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Infantile Colic

What is infantile colic?

Infantile colic is a condition, in which an otherwise healthy baby cries excessively, frequently and at an abnormally high pitch. These crying episodes, which often occur in the evening, are the most typical symptom. Colicky babies may also be inconsolable during a crying episode.

A physician should exclude any other cause for the excessive crying in order to confirm the diagnosis of infantile colic. Laboratory tests are not usually necessary, unless there is reason to suspect that the crying is caused by an underlying medical condition.[1]

Generally, the condition tends to resolve on its own, with no long-term complications. Studies suggest that up to 40 percent of all newborns and infants experience infantile colic at some point.[2]

Risks

Infantile colic is commonly observed in newborns between the ages of two weeks and four months, with the condition typically peaking at around six weeks of age. It is equally frequent in both male and female infants.

Good to know: If a toddler is exhibiting colicky symptoms, it is unlikely to be colic. The child should be examined by a pediatrician, and other causes for excessive crying should be investigated.

The causes of infantile colic are largely unknown. However, colic may be the result of physical, social and/or environmental factors that may be out of the parents’ control. These include:[2][1][3]

  • An imbalance in the infant’s gut microflora
  • Overfeeding or underfeeding
  • Food allergies, including allergy to milk proteins and lactose intolerance
  • Incomplete burping after feeding
  • Exposure to cigarette smoke or metabolites of cigarette smoke
  • Parental stress or anxiety

There is some evidence that colic is more common in infants whose mothers have had postnatal depression[1]. It is known that babies respond to parental anxiety. Lactose intolerance is a relatively rare cause of colic. There is some evidence that breastfed infants are less likely to have infantile colic.[4]

There is no evidence that fermentation in the colon causes colic.[1]

Symptoms

The most typical symptom of infantile colic is episodes of high-pitched, excessive crying, which often occur during the evening hours. Colicky crying is often described as more high-pitched and strained than ordinary crying[1]. The “rule of three” is often used to determine whether the excessive crying is the result of colic. Colicky babies may cry for:[2]

  • Three or more hours a day
  • Three or more days a week
  • Three or more weeks

Not all babies with colic will necessarily follow this pattern. If a parent is unsure of whether the crying is colic or not, they should consult their baby’s doctor or nurse.

Good to know: Colicky crying is still within the normal range of infant crying. Most infants cry more in the afternoon and evening, with their tendency to cry peaking at around six weeks of age. The difference between normal crying and colicky crying is that babies with colic cry for longer than babies without and are much harder to soothe.[2]

Babies with colic may show distinctive behaviour while crying. They may:[2][1]

  • Grimace or scowl
  • Furrow their brows
  • Draw their legs up to their belly
  • Clench fists
  • Flush
  • Stiffen

The infants are usually otherwise healthy babies, with a normal appetite and normal weight gain.

However, some behaviours that are associated with crying, but are not part of normal crying, may indicate an undiagnosed cardiopulmonary disorder. These include:[2]

  • Apnea, a temporary pause in breathing during sleep, or struggling to breath
  • Cyanosis, a bluish colour in the skin or mucus membranes that indicates low oxygen levels in the blood
  • Fever

If a baby exhibits any of these three symptoms, they should be taken to a medical practitioner immediately.

Diagnosis

To confirm the diagnosis, other causes for the crying should always be excluded first. It is often defined by rule of three: crying for more than three hours per day, for more than three days per week and for longer than three weeks, in an infant who is well-fed and otherwise healthy. However, other things that the doctor will take into account are:[5]

  • The age of the baby at the onset of symptoms of colic
  • How the parents respond to the crying
  • How intense the crying is
  • How the child is fed, including what position the baby is in, whether it is burped, and whether it is bottle fed or breastfed.

If the baby is being bottle fed, the type of milk and the type of teat used will also be examined. If the baby is being breastfed, the doctor may also ask about her diet.

