Colic
The hardest thing for parents to experience is watching their baby erupting in ear-shattering wails, complete with clenched fists, and an unhappy red face and no matter what you try you cannot comfort your miserable, crying baby. I remember when my daughter was only a few weeks old when she got colic. I did not know much about it then, but read and tried everything to help her relieve her discomfort.
Looking after a colicky baby can be very frustrating and distressing. Fortunately, colic does not last long. Most bouts peak at around six weeks and then typically start to taper off by 10 to 12 weeks. By the time your baby reaches its 4th month of life all the symptoms of colic and crying are usually gone.
The aim of this article is to explain what colic is, what causes colic and its signs and symptoms and how you can help your baby to settle and relieve some of the discomfort and pain she is experiencing.
What is colic?
Colic is the name for excessive, frequent crying in a baby who appears to be otherwise fit and healthy. It's a common problem that affects up to one in five babies.
Colic tends to begin when a baby is a few weeks old, peak at six weeks of age and get better around week 10 -12. It normally stops by four months of age, or by six months at the latest.
Crying episodes can go on for hours at a time, sometimes late into the night. Worst of all, it's extremely difficult to calm a colicky baby, which only compounds your own frustration, worry, and exhaustion.
Doctors usually diagnose colic based on the "rules of three".
Your baby's crying:
Lasts at least three hours at a stretch
Occurs at least three days a week
Persists for at least three weeks in a row
Signs and symptoms of colic include:
Intense crying bouts which seem to occur for no reason.
Crying in the late afternoon or evening that lasts several hours
Your baby's face being red and flushed when they cry
Your baby clenching their fists, drawing their knees up to their tummy, or arching their back while crying
Bowel activity may increase, and your baby may pass gas or spit up.
Eating and sleeping are disrupted by the crying — baby frantically seeks a nipple only to reject it once sucking has begun, or dozes for a few moments only to wake up screaming.
Your baby's crying outbursts are not harmful, and your baby should continue to feed and gain weight normally.
What causes colic?
The cause or causes of colic are unknown, but some theories have been suggested. These include indigestion, trapped wind, or a temporary gut sensitivity to certain proteins (cow's milk protein) and sugars (lactose) found in breast and formula milk.
Indigestion and trapped wind
Doctors don't clearly understand why some babies cry excessively and others don't, but a new study suggests abnormal gut bacteria could play a role.
The research identified a distinct bacterial "signature" in the guts of infants with colic, a term that describes babies who cry for more than three hours a day without a medical reason.
In the first few weeks of life, the research found, colicky babies had higher numbers of bacteria from a group called Proteobacteria in their guts compared to babies without colic. Proteobacteria include bacteria known to produce gas, which may cause pain in infants and lead to crying, said study researcher Carolina de Weerth, a developmental psychologist at Radboud University Nijmegen in the Netherlands.
Cow's milk sensitivity
Cow’s milk (either in the mother’s diet or engineered into formula) is a common source of food sensitivity in babies. Cow’s milk sensitivity or allergy can cause colic-like symptoms, eczema, wheezing, vomiting, diarrhea (including bloody diarrhea), constipation, hives, and/or a stuffy, itchy nose. Around 10% of babies with colic symptoms have cow's milk sensitivity.
Although cow’s milk protein sensitivity and lactose intolerance are not the same thing, they can sometimes occur at the same time, since food allergy can cause secondary lactose intolerance due to the damage of the intestine wall due to inflammation, thus reducing lactase activity (lactase is the enzyme which breaks down lactose - milk sugar).
Lactose
Congenital lactose intolerance or congenital lactase deficiency is extremely rare in babies.
However, lactose overload can occur in baby when mom has an oversupply of milk. The milk that baby gets earlier in a feeding (foremilk) is higher in lactose and lower in fat than the milk later in the feeding (hindmilk).
Although infants are not lactose intolerant by nature, a high volume of lactose can overwhelm a baby’s digestive system. When there is not enough lactase to break down all the lactose, the excess lactose causes gassiness and discomfort, and frequently green, watery or foamy stools. Over time, large amounts of undigested lactose can irritate the lining of the intestines so that even a little bit passing through can cause irritation. Occasionally, this can result in small amounts of bleeding into stools that can be misdiagnosed as a food allergy. Some pediatricians will mistakenly diagnose lactose intolerance if there is undigested sugar in the baby’s stool.
Colic occurs equally in girls and boys, and both in babies who are breastfed and those who are bottle-fed.
Treatment for colic
The following suggestions may help:
Holding your baby during a crying episode can sometimes help, as can wrapping them snugly in a blanket or baby sling.
Hold your baby in different positions – such as on your shoulder, cradled in your arms, or lying with their tummy faced down along your forearm.
Sit or hold your baby upright during feeding to prevent them swallowing air.
Don't drink too much tea, coffee, and other caffeine drinks if you're breastfeeding – some women also find spicy food and alcohol can aggravate colic.
Burp your baby after feeds – to do this, sit your baby upright or hold them against your shoulder and gently rub their back and tummy until they burp. They may vomit a small amount of milk when you do this.
Avoid overstimulating your baby by continually picking them up and putting them down – gently comforting your baby in a quiet, darkened room may be better. If you're satisfied your baby isn't hungry, tired, too hot or cold, or in need of a nappy change, it may help to leave them in their cot for a short while.
