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Colic in babies

Colic in babies

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What is colic?

Colic is a term referring to healthy babies who cry for long periods of time, often without obvious reason. It differs from ‘normal’ crying in that it cannot easily be soothed by feeding, rocking, wrapping or settling.

Colic is defined by periods of baby crying:

  • lasting longer than 3 hours a day
  • episodes occurring more than 3 days a week
  • continues for longer than 3 weeks

What causes colic?

Research discusses various causes for colic in babies – but mostly these are still theories, and further research is required to help pinpoint colic causes and identify babies who are more at risk of colic.

Some suspected theories are:

  • Suspected gastrointestinal sensitivity, meaning, some babies might be more sensitive to a painful and windy tummy. But there isn’t strong scientific evidence to support this – colicky babies may appear to have more wind, but this can often be attributed to the swallowing of air when crying more.
  • Maladaptation and overstimulation – some babies may have a difficult time adjusting to their new environment with all its lights, noises and discomforts. There is also not enough evidence to support this theory, although it is recognised every baby is different in personality, temperament and adaption to their environment.
  • Food intolerance or allergy – evidence remains inconclusive when investigating milk protein allergies and their relationship with colic. There is evidence to suggest hypoallergenic diets for breastfeeding mothers can reduce distress in colicky babies, but it is unknown if this is the cause or symptom treatment.

How is colic diagnosed?

The symptoms of colic may be indicative of other health issues so it's important to have your baby reviewed by a health professional if you suspect their crying is not normal.

Some of the symptoms of colic can be:

  • Colicky episodes usually have a clear beginning and end
  • They often appear unrelated to baby behaviour prior to the episode
  • Can have a sudden onset and occur in clusters, often during evening hours
  • Colic cry is often louder in pitch then a non-colic cry
  • Parents often describe their baby’s colic cry as ‘panicked, urgent, distressing, piercing’
  • Colic episode can be accompanied by a red and flushed face, clenching of fists and arching of the back.

What babies are more at risk for colic?

The incidence of colic does not appear to differ between babies of either gender, gestational age at birth or whether breast or bottle fed. Any baby can suffer from colic.

Associations between colic and family stress, dissatisfaction and difficulty adapting to parenthood have been reported in several large studies. It is hard to label these as a ‘risk’ for colic however, because both colic and family stress are affected by one another.

Some of the complications associated with colic are:

  • Parents distress
  • Sleep deprivation
  • Relationship strain
  • Negative associations to parenthood

Assessment for colic

Your healthcare provider should discuss and examine your baby for suspected colic to rule out any possible other health issues. They should ask you questions such as:

  1. When does the crying typically occur?
  2. How long does it last for?
  3. How do you respond to your baby when they cry?
  4. What is their feeding like?
  5. Are there any other issues with your baby’s diet, behaviour, sleeping patterns or routine?
  6. Is there any history of health issues in your family with possibilities for metabolic or gastrointestinal conditions?

When checking for colic, your doctor should also examine your baby for:

  • Response to stimuli
  • Pattern of growth and weight gain
  • Possible alternative causes for prolonged crying such as injury, infection or malnutrition
  • Anatomical issues associated with poor feeding (tongue ties, oral thrush)

Your healthcare provider will want to observe your baby’s behaviour and interactions with you including how you feed, settle and soothe your baby during these episodes. This will help them determine if there are any other ways to alleviate your baby’s distress.

When should you be worried about colic?

You should contact your healthcare provider if your baby is:

  • Drinking less milk then usual or refusing breast/bottle
  • Projectile vomiting after all feeds
  • Becoming more distressed when held or touched
  • More sleepy/lethargic then usual
  • Less wet nappies
  • A fever of 38°C (100°F) or higher

How to manage a colicky baby

Having a colicky baby is stressful and tiring. It’s important to know that in instances where you are not able to settle your baby, crying is not harmful to them in the short or long term.

Studies show no negative associations with prolonged periods of crying in infancy when compared to babies who didn’t cry excessively.

The bigger risk to a crying baby is the effect their crying has on their parent.

Colic has been associated with increased risks of postpartum depression, early weaning and shaken baby syndrome. If you are becoming overwhelmed by your baby’s colic crying, its important to take a break. Allowing a family member, partner or friend to try settle your baby can be more beneficial than your continued efforts to settle them while you are stressed. 

