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Colic: Crying That Just Doesn't Quit

June 10, 2008 - 7:30am
 
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Colic: Crying That Just Doesn't Quit

image Four million babies are born every year in the United States. About 10% to 20% of them will have colic sometime during their first three months of life.

What Is Colic?

Broadly defined, colic refers to excessive, extended periods of uncontrollable crying (sometimes for an hour or longer at a time) by an otherwise healthy baby. Among pediatricians, the "rule of three" is often used to diagnose colic: an infant who cries for no apparent reason, for more than three hours per day (usually at night), for more than three days per week, up until three months of age (though colic can continue until age four to five months).

Judy S. of Boston vividly remembers her daughter Julie's first two months of life. "Nobody slept. Julie cried up to seven hours a day from the time she was six weeks old until she was about two months old. Most of the time she was inconsolable. We tried everything. What eventually seemed to work was a combination of my realizing that I didn't need to pick her up every time she cried, gentle massage when she was at her worst, and lots of car rides around the neighborhood."

Why Does Colic Affect Some Babies and Not Others?

No one knows for certain exactly what causes colic. Many believe it's caused by digestive-related abdominal pain, although there is no definitive scientific proof of this. Other hypotheses include:

  • An overly sensitive nervous or digestive system
  • An overactive colon
  • Difficulty moving food through the intestines
  • Gas trapped in the bowels
  • Sensitivity to cow's milk
  • Sensitivity to and/or overheated infant formula.
  • Sensitivity to certain foods or vitamins in breast milk
  • Sensitivity to solid foods introduced before four months of age

Not a Sign of Bad Parenting

Infants that get colic for no apparent reason also grow out of it for no apparent reason. Most physicians agree that your skills as a parent have nothing to do with your baby's colic. They also agree that your ability to remain calm during your infant's colicky period may help limit the intensity of the event.

Colicky infants can be very trying for parents. When your baby is crying, your first instinct is to pick him up and console him, which can become very wearisome if the crying goes on for hours. Remember that crying, even excessive crying, will not hurt your little one. Although you instinctively want to console a crying baby, sometimes the best option is simply to leave her in her crib to "cry herself to sleep."

Not Necessarily a Sign of Illness

A baby with colic isn't necessarily sick. Quite the contrary. Colicky babies tend to be perfectly healthy and normal, and will grow out of it after about three months. Just in time since most adults can't go without extended periods of sleep for more than three months.

More Serious Conditions

Excessive, extended crying isn't always due to colic, though. In some, albeit limited, cases, this type of crying can be the sign of a more serious condition such as a hernia or gastroesophageal reflux disease (GERD). Some telltale signs that the episode is more serious than colic include:

  • Poor appetite and poor sucking reflexes. Colicky babies retain a good appetite and good sucking reflexes. Infants who are sick often drink less milk and have a diminished sucking reflex.
  • Resistance to being handled. Despite their discomfort, colicky babies generally like to be cuddled. Conversely, infants who are sick often resist being cuddled, often reacting as if they are sore or in pain.
  • Spitting up. All infants, including colicky babies, spit up from time to time. An infant who is sick, however, will often vomit excessively.

So if your infant vomits excessively, or shows any other signs that her excessive crying may not be due to colic, its best to contact your pediatrician. Dr. Hank Bernstein, associate chief of general pediatrics, at Boston's Children's Hospital explains, "Because excessive crying is not always due to colic, [anytime] the quality or length of crying becomes different than what you're used to or comfortable with, contact your pediatrician to discuss whether further evaluation is necessary."

Treating Colic

Just as there are numerous theories for the cause of colic, there are numerous theories on how to control it. Two of the most popular are:

Dietary Changes

For breast fed babies, elimination of cruciferous vegetables (such as broccoli, cauliflower, and onions), dairy products (especially cow's milk), wheat, peanut products and citrus fruits from the diet of the breast-feeding mother might help. Although there is little solid evidence.

Note that the breastfeeding mother needs to maintain an adequate intake of calcium, protein, and other nutrients. For bottle fed babies, there is some evidence that eliminating cow's milk from the formula can help colic. A “protein hydrolysate” formula (Alimentum, Nutramigen, and others) may be more beneficial than a soy-based one

Medication

Mylicon drops are over-the-counter liquid drops containing simethicone, an antiflatulent drug that purportedly relieves gas pain. They are probably harmless, but a number of scientific studies have not shown benefit in relieving colic. In recent years, some doctors have prescribed sedative medications such as phenobarbital and meclizine (Dramamine) to treat colic.

Evidence does show that “anticholinergic” medications (dicyclomine and others) help colic. However, most doctors strongly advise against the use of these medications because of their possible moderately-severe side effects, including excessive drowsiness, depression of the central nervous system, apnea, or seizures and the danger of excessive dosage.

Home Remedies

There is a long list of home remedies thought to soothe colicky infants. However, none have strong supporting evidence, and some have failed to prove effective in studies. Some of the more popular of these include:

  • When feeding, burp the baby regularly (after each ounce of milk or formula).
  • Since colic usually happens in the evening or at night, try not to let your infant sleep for more than three hours at a stretch during the day.
  • Placing the baby in a mechanical swing chair.
  • Wrapping the baby snugly in a blanket.
  • Rocking your baby in a rocking chair or cradle.
  • Taking the infant for a ride in your car. Recently, a product known as Sleeptight, which attaches to a crib and simulates the motion of a moving car has been marketed. Although Dr. Bernstein has heard of no safety issues with this device, this should not be taken as an endorsement of the product.
  • Hold your baby face down, with the side of his face on your open hand and his legs on each side of the inside of your elbow. Supporting his back with your other hand, either rock gently in a rocking chair or walk around the house for 10-15 minutes while holding him this way.
  • Place a running fan, vacuum, or other electric appliance that makes a repetitive "white noise" in the baby's room. You can also buy small, battery-operated devices that emit wind, ocean wave, and other white noise sounds.
  • There is some evidence that herbal teas, including fennel, chamomile, and lemon balm might be helpful may be effective in colic. Note that the the safety of these herbs in infants has not been established

Take Care of Yourself

Although colic is limited in duration and not particularly dangerous, it can be extremely stressful for you. So while you care for your colicky baby, take care for yourself, too. Remember that colic is not a result of something you've done or not done. Seek help with care-taking from friends, family, partner or a trusted babysitter so you can get a break—and maybe a nap. If possible exercise during these breaks to reduce or alleviate tension. Talk to the neighbors if you have thin walls or ceilings. Explain that you and your doctor are doing everything you can and that colic almost never continues after 3-5 months of age.

If the pressure of trying to soothe a colicky baby becomes too much for you, leave him alone in the crib for a while. Go into another room and calm yourself down. Leaving him to cry alone in his crib won't hurt him, losing your temper might.

RESOURCES:

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

Infant Colic Study. Indiana University School of Nursing
http://nursing.iupui.edu/Research/

CANADIAN RESOURCES:

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

Alberta Children's Services
http://www.child.alberta.ca/home/

References

Lucassen PL, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ. 1998 May 23;316(7144):1563-9.



Last reviewed March 2008 by Marcin Chwistek, 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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