Colic

Definition

Colic is a frustrating condition marked by predictable periods of significant distress in an otherwise well-fed, healthy baby. Babies with colic often cry more than three hours a day, three days a week for three weeks or longer. Nothing you do to try to help your baby during these episodes seems to bring any relief.

Colic can be distressing for both you and your baby. But take comfort: Colic is relatively short-lived. In a matter of weeks or months, the colic will end, and you'll have weathered one of the first major challenges of parenthood.

Symptoms

Fussing and crying are normal for infants, and a fussy baby doesn't necessarily have colic. In an otherwise healthy, well-fed baby, signs of colic include:

• Predictable crying episodes. A baby who has colic often cries about the same time every day, usually in the late afternoon or evening. Colic episodes may last from a few minutes to three hours or more on any given day. Your baby may have a bowel movement or pass gas near the end of the colic episode.
• Intense or inconsolable crying. Colic crying is intense, sounds distressed and is often high pitched. Your baby's face may flush, and he or she is extremely difficult — if not impossible — to comfort.
• Crying that occurs for no apparent reason. It's normal for babies to cry sometimes. But, crying usually means your baby needs something, such as food or a clean diaper. Crying associated with colic occurs with no clear cause.
• Posture changes. Curled up legs, clenched fists and tensed abdominal muscles are common during colic episodes.

Colic is common. It usually starts a few weeks after birth and often improves by age 3 months. By ages 4 to 5 months, the majority of babies with colic have improved.

When to see a doctor

Seek immediate medical attention if your baby's crying could be the result of a fall, injury or illness.

Contact your baby's doctor if:

• You notice a bluish-cast to your baby's lips or skin during a crying episode.
• You're concerned about your baby's crying, especially if you notice changes in your baby's eating, sleeping or behavior.

You can help your baby's doctor by tracking in a diary when your baby cries and for how long. Also record your baby's sleeping and eating patterns.

Causes

The cause of colic is unknown. Researchers have explored a number of possibilities, including allergies, lactose intolerance, changes in the normal bacteria found in the digestive system, a digestive system that hasn't fully developed, anxious parents, and differences in the way a baby is fed or comforted. Yet it's still unclear why some babies have colic and others don't.

Risk factors

Infants of mothers who smoke during pregnancy or after delivery have a greater risk of developing colic.

Many other theories about what makes a child more susceptible to colic have been proposed, but none have been proved. For instance:

• Colic doesn't occur more often among firstborns or formula-fed babies.
• A breast-feeding mother's diet probably doesn't trigger colic.
• Girls and boys — no matter what their birth order or how they're fed — experience colic in similar numbers.

Complications

Although colic can be difficult to live through for the whole family, colic doesn't appear to have any lasting medical consequences. Babies who have colic grow and develop normally.

Preparing for your appointment

When you take your baby to his or her doctor, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

To prepare for your appointment, you can:

• Track your baby's crying episodes, including when and how often they occur, how long they last, and any observations you've made about your baby's behavior before, during and after the episodes.
• Write down how you've tried to soothe your baby and the results.
• Record your baby's diet and feeding schedule, as well as weight gain or loss.
• Write down questions to ask your baby's doctor.

Preparing a list of questions helps make the most of your time with your baby's doctor. For colic, some basic questions to ask include:

• Does my baby have colic or is there another reason for the crying episodes?
• What effects can colic have on my baby's growth and development?
• Are there any effective treatments for colic?
• How can my family and I cope with the crying?
• Do you have brochures or other printed material that I can take with me? What websites do you recommend?

During your appointment, don't hesitate to ask any other questions as they occur to you.

What to expect from your doctor

Your baby's doctor is likely to ask a number of questions, such as:

• Can you describe a typical crying episode? When does it occur? How long does it last? What does your baby's cry sound like?
• What things do you do to try to soothe your baby? How well do those things work?
• Does your baby have any problems with eating?
• What do you feed your baby, and how often do you feed him or her?
• How often and how much does your baby spit up?
• Does your baby ever seem to have trouble breathing during these episodes?
• How do you cope when your baby is crying? What about the rest of your family?

Tests and diagnosis

Your baby's doctor will do a physical exam to identify any possible causes for your baby's distress, such as a blockage in your baby's intestines (intestinal obstruction). If your baby is otherwise healthy, he or she may be diagnosed with colic.

Lab tests, X-rays and other diagnostic tests aren't usually needed, but in unclear cases they help to exclude other conditions as possible causes.

Treatments and drugs

Colic improves on its own, often by age 3 months. Unfortunately, there are no proven treatments that consistently help every baby. Treatments that have been tried include:

• Gas-relief medications. Available over-the-counter, gas-relief medications such as simethicone (St. Joseph Baby Infants' Gas Relief, Infants' Mylicon Gas Relief, others) probably won't do much to ease your baby's symptoms. These medications are generally considered safe, except for babies who have to take thyroid replacement medications.
• Probiotics. Probiotics are substances that help maintain the natural balance of "good" bacteria in the digestive tract. Since babies with colic may have an imbalance of these helpful bacteria, researchers have tried to replace some of these probiotics in a number of studies. One in particular, called Lactobacillus reuteri, significantly decreased colic symptoms. But, study results have been mixed. Some have shown benefits, while others have found none. Overall, experts don't feel that there's enough evidence to recommend the use of probiotics for treating colic right now.

Talk to your baby's doctor before giving your baby any medication to treat colic.

Lifestyle and home remedies

Your baby's doctor may not be able to fix colic or make it go away sooner, but there are many ways you can try to soothe your baby.

