Colic is a condition where there are repeated bouts of excessive crying in a baby who is otherwise healthy. The definition doctors use is: a baby crying for more than three hours a day, for more than three days a week, for at least one week. Colic is common and can be distressing for parents. It usually goes away by the age of 3-4 months. Ways that may help to ease colic in some cases, and some tips on how to cope, are given below.
A typical baby with colic
Colic is common and can affect up to three out of ten babies. A healthy newborn baby may have periods of crying. For no apparent reason he or she cries as if in pain. The usual methods of comforting do not work very well. He or she does not want to feed and may pull up their knees. Sometimes the baby's tummy (abdomen) appears to rumble. The cry may sound different and more piercing than normal. He or she may appear to be settling when suddenly another bout of crying occurs. This may go on and off for several hours until he or she settles and falls asleep.
The rest of the time he or she is fine. However, the bouts of colic occur regularly, most commonly every evening, but can occur at any time. Bouts of colic gradually become less frequent and have gone in most babies by the age of 3-4 months.
Variations on a theme
In some babies, a period of restlessness in the evening may be all that you notice. In some babies with severe colic, the crying may go on for many hours throughout the day (and/or night). However, babies with colic are fine between bouts of colic. They feed well, grow well, and do not show any other signs of illness.
What causes colic?
Despite a huge amount of research on this condition, the actual cause is still not clear. The term colic is used as it is thought the baby has pain in the tummy (abdomen). Research suggests this may be related to a change in the level of hormones that control the movement of gut muscles. Another theory is that babies with colic may have an abnormal balance of germs (bacteria) in their gut, which gradually corrects itself over a few weeks. Some (but certainly not the majority) of babies with colic have an intolerance to cow's milk.
Smoking during pregnancy and also taking nicotine replacement treatment during your pregnancy does increase the risk of your baby developing baby colic. Being in a smoky atmosphere (passive smoking) also increases the risk. Colic is more common in babies who are born prematurely.
Some parents feel that they have done something wrong in some way. This is not the case.
How is colic diagnosed?
Colic is diagnosed by excluding other causes of persistent crying. Babies with colic are otherwise well and continue to put on weight normally. In the majority of babies who cry a lot, no illness can be found and colic is often the cause of this. Remember, a baby with colic will have spells when they are perfectly fine in between bouts of crying.
Conditions sometimes mistaken for colic include:
- Reflux oesophagitis.
- Secondary lactose intolerance (a short-lasting phase, usually after a tummy bug).
- Cow's milk allergy.
- Severe nappy rash.
- Scratches in the eyes because the baby's nails are too long.
- A twist in the bowels (volvulus).
- A part of the bowel telescoping into itself (intussusception).
- Strangulated hernia.
- A twisted testicle.
- Non-accidental injury (child abuse).
If you are unsure as to the reason why a baby is distressed or crying, then see a doctor.
Helping colicky babies and their parents
There is no treatment that cures colic. Every parent has their own way of coping and may find different things helpful. Try not to despair. You have to remember that there is nothing that you have done to cause the colic. Also, be aware that colic usually goes away by 3-4 months of age, often much sooner.
One or more of the following may help:
Check for causes of discomfort
Make sure the baby is not cold, is not hungry and is changed often enough.
Even newborn babies may sense anxiety. This can make things worse. Try to create a relaxed atmosphere. If possible, have a rest and meal before the colic begins (usually in the evening). The more rested and relaxed you are, the better you will be able to cope.
Colic happens more frequently when the mother has postnatal depression or feels very down after the baby has been born. If this is the case, see your doctor for some help.
It is natural to try to soothe a crying baby. Holding a baby through the crying episode may help to soothe. However, a colicky baby may simply not be comforted or soothed. At such times it is acceptable to leave a baby to cry for short periods if you are satisfied that he or she is not hungry, too cold, too hot, wet, or unwell. Remember - never shake a baby.
If you need a break from the crying, or if you feel at the end of your tether, gently place the baby in his or her cot and leave the room for around 10 minutes. You could then do something which will help you - perhaps have a cup of tea, a snack or phone a friend.
Friends or other family members may be willing to help. However, try to avoid several people fussing at once, as this may cause anxiety. It may be sensible to leave the coping to one person at a time. Take it in turns if you have help. If possible, it is good to have time out and leave someone else to look after your baby for a few hours.
If you have a partner, it can be worth taking it in turns to do the 'night shift'. Many mums, even with partners, always try to do the nights themselves. This can be exhausting. It may be sensible to take it in turns to get a good night's sleep. If you are breast-feeding, you may be able to express enough milk in the day for a feed to be given in the night by your partner.
Research suggests that some babies with colic may be intolerant to a sugar called lactose, which is found in milk. This is quite rare. More commonly babies become intolerant after a tummy bug (gastroenteritis). This is usually a short-lived phase. Changing from ordinary baby formula milk to a baby formula milk that is free from, or low in, lactose is an option. However, you should check with your doctor or health visitor before trying this. Another method which your doctor or health visitor may suggest is to add lactase drops to the milk, which breaks down lactose. Once things settle down you should try the baby with ordinary formula milk again, as lactose may play a part in keeping the bowel healthy in the long term.
Other formula milks
If it is thought that there is an allergy to cow's milk then switching to a hypoallergenic milk formula may be tried. However, if the baby's symptoms do not improve after feeding with hypoallergenic milk for a week then the baby should return to their normal feed.
Soy-based formula milks are not recommended and should not be given to babies with colic.
The diet of breast-feeding mothers
If you breast-feed, there's some evidence that it may help if you do not have cows' milk, dairy products, eggs, wheat, nuts and caffeine (which can also be found in some painkillers). Some women find cutting out spices or garlic is also helpful, although there's little scientific support for this. If there's no improvement after you've made changes for a week, go back to your normal diet.
What about medicines?
If simple things don't work, you could try a medicine called simeticone (for example, Infacol®). However, there is no scientific evidence to support its use. If the baby's symptoms do not improve after a week then this can be stopped.
Dicycloverine used to be used but is now considered unsafe. Some people find gripe water helpful but its use is not supported by research.
Popular but non-proven advice
The following tips are often given. However, the advice is based on individual experiences and no research studies have proved that they help. So, they may or may not help.
Some people say that white noise helps to soothe colicky babies. White noise is background, nonspecific noise such as that made by vacuum cleaners, washing machines, etc. You can even buy CDs of white noise which claim to soothe crying babies. There is a lack of research that proves that this works in most babies but it may be worth a try.
Rides and carrying
Crying babies may settle on car journeys. It is possibly the white noise of the car engine and the gentle movements of the car that do the trick. Pram rides seem good too - it may be the movement that helps to soothe some babies. Or, simply walking with the baby in a sling or baby carrier may help to soothe.
Complementary and alternative remedies
Many alternative therapies are promoted and advertised for colic. There is no firm evidence that any of these are beneficial.
Note: not all alternative therapies are without risk. For example, some herbal products, such as star anise, have caused serious reactions in some babies and are not recommended.
Sometimes parents become angry, tearful, or resentful towards a baby with colic. These are normal and common emotions. The crying can seem distressing, intolerable and very frustrating.
If you are finding it hard to cope then do see your health visitor or doctor, or call Cry-sis (see below) for advice.
Dr Tim Kenny
Dr Louise Newson
Dr Helen Huins