Colic and crying

Definition

Almost all babies go through a fussy period. When crying lasts for longer than about three hours a day and is not caused by a medical problem (such as a hernia or infection), it is called colic. This phenomenon occurs in almost all babies. The only thing that differs is the degree.

Alternative Names

Causes

Colic usually strikes toward the end of a long day, when your baby is just about at the age when your sleep deprivation has really begun to set in. Your baby stops being the quiet, peaceful, miracle baby and begins screaming every evening. It is no wonder that parents can become frustrated, discouraged, and depressed.

The child with colic tends to be unusually sensitive to stimulation. Some babies experience greater discomfort from intestinal gas. Some cry from hunger, others from overfeeding. Some breastfed babies are intolerant of foods in their mothers' diets. Some bottle-fed babies are intolerant of the proteins in formula. Fear, frustration, or even excitement can lead to abdominal discomfort and colic. When other people around them are worried, anxious, or depressed, babies may cry more, which in turn makes those around them even more worried, anxious, or depressed.

About 20% of babies cry enough to meet the definition of colic. The timing varies, but colic usually affects babies beginning at about 3 weeks of age and peaking somewhere between 4-6 weeks of age.

Colic will not last forever! After about 6 weeks of age, it usually begins improving, slowly but surely, and is generally gone by 12 weeks of age. When colic is still going strong at 12 weeks, it's important to consider another diagnosis (such as reflux).

Symptoms

Colic frequently, but not always, begins at about the same time every day. For most infants the most intense fussiness is in the evening. The attack often begins suddenly. The legs may be drawn up and the belly distended. The hands may be clenched. The episode may last for minutes or hours. It often winds down when the baby is exhausted, or when gas or stool is passed.

In spite of apparent abdominal pain, colicky infants eat well and gain weight normally.

Exams and Tests

Colic is usually diagnosed by the parent's description of the crying. A careful physical exam is wise to be sure the baby does not have a hernia, intussusception

Treatment

Helping a child with colic is primarily a matter of experimentation and observation. If you can identify and eliminate a trigger for the colic, that is best. Even if you can't, learn which measures most comfort your baby.

POSSIBLE TRIGGERS

• Foods - If you are breastfeeding, avoid stimulants such as caffeine and chocolate. Try eliminating dairy products and nuts for a few weeks, as these may be causing allergic reactions in the baby. Other foods may also irritate the baby.
• Formula - Switching formulas is NOT helpful for most babies, but is very important for some.
• Medicine - Some medicines mom may be taking can also lead to crying.
• Feeding - If a bottle feeding takes less than 20 minutes, the hole in the nipple may be too large. Avoid overfeeding the infant or feeding too quickly.

People often hear that breastfeeding moms should avoid broccoli, cabbage, beans, and other gas-producing foods. However, there is not much evidence that these foods are a factor.

TIPS FOR COMFORTING THE BABY

Different children are comforted by different measures. Some prefer to be swaddled in a warm blanket; others prefer to be free. Try many different things, and pay attention to what seems to help, even just a little bit.

• Holding your child is one of the most effective measures. The more hours held, even early in the day when they are not fussy, the less time they will be fussy in the evening. This will not spoil your child. Body carriers can be a great way to do this.
• As babies cry, they swallow more air, creating more gas and perhaps more abdominal pain, which causes more crying. This vicious cycle can be difficult to break. Gentle rocking can be very calming. This is directly comforting and seems to help them pass gas. When you get tired, an infant swing is a good alternative for babies at least 3 weeks old with good head control.
• Singing lullabies to your baby can be powerfully soothing. It is no accident that lullabies have developed in almost every culture.
• Holding your child in an upright position may help. This aids gas movement and reduces heartburn. A warm towel or warm water bottle on the abdomen can help. Some babies prefer to lie on their tummies, while awake, while someone gives them a back rub. The gentle pressure on the abdomen may help. (To avoid SIDS, DO NOT put babies on their tummies to sleep.)
• Some babies are only happy when they are sucking on something. A pacifier can seem like a miracle in these cases.
• The concentration of breast milk changes during a feeding. The "foremilk" at the beginning is plentiful but low in calories and fat. The "hindmilk" at the end of emptying each breast is far richer. Sometimes you can reduce colic by allowing the baby to finish the first breast before offering the second. If the baby still seems uncomfortable or eating too much, then offering only one breast (as often as desired) over a 2-3 hour period might give the baby more hindmilk, which is richer and sometimes more soothing.
• Some children seem to do best when they are riding in a car. If your child is one of these, you might try a device developed by a pediatrician to imitate car motion and sound. Alternatively, some kids do better with cheaper forms of white noise, such as a vacuum cleaner motor or the sound of a washing machine or dishwasher.
• Simethicone drops, a defoaming agent that reduces intestinal gas, may help. It is not absorbed into the body and is therefore quite safe. Sometimes doctors will prescribe stronger medicines for severe colic (but this should only be done after a physical exam).

Take breaks. Each of you can take charge and relieve the other. Time for oneself is an important part of the new family dynamic. You will be able to pay more loving attention to your baby when you've had a chance to get refreshed.

Outlook (Prognosis)

Colic is a benign condition that the baby usually outgrows at three to four months of age.

Possible Complications

There are usually none.

When to Contact a Medical Professional

Call your health care provider if you have concerns. The most important thing to keep in mind is not to misdiagnose a serious condition and call it colic. If your baby's behavior or crying pattern changes suddenly or if the crying is associated with fever, forceful vomiting, diarrhea, bloody stools, or other abnormal activity or symptoms, call your doctor immediately.

Do not be afraid to seek help immediately if you feel overwhelmed and are afraid that you may hurt your baby.

Prevention

A fussy period is likely no matter what prevention techniques are undertaken. However, good feeding techniques (as advised by a lactation consultant, if you are breastfeeding), good burping, and early identification of possible allergies in the baby's or mother's diet may help prevent colic. Try different comfort techniques before colic develops to identify your baby's needs and desires. This can help stop the fussy period from becoming so intense.

Barr R. Colic and crying syndrome in infants. Pediatrics. 1998; 102(5): 1282-1286.

Garrison M, Christakis D. A systematic review of treatments for infant colic. Pediatrics. 2000; 106(1): 184-190.