Colic

Definition

Colic is sustained episodes of crying in a baby, for no apparent reason. Sometimes episodes last for several hours at a time. Colic usually begins within the first couple weeks of life and is usually gone by the time a baby is about five months old.

Causes

The cause of colic is not known. Experts suggest that the following may contribute to colic:

  • Abdominal pain due to excess air in the bowel
  • Excess energy at a time when babies don't have any other means to tire themselves
  • In breastfed babies, allergy or sensitivity to foods in the mother's diet, such as:
    • Garlic
    • Caffeine
    • Cruciferous vegetables (cabbage, broccoli, etc.)
    • Beans
    • Dairy products
  • Gastrointestinal distress due to:
    • Feeding too briefly on one breast, then switching to the other breast. This gives the higher sugar foremilk without the rich, fatty hindmilk.
    • Allergy to formulas containing dairy proteins
    • Overfeeding

Symptoms

Symptoms include:

  • Loud, high-pitched, inconsolable crying, sometimes for several hours at a time
  • Primarily occurs in the late afternoon or evening
  • Pulling up the legs toward the body
  • Tight or hard abdomen due to screaming
  • Burping and flatulence due to swallowing air while crying

Diagnosis

The doctor will ask about the baby's symptoms and medical history, and perform a physical exam. The doctor will look for signs of other illnesses that may cause the colicky crying.

The following questions will help determine if the baby has colic rather than a more serious medical condition:

  • Is she eating well/normally?
  • Is she growing well?
  • Is she producing 5 to 8 very wet diapers each day?
  • Is she producing stool normally?
  • Is she having colic-free periods?
  • Does she have a fever?
  • Are there findings of ear infection or another more serious medical conditions?
    • Serious medical conditions may be more likely if:
      • This is the first time the baby has ever had inconsolable crying
      • The baby appears pale or sick when crying
    • Relatively rare conditions sometimes wrongly diagnosed as colic include:
      • A painful scratched eye called corneal abrasion (The eye is usually red.)
      • Hair wrapped tightly around a finger, toe, or the penis
      • Painful reflux of acid into the esophagus and throat often associated with spitting up
      • A section of bowel trapped by a hernia or “intussusception” (Babies with these conditions may appear pale and sick.)

Intussusception

Intusssusception

© 2008 Nucleus Medical Art, Inc.

Treatment

Treatments to Help Soothe a Colicky Baby

Unless one of the conditions above or a specific food intolerance can be found, there are no safe and effective treatments for colic. The colic should stop by the time the baby is about five months old. Taking care of a baby with colic can be very frustrating and upsetting. You'll have to try lots of different remedies. What works during one episode of colic may not work the next time. If you feel that you are getting frustrated or angry, put the baby down safely in the crib until you feel that you are in control again.

The following remedies may soothe a colicky baby:

  • If you're breastfeeding:
    • Avoid caffeine, cruciferous vegetables, beans, and garlic.
    • Consider briefly eliminating dairy products from your diet to see if the colic improves.
    • Consider working with a lactation consultant to learn about techniques to ensure that your baby is getting plenty of hindmilk and not too much foremilk.
  • If you're bottlefeeding, ask your doctor about switching to a nondairy formula.—There is evidence that (expensive) whey protein hydrolysate formulas can help relieve symptoms in some formula-fed babies with colic. Formula changes may be more likely to succeed when colic first begins after a month of age. Later onset colic may be more likely due to food intolerance.
  • Two herbal formulations have been shown to be helpful in limited studies: fennel alone and a combination of chamomile, fennel, vervain, licorice, and balm mint. Discuss these herbs with your doctor before giving them to your baby.
  • Burp your baby well after feedings.
  • Make sure your baby isn't too warm or too cold.
  • Swaddle your baby with a soft blanket.
  • Try skin-to-skin contact.
  • Hold your baby close, and bounce gently or walk.
  • Rock your baby.
  • Put the baby on his tummy on your lap.
  • Pat your baby's back.
  • Play soft music.
  • Wear your baby in a baby sling or other safe baby carrier.
  • Give your baby a warm bath, or take your baby into a bath with you.
  • Let your baby use a pacifier.
  • Take your baby into the bathroom, and let him listen to the water running in the sink.
  • Learn baby massage.
  • Put your baby in a safe baby swing.
  • Go for a stroller walk.
  • Go for a car ride.

Treatments to Avoid

  • Treatments unlikely to work:
    • Drops to relieve “gas”
    • Automatic rockers or car seat simulators
    • Special blankets
    • Sound generators that make noises like a baby might hear in the womb
    • Switching to a soy-based formula
  • Treatments for which risks probably outweigh benefits:
    • Anticholinergic medications, such as dicyclomine, have been shown to reduce crying in colicky babies, but treatment (especially when too much medication is given) may lead to serious complications such as seizures or breathing abnormalities.
      • Because of rare but serious risks, most experts do not recommend treating colic with anticholinergic medicines. If your doctor proposes this kind of medication, be sure you understand the maximum dose to be given and how to recognize early symptoms of harmful outcome.

Treatments to Help Soothe Parents of Colicky Babies

  • Understand that everyone finds the high-pitched crying of a colicky baby difficult to listen to.
  • Play your favorite music with headphones to take a brief break.
  • Use earplugs. They won’t keep you from hearing the baby, but they will cut some of the very high frequencies of the crying and make it easier for you to be close to him or her.
  • Consider asking for help from family or friends, or hiring a sitter to come in and give you time to rest.
  • Know that if the baby doesn’t stop crying it’s not your fault:
    • Most colicky babies cry even if their parents do all of the things listed above.
  • Remember that most colic is gone by three to five months of age.
    • Count the days and plan how to survive this short, but intense ordeal
    • After five months, most colicky babies prove to be no more difficult than non-colicky babies.

Prevention

There are no guidelines for preventing colic because the causes are not well understood.

Smoking during pregnancy may increase the risk of colic. This is yet another reason for mothers not to smoke.

RESOURCES:

American Academy of Pediatrics
http://www.aap.org

KidsHealth
http://www.kidshealth.org

CANADIAN RESOURCES:

About Kids Health
http://www.aboutkidshealth.ca

Alberta Health and Wellness
http://www.health.gov.ab.ca/

References:

American Academy of Pediatrics website. Available at: http://www.aap.org .

Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics. 2000;106:184-190.

Kleigman RM, Jensen HB, Behrman RE, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007.



Last reviewed November 2007 by Kari Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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