregular heartbeat.
NEVER give antihistamines to a baby or child without first consulting a doctor.
The two most commonly prescribed antispasmodic medications used in the treatment of infant colic are...
- Dicyclomine (Bentylol®, Merbentyl®)
- Hyoscyamine (Levsin Drops®, Donnalix Infant Drops®)
How do antispasmodics work?
All antispasmodics relax the muscles in the wall of the intestines (and also the urinary bladder) preventing spasms from occurring. Although the exact process of how antispasmodics work is unclear it is known that these medications block nerve impulses from the brain and spinal cord to the intestinal wall, reducing intestinal spasms.
Are antispasmodics effective in the treatment of infant colic?
Antispasmodic medications are prescribed with the assumption that infant colic is due to an abdominal cramps or spasms from an overactive gastro-colic reflex.
Studies using antispasmodics have demonstrated a reduction in the amount of time a colicky baby spends crying each day and an increase in sleeping. However, there is much debate among health professionals as to whether this is due to relief of gastric discomfort or due to the sedative effects of these medications.
Are antispasmodics safe in the treatment of infant colic?
No medicine is completely safe. Although side effects from antispasmodics are not common, they can occur.
Side effects include: heartburn, dilated pupils, dry mouth, rapid heartbeat, constipation, blurred vision, confusion, dizziness, decreased sweating, drowsiness or difficulty sleeping, headache, breathing difficulties, weakness, lack of co-ordination, loss of taste, nausea, vomiting, skin reactions, nervousness and allergic reactions.
Up to 5% of infants treated with dicyclomine (Bentylol®, Merbentyl®) may develop serious side effects, including breathing difficulties, apnea, seizures, syncope, asphyxia, coma and muscular hypotonia. In addition, several cases of death have been reported in infants taking dicyclomine. As a result dicyclomine is no longer approved for use in the United States in babies younger than 6 months of age.
Antispasmodic drugs are only available by doctor's prescription. Given the severity of potential side effects it's not surprising that these drugs are rarely prescribed by pediatricians for infant colic.
Several sedative or sleep-inducing drugs including alcohol have been reported as effective treatments for infant colic. However, there is a potential for serious side effects associated with using these medications and the risk to a healthy (yet colicky) baby far outweigh any benefits.
What sedatives have been used in the past to treat infant colic?
- Phenobarbital (also known as phenobarbitone in some countries)
- Chloral hydrate (Notec®)
- Alcohol (brandy, whiskey etc.)
- Many medicines contain mixtures of different drugs which combines antispasmodic medications with Phenabarbital or alcohol, or both e.g. Donnatal®.
How do sedatives work?
Sedatives (including alcohol) are strong drugs which depress a child's central nervous system; this means pulse, breathing rate and level of awareness, resulting in abnormally deep sleep. The child's ability to respond is also affected. Feelings of pain are decreased.
Phenobarbital is frequently used in the treatment of seizures.
Are sedatives effective in the treatment of infant colic?
These medications are very effective in reducing the amount of time a baby spends crying and increasing the amount of time a baby spends sleeping (albeit abnormal sleep). But apart from sedative a baby these medications will do nothing to treat any possible underlying problems that is causing the baby to cry in the first place, so crying is likely to continue once the sedation wears off.
Are sedatives safe in the treatment of infant colic?
Although these drugs are important in treating certain medical conditions most health professionals would agree these drugs should never be given to a healthy baby simply to stop his/her crying.
Side effects include: decreased breathing rate, slow heartbeat, sluggishness, excessive drowsiness, lack of muscle coordination, temporary cessation of breathing, apnea, nightmares, anxiety, delirium, difficulty sleeping, excitement, irritability and hyperactivity in children, hallucinations, increased physical activity and muscle movement, headache, confusion, dizziness, seizures, nausea, vomiting, poor feeding, constipation, nervousness, agitation, anemia, allergic reactions (localized swelling, especially of the eyelids, cheeks, or lips, skin redness and inflammation), angioedema (swelling of face around lips, tongue, and throat, swollen arms and legs, difficulty breathing), low blood pressure, fainting, fever, muscle, nerve or joint pain, softening of bones. Many sedative medications are addictive.
Many different antacid medications are used to treat infant colic with the assumption that an infant's distress is due to the burning effects of heartburn, associated with gastro-esophageal reflux. (See Antacids for more details on the various antacids; their advantages, disadvantages and side effects.)
- Diphenoxylate (Lamitol®, Lomitol®)
Past generations of parents were advised to use diphenoxylate to treat infant colic. Diphenoxylate works by reducing excessive contractions of the intestines which result in diarrhea. However, diphenoxylate is not a medication that health professionals would recommend these days to treat infant colic, because diphenoxylate is a narcotic-derivative, which means it has sedative properties. Many of the side effects described under 'Sedatives' above are also relevant to diaphenoxylate.
Even in the treatment of diarrhea, antidiarrheals are not generally recommended for children. Diphenoxylate should not be used for children under the age of 2 years. Loose watery bowel movements (diarrhea) can be perfectly normal for infants or they can be a sign of an illness or underlying medical condition. Have your baby seen by a doctor is you are concerned about his/her bowel motions.