Important points to consider

  • Colic will usually resolve on its own by 3 months of age
  • If not by three months, then the majority of colicky babies are better by 6 months of age
  • Colicky babies are often fussy, gassy and don’t sleep well. However, this doesn’t mean they aren’t healthy. If they are gaining weight, meeting expected development milestones and continuing copious wet/dirty nappies – their crying doesn’t necessarily indicate a problem with their health.
  • Its important to have your baby assessed if you think they may have colic, to rule out other serious health concerns and find strategies to cope with this period of your baby’s life.

Written by Keryn Thompson RM & IBCLC (L-301766)

References:

Daelemans, S., Peeters, L., Hauser, B., & Vandenplas, Y. (2018). Recent advances in understanding and managing infantile colic. F1000Research, 7, 1426. https://doi.org/10.12688/f1000research.14940.1

Gelfand, A. A. (2016). Infant Colic. Seminars in Pediatric Neurology, 23(1), 79–82. https://doi.org/10.1016/j.spen.2015.08.003

Goldman, M., & Beaumont, T. (2017). A real world evaluation of a treatment for infant colic based on the experience and perceptions of 4004 parents. Journal of Health Visiting, 5(3), 134–142. https://doi.org/10.12968/johv.2017.5.3.134

Kaur, R., Bharti, B., & Saini, S. K. (2014). A randomized controlled trial of burping for the prevention of colic and regurgitation in healthy infants. Child: Care, Health and Development, 41(1), 52–56. https://doi.org/10.1111/cch.12166

Kruijff, I., Veldhuis, M. S., Tromp, E., Vlieger, A. M., Benninga, M. A., & Lambregtse‐van den Berg, M. P. (2021). Distress in fathers of babies with infant colic. Acta Paediatrica, 110(8), 2455–2461. https://doi.org/10.1111/apa.15873

Lam, T., Chan, P., & Goh, L. (2019). Approach to infantile colic in primary care. Singapore Medical Journal, 60(1), 12–16. https://doi.org/10.11622/smedj.2019004

Mai, T., Fatheree, N. Y., Gleason, W., Liu, Y., & Rhoads, J. M. (2018). Infantile Colic. Gastroenterology Clinics of North America, 47(4), 829–844. https://doi.org/10.1016/j.gtc.2018.07.008

McGann, J., Manohar, J., Hiscock, H., O'Connor, D., Hodgson, J., Babl, F., & Sung, V. (2018). Caring for crying babies: A mixed-methods study to understand factors influencing nurses' and doctors' management of infant colic. Journal of Paediatrics and Child Health, 54(6), 653–660. https://doi.org/10.1111/jpc.13858

Nocerino, R., Pezzella, V., Cosenza, L., Amoroso, A., Di Scala, C., Amato, F., Iacono, G., & Canani, R. (2015). The Controversial Role of Food Allergy in Infantile Colic: Evidence and Clinical Management. Nutrients, 7(3), 2015–2025. https://doi.org/10.3390/nu7032015

Rhoads, J. M., Collins, J., Fatheree, N. Y., Hashmi, S. S., Taylor, C. M., Luo, M., Hoang, T. K., Gleason, W. A., Van Arsdall, M. R., Navarro, F., & Liu, Y. (2018). Infant Colic Represents Gut Inflammation and Dysbiosis. The Journal of Pediatrics, 203, 55–61.e3. https://doi.org/10.1016/j.jpeds.2018.07.042

Rivas-Fernández, M., Diez Izquierdo, A., Cassanello, P., & Balaguer, A. (2019). Do probiotics help babies with infantile colic? Archives of Disease in Childhood, 104(9), 919–923. https://doi.org/10.1136/archdischild-2019-317368

Sung, V. (2018). Infantile colic. Australian Prescriber, 41(4), 105–110. https://doi.org/10.18773/austprescr.2018.033

Zeevenhooven, J., Browne, P. D., L’Hoir, M. P., de Weerth, C., & Benninga, M. A. (2018). Infant colic: mechanisms and management. Nature Reviews Gastroenterology & Hepatology, 15(8), 479–496. https://doi.org/10.1038/s41575-018-0008-7

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