What Is Colic?
Colic in infants frequently generates anxiety in new parents. First described in biblical times, Dr. Morris A. Wessel defined colic in 1954 as "excessive" crying lasting more than three hours a day, more than three days per week, and for more than three consecutive weeks. These children are otherwise well, and their crying is not due to either pain or hunger. This inordinate crying starts at about 2 weeks of age, hits a maximum in intensity at about 6-8 weeks of age, and then gradually diminishes with resolution by 16 weeks of age. Many developmental specialists point out that premature babies will follow this same pattern and also start their colicky experience about two weeks after their due date (regardless of actual date of birth). Studies have indicated that 10%-25% of healthy newborns may experience colic.
What Are Causes of Colic?
The proposed causes of colic tend to focus on the immaturity of the child's intestinal tract and/or nervous system. Colic is an equal opportunity tormentor. Symptoms show no predilection with respect to racial, ethnic, socioeconomic group, or gender. While much research has been focused on the topic, no consistent explanation as to cause has yet been defined. Rather, most specialists hypothesize the cause to be multifactorial -- a combination of genetic predisposition, neurodevelopmental immaturity, and possibly influenced by behavioral and social/cultural aspects.
What Are Risk Factors for Colic?
Many child-care specialists believe colic is a relatively common and normal infant behavior pattern. It may tend to occur more commonly in firstborn children. Some believe that the normal anxiety of being a first-time parent may be a predisposing factor. These developmental behavioral specialists propose the infant can sense their parent's apprehension via body language, pitch/tone/volume of voice, and a more tense or stiff technique when handling their newborn.
What Are Symptoms and Signs of Colic?
Crying usually begins suddenly. Most parents report their infant's crying symptoms build to a crescendo during late evening and into the night. For unknown reasons, the baby's cessation of symptoms often ends as abruptly as they start. Colicky babies may have a host of behaviors (none of which are only limited to an episode of colic). These include
- arching the back;
- extending the legs;
- clenching the fists;
- reddening of the face;
- belching or spitting up excessively after feeding, which may relieve symptoms;
- passing gas; and
- having difficulty passing stools.
Many parents will notice that their infant seems to experience a less intense form of colic. Pediatricians refer to this as "nighttime fussiness," The onset, peak, and resolution of symptoms are the same as colic. Babies with colic, however, seem more inconsolable for longer periods of time than those experiencing nighttime fussiness. Parents with colicky children find no trick to intercede in their child's frustration. Parents with nighttime fussiness children find themselves helping their infant gain control of their frustrations only to have symptoms surge and "we're right back where we started from!"
What Specialists Treat Colic?
Pediatricians are the best resource to help concerned parents to diagnose a child, as well as counsel parents regarding colic.
How Do Health-Care Professionals Diagnose Colic?
A doctor will assess your baby to rule out other causes for crying, such as an infection or an intestinal condition. It is rarely necessary to perform laboratory or radiology (for example, X-ray, CT, ultrasound, MRI) studies to establish the diagnosis of colic.
When Should One Seek Medical Care for Colic?
The diagnosis of colic is made by the characteristic history detailed above complemented by normal findings during a physical exam. By definition, colic is what is termed as a "diagnosis of exclusion," for example, all other pathologic conditions have been eliminated. Other conditions your doctor will consider may include infection, gastroesophageal reflux (GERD), milk protein (human or cow) allergy, and a number of relatively rare metabolic and intestinal conditions.
If the baby's symptoms suggest other causes, such as fever, excessive sleepiness, recurring vomiting, and out of the ordinary inconsolability, you should seek medical attention. You should also see a doctor if the excessive crying causes you or other family members extreme frustration and anger. A screaming infant, sleep deprivation, and the transition from pregnant to nonpregnant health status can easily wear down even the most loving of parents.
Colic in itself is not a medical emergency. However, if you suspect other conditions may be causing irritability and pain in your infant, go immediately to a hospital's emergency department.
Are There Home Remedies for Colic?
There are no surefire treatments, but you may try the following:
- Use a pacifier. Swaddle your infant tightly.
