Colic

Colic is frequent, prolonged and intense crying or fussiness in a healthy infant. Colic can be particularly frustrating for parents because the baby's distress occurs for no apparent reason and no amount of consoling seems to bring any relief. These episodes often occur in the evening, when parents themselves are often tired.

Episodes of colic usually peak when an infant is about 6 weeks old and decline significantly after 3 to 4 months of age. While the excessive crying will resolve with time, managing colic adds significant stress to caring for your newborn child.

You can take steps that may lessen the severity and duration of colic episodes, alleviate your own stress, and bolster confidence in your parent-child connection.

Symptoms

Babies have been known to fuss and cry, especially during the first three months of life. The range for what's considered typical crying is difficult to pin down. In general, colic is defined as crying for three or more hours a day, three or more days a week, for three or more weeks.

Features of colic may include the following:

• Intense crying that may seem more like screaming or an expression of pain
• Crying for no apparent reason, unlike crying to express hunger or the need for a diaper change
• Extreme fussiness even after crying has diminished
• Predictable timing, with episodes often occurring in the evening
• Facial discoloring, such as skin flushing or blushing
• Body tension, such as pulled up or stiffened legs, stiffened arms, clenched fists, arched back, or tense abdomen

Sometimes there is relief in symptoms after the infant passes gas or has a bowel movement. Gas is likely the result of swallowed air during prolonged crying.

When to see a doctor

Excessive, inconsolable crying may be colic or an indication of an illness or condition that causes pain or discomfort. Schedule an appointment with your child's health care provider for a thorough exam if your infant experiences excessive crying or other signs or symptoms of colic.

Causes

The cause of colic is unknown. It may result from numerous contributing factors. While a number of causes have been explored, it's difficult for researchers to account for all the important features, such as why it usually begins late in the first month of life, how it varies among infants, why it happens at certain times of day and why it resolves on its own in time.

Possible contributing factors that have been explored include:

• Digestive system that isn't fully developed
• Imbalance of healthy bacteria in the digestive tract
• Food allergies or intolerances
• Overfeeding, underfeeding or infrequent burping
• Early form of childhood migraine
• Family stress or anxiety

Risk factors

Risk factors for colic are not well-understood. Research has not shown differences in risk when the following factors were considered:

• Sex of the child
• Preterm and full-term pregnancies
• Formula-fed and breast-fed babies

Infants born to mothers who smoked during pregnancy or after delivery have an increased risk of developing colic.

Complications

Colic does not cause short-term or long-term medical problems for a child.

Colic is stressful for parents. Research has shown an association between colic and the following problems with parent well-being:

• Increased risk of postpartum depression in mothers
• Early cessation of breast-feeding
• Feelings of guilt, exhaustion, helplessness or anger

Shaken baby syndrome

The stress of calming a crying baby has sometimes prompted parents to shake or otherwise harm their child. Shaking a baby can cause serious damage to the brain and death. The risk of these uncontrolled reactions is greater if parents don't have information about soothing a crying child, education about colic and the support needed for caring for an infant with colic.

Diagnosis

Your baby's care provider will do a complete physical exam to identify any possible causes for your baby's distress. The exam will include:

• Measuring your baby's height, weight and head circumference
• Listening to the heart, lungs and abdominal sounds
• Examining the limbs, fingers, toes, eyes, ears and genitals
• Assessing reaction to touch or movement
• Looking for signs of rash, inflammation, or other signs of infection or allergies

Lab tests, X-rays and other diagnostic tests aren't usually needed, but in unclear cases they help to exclude other conditions as possible causes.

Treatment

The primary goals are to soothe the child as much as possible with a variety of interventions and ensure that parents have the support they need to cope.

Soothing strategies

You may find it helpful to have a plan, a list of soothing strategies you can try. You may need to experiment. Some may work better than others, and some may work one time but not another. Soothing strategies may include:

• Using a pacifier
• Taking your infant for a car ride or on a walk in a stroller
• Walking around with or rocking your baby
• Swaddling your baby in a blanket
• Giving your baby a warm bath
• Rubbing your infant's tummy or placing your baby on the tummy for a back rub
• Playing an audio of heartbeats or quiet, soothing sounds
• Providing white noise by running a white noise machine, a vacuum cleaner or clothes drier in a nearby room
• Dimming the lights and limiting other visual stimulation

Feeding practices

Changes in feeding practices may also provide some relief. Bottle-feed your baby in an upright position and burp frequently during and after a feeding. Using a curved bottle will help with upright feeding, and a collapsible bag bottle can reduce the intake of air.