Laboratory tests are usually not needed. Physicians will take note of the baby’s family situation and their medical history. They will also take a history of the baby’s feeding and diet patterns in order to rule out gastroesophageal disorders such as GERD and allergies.[2] To rule out urinary tract infections or other infections, the baby’s patterns of defecation, urination and sleeping will also be reviewed. If there is any history of fever, vomiting or trauma, this should be noted because it may be relevant.[5]

Doctors who are examining a baby who is suspected of having colic will also routinely check for:

  • Fractures, cuts, scrapes or bruises
  • Hairs or fibres wrapped around fingers or toes
  • Skin irritation and diaper rash

Treatment

Since the causes of the condition are largely unknown, treatment options are limited. As the condition does not cause serious problems, parents are advised to develop techniques to help the infant to stop crying, such as singing, swaddling or holding the infant. It is also important to make sure that the baby is in an upright position during feeding. Changes in feeding habits or diet are usually not recommended.

Parental reassurance and stress management

One of the most important elements of treatment for infantile colic is keeping the parents calm and to reassure them that the condition is temporary and that their baby is generally healthy.[2] Colic is distressing for babies and their caregivers, and colicky babies are at increased risk of being shaken and injured[3], as parents may become frustrated that they cannot calm or console the baby during a crying episode.

Because colicky babies cannot be soothed, caregivers may set the baby down in a safe place, such as their cot, to cry unattended for a short while. This is acceptable, as long as the baby is not cold, wet, unwell, hungry or too hot,[3], and as long as the baby is not left alone for very long.

Because colicky crying also occurs most often in the evening, parents may also experience some sleep loss, which can contribute to feelings of frustration and stress. Parents should take care to ensure that they are rested, possibly by taking it in turns to attend to the baby. It is also acceptable to leave the baby with other competent caregivers for short periods of time, in order for parents to rest.[3] Colicky babies should not be left unattended for long periods of time.

Drugs, medication and dietary modifications for colic

Medication is not usually very useful in treating colic.

Good to know: Spinal manipulation, while occasionally said to relieve colic, is unsafe for babies and should not be considered as a treatment option. Likewise, sedatives such as phenobarbital and chloral hydrate are unsafe for babies and should not be used in the treatment of colic.

In some cases, if the mother is breastfeeding the infant, colic can be alleviated by excluding some foods from the mother’s diet. These include:[1]

  • Cow’s milk and dairy products
  • Eggs
  • Wheat
  • Nuts
  • Spice and garlic
  • Caffeine
  • Alcohol

Eliminating these foods will not necessarily help relieve infantile colic in all cases.

If the cause of the colicky crying is suspected to be an allergy to cow’s milk, a low-lactose formula or lactase drops, which are added to milk, may be recommended. Soy-based formulas are not very often recommended for colicky babies.[1] However, lactose intolerance is relatively rare.

Gripe water

Gripe water[6] is a traditional remedy for colic, and while there is anecdotal evidence that it works, no formal reviews have ever proven that it is helpful. Many brands of gripe water contain alcohol, dill oil, an alkalinizing agent, such as bicarbonate of soda, and sugar. In many countries, the composition of gripe water is not regulated. Gripe water may also cause constipation.

Alcohol is unsafe for babies, while dill oil may only be of help in cases where excess gas is a cause of pain. Bicarbonate of soda is not thought to be helpful, as stomach acid is not the cause of colic.

There is some evidence that administering an oral sweet solution of sugar to babies does help to relieve pain, and this is probably the basis for the success of gripe water in relieving colic, as the sweetness itself is soothing. However, in this case, it is better to consult a doctor about using a simple oral glucose solution rather than gripe water.

Other names for infantile colic

  • Baby colic
  • Infant colic
  • Colic

  1. Medscape. “Colic: Practice essentials”. 28 November 2017. Accessed 14 May 2018.

  2. American Family Physician. “Infantile Colic: Recognition and Treatment”. 1 October 2015. Accessed 14 May 2018.

  3. Patient.info. “Baby colic.”. 23 October 2015. Accessed 15 May 2018.

  4. BMJ Best Practice. “Baby colic: aetiology”. 25 June 2018.

  5. BMJ Best Practice. “Baby colic: Diagnosis and Approach”. 25 June 2018.

  6. Journal of the Royal Society of Medicine. “The gripe water story”. April 2000. Accessed 13 May 2018.