- Ibuprofen (Mortin®, Advil®, Nurofen®)
- Acetaminophen (Tylenol®)
- Paracetemol (Panadol®, Dymadon®)
These drugs are used to treat fever and pain. Many painkillers also have a mild sedative effect. Although a colicky baby often appears to be in pain, many causes of infant colic are not related to physical discomfort or pain. Pain killers should not be used for healthy crying babies when the cause of crying is unclear.
OTC painkillers need to be treated with respect and caution, like any other drug. It's always a good idea to discuss the use of medications with your baby's doctor. OTC pain killers also have potential side effects, particularly if they are taken in large doses over a long period of time.
Side effects include: Ibuprofen - headache, nausea, stomach irritations and upsets, skin rashes, fatigue, dizziness, sleep problems. Acetaminophen - anorexia, abdominal pain, nausea, vomiting, liver failure. Paracetamol - skin rash, fever, kidney damage.
See Pain Relievers for more information.
Lactase drops are often recommended based on the assumption that colic is due to abdominal gas caused by lactose intolerance. However, studies have shown no difference between lactase drops and placebos in reducing colicky babies' crying.
For a baby
There are direct benefits to the child. A secondary benefit may be that sedating a baby may reduce the risk of harm from overwrought and overstressed parents/caregivers whose tolerance has been stretched beyond their ability to cope.
As any parent with a colicky baby will testify, it is exhausting and extremely stressful to continue to cope with the demands of a distressed, overtired, crying baby day after day (sometimes night after night). Many exhausted, stressed parents will resorting to sedating their baby but only once they feel no other option is available.
For health professionals
Recommending medications to treat infant colic is time efficient. Many have limited time for appointments and are not able to spend the necessary time counseling worried parents. Also many health professionals are not familiar with the use of effective behavioral methods to calm colicky (yet healthy) babies.
The use of medications in the treatment of infant colic is highly debatable among health professionals. While some health professionals recommend the use of medications, many do not. Medications that can appear to successfully treat infant colic, in other words minimise the baby's crying, often do so because of their sedating effects. Once the sedating effect wears off, crying quickly returns.
For a baby
Separate from the risk of serious side effects (some of which can be life threatening) there are also the possibility other less obvious problems that may result from long term use of sedating medications (i.e. antihistamines, antispasmodics and sedatives).
- Feeding may be affected resulting in decreased weight gain.
- The sleep obtained by sedation is abnormally deep sleep. Babies normally spend 50% of their time in REM (rapid eye movement) sleep, which is a light sleep stage. (See Infant sleep patterns.)
- The use of sedating medications may interfere with bonding as a baby cannot engage fully with parents when he/she is sedated.
- When experiencing the 'out of touch' feeling caused by sedation a baby cannot fully appreciate and interact with the world around them.
- Babies are learning from birth (before birth in fact). Anything that impairs with their ability to interact may also affect their ability to learn.
- Children need to practice physical tasks (such as hold their head up, rolling etc.) in order to develop muscle control and master these skills. Prolonged use of sedating medications restrict a baby's ability to practice.
- The side effects of using medications in the treatment of infant colic may create greater problems than the drug was intended to treat.
- Once on the path of believing their baby's crying is due to a medical reason parents often search for a 'cure' in the form of medications. As each medication fails (as they often do) this may result in further use of different medications or herbal remedies, in addition to making multiple dietary changes. All of which further complicates the situation making it more and more difficult for parents to work out exactly what is going on.
- Medications are expensive... especially if they don't work.
What else to try?
Most of the above medications are given to crying babies based on the assumption that 'infant colic' is a condition caused by intestinal gas or spasms; some medications are given purely for their sedative effect.
Infant colic is not a condition but a term used to describe "excessively long periods of crying in an otherwise healthy, thriving baby". In other words "infant colic" describes how a baby behaves rather than what a baby has. Babies can become distressed for numerous reasons; many of which have nothing to do with gastrointestinal discomfort. (See Infant Colic.) For each individual baby the reason, or reasons as can often be the case, can differ.
The most effective treatment for your baby's distress will rely on accurate identification the underlying cause. This will enable you to take appropriate steps to remedy the situation. Steps could involve honing your skills in interpreting your baby's behavioural cues, or changing some of your infant feeding or settling practices, or making adjustments to baby's feeding or sleeping patterns.
At Baby Care Advice, we find we are able to help parents to successfully resolve their baby's distress without the use of medications. We achieve this by assisting parents to identify the underlying cause of their baby's distress, and by advising parents on strategies to promote their baby's contentment.
A key component of our success is that we don't make assumptions about the cause, rather we take great care to assess all potential reasons for a baby's distress. An assessment is done by asking the parent to complete an emailed questionnaire comprising of approximately 80 questions about their baby; his/her birth, growth pattern, physical health, feeding method, feeding patterns and behaviour, sleeping patterns and behaviour, and the parent's infant feeding and settling practices. (See Consultations for more details on what we can do.)
Written by Rowena Bennett.