Trial changes in diet

If soothing or feeding practices aren't reducing crying or irritability, your doctor may recommend a short-term trial of dietary changes. If your baby has a food allergy, however, there would likely be other signs and symptoms, such as a rash, wheezing, vomiting or diarrhea. Dietary changes may include:

• Formula changes. If you feed your infant formula, your doctor may suggest a one-week trial of an extensive hydrolysate formula (Similac Alimentum, Nutramigen, Pregestimil, others) that has proteins broken down into smaller sizes.
• Maternal diet. If you're breast-feeding, you may try a diet without common food allergens, such as dairy, eggs, nuts and wheat. You may also try eliminating potentially irritating foods, such as cabbage, onions or caffeinated beverages.

Parent self-care

Caring for an infant who has colic can be exhausting and stressful, even for experienced parents. The following strategies can help you take care of yourself and get the support you need:

• Take a break. Take turns with your spouse or partner, or ask a friend to take over for a while. Give yourself an opportunity to get out of the house if possible.
• Use the crib for short breaks. It's OK to put your baby in the crib for a while during a crying episode if you need to collect yourself or calm your own nerves.
• Express your feelings. It's normal for parents in this situation to feel helpless, depressed, guilty or angry. Share your feelings with family members, friends and your child's doctor.
• Don't judge yourself. Don't measure your success as a parent by how much your baby cries. Colic isn't a result of poor parenting, and inconsolable crying isn't a sign of your baby rejecting you.
• Take care of your health. Eat healthy foods. Make time for exercise, such as a brisk daily walk. If you can, sleep when the baby sleeps — even during the day. Avoid alcohol and other drugs.
• Remember that it's temporary. Colic episodes often improve after age 3 to 4 months.
• Have a rescue plan. If possible make a plan with a friend or relative to step in when you're overwhelmed. If necessary, contact your health care provider, a local crisis intervention service or a mental health help line for additional support.

Potential future treatments

One factor that may contribute to colic is an imbalance of the helpful bacteria in an infant's digestive tract. One treatment under investigation is the use of good bacteria (probiotics) to create an appropriate bacterial balance to improve overall digestive health.

Some studies have shown a reduction in crying times when babies with colic were treated with a bacterium called Lactobacillus reuteri. The studies have been conducted with small groups, and results have been somewhat mixed. Most experts agree there's not enough evidence at this time to support the use of probiotics to treat colic.

Alternative medicine

Several small studies have shown some benefits or mixed results for alternative treatments. There's not enough evidence, however, to judge the potential benefit over the risks. Alternative remedies under investigation include:

• Herbal teas
• Herbal remedies, such as fennel oil
• Sugar water
• Gripe water, a mix of water and herbs
• Massage therapy
• Chiropractic manipulation
• Acupuncture

Known risks include the following issues:

• Regular use of herbal teas or other liquid preparations may lead to decreased milk intake or a drop in sodium levels in an infant's blood.
• The lack of product regulation may result in contamination, unlabeled ingredients or inconsistent dosages in herbal remedies.
• Some homeopathic remedies contain low amounts of potentially toxic substances.

Talk to your baby's care provider before using an alternative medicine to treat your infant for colic.

Preparing for an appointment

It's a good idea to prepare ahead of time for an appointment with your baby's health care provider. Here's some information to help you get ready.

What you can do

To prepare for your appointment, make some notes about:

• The time and duration of crying episodes
• The age of your infant when the prolonged and recurrent crying pattern began
• Observations about your baby's behavior or other factors before, during or after an episode
• Your baby's feeding and sleeping schedule
• Strategies that you have used to soothe your child
• The people involved in caring for your infant, such as the other parent, grandparents, baby sitter or child care center professionals

Write down any additional questions you have about your baby's health or development. During your appointment, don't hesitate to ask any other questions as they occur to you.

What to expect from your doctor

Your baby's care provider is likely to ask a number of questions, such as:

• Can you describe a typical crying episode?
• What does your baby's cry sound like?
• Does your baby's body tense up?
• When do episodes occur? How long do they last? How many times a week?
• What things do you do to try to soothe your baby? How well do those things work?
• Does your baby have any problems with eating?
• Does the crying happen right after eating?
• What do you feed your baby, and how often?
• How often and how much does your baby spit up?
• How long does your baby sleep at a time? Have there been recent changes in sleep patterns?
• Does your baby ever seem to have trouble breathing during these episodes?
• How do you cope when your baby is crying? What about the rest of your family?

Your answers to these questions can help your baby's care provider determine if there are other conditions that may be contributing to crying and discomfort.

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