- Gently rock the infant using a rocking chair or lap.
- Softly massage the infant's abdomen or back.
- Play relaxing music (even if it works just for the parent!). Studies have shown, however, that excessive limiting of stimulation (prolonged dark and quiet room) may worsen symptoms.
If these attempts are not helpful -- don't give up! Remember that every day your child is getting closer to being 4 months old, and he/she will ultimately resolve these frustrations with a "tincture of time." Research has shown that holding and rocking your baby may reduce the intensity but not duration of crying episodes. You cannot spoil an infant by holding him too much.
What Are Treatment Options for Colic?
Infantile colic is a condition that is difficult to treat. Current conventional treatments fall into one of the following four categories: dietary, physical, behavioral, and pharmacological. With little evidence to favor the first three approaches, there is some evidence that the drug dicyclomine hydrochloride can be effective, although its safety came into question after reports of severe side effects occurring in about 5% of infants, and in some extreme cases it has been linked to infant death
Although some encouraging results exist for fennel extract, mixed herbal tea, and sugar solutions, design flaws and the absence of independent replications preclude practice recommendations. The evidence for probiotic supplements and manual therapies does not indicate an effect. Thus, the notion that any form of complimentary or alternative medicine is effective for infantile colic is currently not supported from the evidence from the included RCTs. Additional research into this prevalent, and often difficult to treat, condition seems warranted.
Many therapies (both traditional and holistic) have been tried to help lessen the symptoms and duration of colic. Many of these anecdotal approaches have not demonstrated success in scientific studies. Some involve the following:
- Simethicone drops (Maalox, Gas-X, Mylanta, Phazyme) may relieve gas. There are no documented studies indicating that excessive gas is a cause for colic.
- Ensure a quiet, non-stimulating environment when colic begins. This advice implies that you run the house you would if your child were not in the home. You don't have to "tiptoe around." Conversely, having multiple people pick up and play with your baby may be overwhelming. Many parents find that "white noise" (for example, the vacuum cleaner) is soothing to their colicky child.
- Change the baby's diet and feeding techniques. For many years, it seemed intuitive that breastfed babies may benefit if the mother avoids dairy products, especially if prone to allergies, or resort to a hypoallergenic diet. Other suggestions include eliminating spicy foods, raw vegetables, and caffeine. Further studies have indicated that children are rarely allergic to human or cow milk protein. Likewise, millions of children are successfully breastfed by mothers in foreign countries in which the diet is filled with highly spiced foods. Children of China and Mexico are not all screaming from intestinal symptoms every night!
- Try an alternative to routine milk-based formulas only if recommended by your baby's doctor. Some studies support that switching from cow milk protein-based formulas may have some effect in some children.
- Hypoallergenic formulas, such as Nutramigen and Alimentum, may reduce colic symptoms in some bottle-fed babies, but clear-cut scientific evidence is lacking. They are more expensive than other formulas. These formulas may sometimes appear successful since the protein, fat, and carbohydrate molecules are "partially digested" and thus easier for the infant to digest.
A variety of herbal and complementary medical therapies have been advocated. Herbal teas (chamomile, licorice, fennel, and mint) have strong support in some communities. It is generally believed that small amounts may provide some relief and will not do harm. They should not be used in place of formula or breast milk.
Several years ago, a medication (dicyclomine [Bentyl, Byclomine, Dibent, Di-Spaz, Dilomine]) was shown to decrease the symptoms of colic. However, rare side effects of sedation, cessation of breathing, coma, seizures, and death occurred and the medication is no longer in use for colic.
What Is the Prognosis of Colic?
Although colic can be a frightening experience for new parents, it is not a dangerous condition for your child. An infant often will outgrow the condition by 4 months of age with no permanent problems (except for perhaps gray hair in the parents).
Is It Possible to Prevent Colic?
Studies have demonstrated that breastfed children are less likely to experience colic, and if they are affected, their symptoms seem to be less intense and of shorter duration. No other proactive approach has been demonstrated.