Tips for feeding your baby

If you think your baby may be hungry, try a feeding to ease fussiness. These other feeding strategies may help, too:

• Hold your baby as upright as possible during feedings. Pause often during feedings to burp your baby. Sometimes smaller, more-frequent feedings are helpful. If you're breast-feeding, it may help to allow your baby to feed at one breast until it's nearly empty before switching sides. This provides your baby with rich, fatty hindmilk, potentially more satisfying than the lighter, thirst-quenching foremilk present at the start of a feeding.
• Consider changing your diet, if breast-feeding. A breast-feeding mother's diet likely doesn't play a role in baby's colicky symptoms. However, in families with a history of allergies, removing potential allergens from your diet might uncover an unknown food allergy in your baby. If you breast-feed, your baby's doctor may suggest that you try eliminating foods most likely to cause allergy — such as dairy, peanuts, tree nuts, wheat, soy and fish — for two weeks to see if your baby's symptoms improve. However, first talk with your baby's doctor before changing your diet.
• Switch baby's formula. As with breast-feeding, your baby's formula isn't a likely cause of his or her symptoms. But, changing to a type of formula called hydrolysate infant formula (Similac Expert Care Alimentum, Nutramigen, Pregestimil) might make a difference if your baby is allergic to cow's milk or has a milk intolerance. The whole milk proteins in these formulas are already broken down, which makes them easier to digest. If an allergy or intolerance was causing your baby's symptoms, you should see a response within two days of changing formula. If there's no improvement, you can switch back to the original formula as the hydrosolate formula is much more expensive than standard formula.
• Change bottles. There are a variety of bottles and nipples from which to choose. Trying a different type of bottle or nipple could help ease some of your baby's symptoms. Bottles that have disposable, collapsible bags may lessen the amount of air your baby swallows.

Tips for soothing your baby

To soothe your crying baby, you can try to:

• Offer a pacifier. For many babies, sucking is soothing. Even if you're breast-feeding, it's OK to offer a pacifier to calm your baby.
• Hold your baby. Cuddling helps some babies. Others quiet when held closely and swaddled in a lightweight blanket. To give your arms a break, try a baby sling or other type of baby carrier. Don't worry about spoiling your baby by holding him or her too much.
• Keep your baby in motion. Gently rock your baby in your arms or in an infant swing. Check with manufacturer's guidelines to be sure the swing is appropriate for your baby's age. Lay your baby tummy down on your knees and then sway your knees slowly. Take a walk with your baby, or buckle your baby in the car seat for a drive. Use a vibrating infant seat or vibrating crib.
• Sing to your baby. A soft tune might soothe your baby. And even if lullabies don't stop your baby's crying, they can be calming for you. Recorded music may help, too.
• Turn up background noise. Some babies cry less when they hear steady background noise. When holding or rocking your baby, try making a continuous "shssss" sound. Turn on a kitchen or bathroom exhaust fan, or play a tape or CD of environmental sounds, such as ocean waves, a waterfall, gentle rain or a human heartbeat. Sometimes the tick of a clock or metronome does the trick.
• Use gentle heat or touch. Give your baby a warm bath. Softly rub your baby's belly.
• Give your baby some private time. If nothing else seems to work, put your baby in his or her crib for five to 10 minutes.

When you run out of ideas

Sometimes, you won't be able to calm your baby's crying. What works well on one day may aggravate your baby on another day. If your nerves get frayed, remember:

• Never shake your baby. If your frustration over your baby's crying threatens to boil over, hand your baby to another trusted adult. If you're alone with your baby, put him or her down somewhere safe, such as in a crib.
• It's OK to let someone else give you a break. It's stressful to listen to your baby cry for long periods, so plan times when you can take a break. Arrange ahead of time for someone to help you with the baby so that you can have a few moments to yourself.

Alternative medicine

Some parents report soothing their crying infants with alternative remedies, such as:

• Herbal teas
• Herbal remedies, such as fennel oil
• Homeopathic remedies
• Sugar water
• Gripe water (a mix of water and herbs)
• Massage therapy
• Chiropractic manipulation
• Acupuncture

But, no alternative therapies for colic have been proved to be consistently helpful. Some might even be dangerous.

Herbal products and supplements aren't regulated in the same way that drugs are. They may contain inconsistent amounts of certain ingredients, or they may be contaminated.

Several homeopathic remedies contain low amounts of potentially toxic substances. Even something that seems harmless, such as sugar water, could be a problem if it causes your baby to stop feeding properly.

Before trying an alternative therapy, talk to your baby's doctor to find out what's safe and what might be harmful.

Coping and support

Caring for an infant who has colic can be exhausting and stressful, even for experienced parents. Remember to take care of yourself too. These suggestions may help:

• Take a break. When you've done what you can, ask your spouse or partner or another loved one to take over for a while. Take advantage of baby-sitting offers from friends or neighbors. Even an hour on your own can help refresh you.
• Express your feelings. It's normal for parents in this situation to feel helpless, depressed, guilty or angry. Confide in your spouse, partner or other good listener.
• Try to stay positive. Don't measure your success as a parent by how much your baby cries. Colic isn't a result of poor parenting.
• Take care of yourself too. Eat healthy foods. Make time for exercise, such as a brisk daily walk. If you can, sleep when the baby sleeps — even during the day. Avoid alcohol and other drugs.
• Remember that it's temporary. Colic episodes often improve by age 3 months.

It's also important to recognize your limits. If your baby's crying is causing you to lose control, put the baby in a safe place — such as a crib — and go to another room to collect yourself. If necessary, contact your doctor, a local crisis intervention service or a mental health help line for additional support. Never shake your baby. These suggestions apply not only to parents but also to any other person who cares for your child.