Babies like movement – pushing them around in their pram or pushchair or going for a drive can be comforting. Rocking them gently over your shoulder or carrying them around the house may also be helpful: but never shake your baby.
Some babies find white noise soothing – this is the background sound of a washing machine, vacuum cleaner or radio static.
Gentle stomach or back rubs or a warm bath may help.
Try gently massaging baby's tummy
You can do a "bicycle exercise" with your baby's legs to reliev some of the wind.
You can also try a Swedish product called "Windy the gas passer" in desperate situations when nothing else works.
Looking after yourself
If your baby has colic, it's important not to forget about your own wellbeing. Looking after a baby with colic can be exhausting and distressing, and it's common for parents to sometimes feel depressed, angry or helpless.
You may find the following tips useful:
If you feel you cannot cope with your baby's crying, it's best to put them down somewhere safe and take a few minutes as a time out.
Ask your friends and family for support – all parents need a break, and even an hour of rest on your own can help you cope better with the situation.
Try to rest when your baby is asleep.
Aim to see and talk to other adults every day, rather than spending all your time alone with your baby – you may find it useful to meet other parents with babies of a similar age to yours.
A support group called Cry-sis can also provide help and advice to parents with babies that cry excessively. You can contact the Cry-sis helpline on 0845 122 8669 (9am-10pm, seven days a week).
Medical treatments
As colic eventually improves on its own, medical treatment isn't usually recommended. But if you're finding it hard to cope, speak to your GP or pharmacist for advice about possible treatments.
There are some over-the-counter treatments available you may want to try. These are described below.
There isn't much good evidence for the effectiveness of these treatments, although some parents find them helpful. It may be worthwhile trying them one at a time for about a week or so each to see if they help.
Simeticone drops
Simeticone drops, such as Infacol, are a supplement that can be added to your baby's bottle or breast milk before a feed. The drops are designed to help release bubbles of trapped air in your baby's digestive system.
A one-week trial of simeticone drops is usually recommended. If your baby's symptoms do not improve within this time, it's usually felt there's little point carrying on with the treatment.
Simeticone drops are safe for babies to have and there have been no reports of side effects from the treatment.
Lactase drops
Lactase is an enzyme that helps break down a sugar called lactose, which is found in breast and formula milk. Your baby may have a temporary problem digesting lactose, which could contribute to their colicky symptoms.
Lactase drops, such as Colief, can be added to your baby's feed to make digesting the lactose easier. As with simeticone, using lactase drops for more than a week if symptoms don't improve isn't usually recommended.
Removing cows' milk
It's possible your baby may have developed a short-term intolerance to proteins found in cows' milk and other dairy products.
If you're breastfeeding, you can try removing dairy products from your diet for a week or two to see if your baby's symptoms improve.
Speak to your GP for advice if you decide to continue with a dairy-free diet after this point, as they may recommend taking additional calcium supplements to ensure you maintain good bone health.
If you're bottle feeding, see your GP for advice about switching to a hypoallergenic milk formula. This type of milk has low levels of the protein that may be causing the intolerance. Again, you can try using it for a week or two to see if your baby's symptoms improve.
Your GP can advise you about the most suitable hypoallergenic milk formula for your baby. Soya milk formula isn't usually recommended for babies less than six months old, as it contains hormones that may interfere with your baby's physical and sexual development.
If your baby's symptoms don't improve after using hypoallergenic milk formula for a week or two, it's usually felt there's little point carrying on with it.
Treatments to avoid
The following treatments could be dangerous for your baby and shouldn't be tried:
dicycloverine (also known as dicyclomine) – a medication used to control stomach cramps that have been used to treat colic in the past, but is now known to cause serious side effects in babies
star anise tea – a herbal tea that has traditionally been used to treat colic, but is no longer recommended because it sometimes contains toxins that could poison your baby
Speak to a pharmacist or your GP for advice before giving your baby a treatment if you're not sure whether it's safe for them to take.
Do I need to see my GP?
Colic may improve using the techniques mentioned above. You can also ask your health visitor for their advice.
See your GP if you're concerned about your baby, or if nothing seems to be working and you're struggling to cope.
Your GP can check for possible causes of your baby's crying, such as eczema or gastro-oesophageal reflux disease (GORD). GORD is a condition where stomach acid moves back out of the stomach and into the gullet (oesophagus).
If no other cause of your baby's symptoms can be found, your GP can advise you about the things you can do to help your baby, including what treatments are available.
When to seek immediate medical advice
You should get medical help immediately if your baby:
has a weak, high-pitched, or continuous cry
seems floppy when you pick them up
isn't feeding
vomits green fluid
has blood in their poo
has a fever of 38C or above (if they're less than three months old) or 39C or above (if they're three to six months old)
has a bulging fontanelle (the soft spot at the top of a baby's head)
has a fit (seizure)
turns blue, blotchy, or very pale
has breathing problems, such as breathing quickly or grunting while breathing
Information used from the NHS website: http://www.nhs.uk/conditions/Colic/Pages/Introduction.aspx and Kellymom:http://kellymom.com/health/baby-health/lactose-intolerance/