Baby colic - what it is, why it happens and what you can do about it

Baby health

Baby colic - what it is, why it happens and what you can do about it

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Baby colic - what it is, why it happens and what you can do about it

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All babies cry. At birth, it is the only way a child can communicate that one or more of its needs aren’t being met. But, as with many things in life, not all crying is equal and while some babies cry more than others, some babies cry so much that there is a special term for the phenomenon. It’s called ‘colic’.

Colic is a very misunderstood term, however. The way it is often used in lay circles leads people to think that it is a single medical condition but that’s a common misconception. In this blog post, I clarify exactly what colic is and discuss why it occurs. I also provide a summary of research into treatments for colic so if you know someone whose baby may have colic, please share this post with them.

Please note that the information included in this blog post is for informational purposes only. It should not be construed as medical advice.

What is colic?

So, if colic isn’t a single medical condition, what exactly is it? It’s basically an umbrella term that describes a baby that cries a lot. The actual medical definition of colic is the occurrence of bouts of crying in an otherwise healthy baby that:

  1. occurs in the first 3 months of life;
  2. lasts more than 3 hours a day;
  3. happens more than 3 days per week; and
  4. occurs each week for at least 3 weeks.

Many babies that cry a lot are labeled as ‘colicky’ by parents and other family members. However, it often turns out that these babies are suffering fromwind pain. It’s only babies that meet the above definition that are medically classed as ‘having colic’. And you’ll note that the definition excludes babies that have a defined illness or medical condition. If a cause for the crying can be identified, then the baby is no longer classed as having colic.

How common is colic?

Because there is no known definitive cause for the crying that defines the phenomenon, colic is poorly understood. However, it is believed to occur in5-28% of babies.

Possible causes for colic

While it is true that researchers can’t yet answer the question ‘what causes colic’, they do have some guesses as topossible causes for colic:

  • a food intolerance or allergy - potentially to cow’s milk or soy protein
  • an immature digestive system
  • an underdeveloped central nervous system
  • ‘difficult infant temperament’
  • a baby’s inability to clearly communicate its needs
  • transference of a caregiver’s anxiety to the baby

As medical professionals have known about colic for an incredibly long time (the ancient Greeks wrote about it) but still haven’t discovered what causes it, it is likely that there are a variety of factors that together cause the excessive crying.

What can be done to help babies with colic?

Unfortunately, colic has not been a major focus of concerted research effort. However, there have been a few rigorous studies and in 2000, a pair of researchers conductedA Systematic Review of Treatments for Infant Colic, which summarises the best data available at the time of publication on possible treatments for colic in babies. A more recent review published in 2016 titledInfant Colic - What works: A systematic review of interventions for breast-fed infants looked specifically at treatments that are commonly used for breastfed and mixed-fed babies younger than six months. The below options for treating colic are derived from those journal articles.

Medication

When one’s baby seems to be in pain, parents and caregivers often feel that some kind of medication may be most helpful in resolving the issue. It is probably for this reason that seven out of the 22 studies analyzed in the first review investigated treatment with medication. A number of studies included in the second review also investigated pharmaceuticals. The medications used in the studies were simethicone, dicyclomine and scopolamine.

Simethicone

Simethicone is a medication that helps break up gas bubbles in the digestive system.

Three of the studies reviewed investigated whether simethicone is effective in treating the unknown cause or causes of colic. Two of the studies failed to find any benefits to treating colicky babies with simethicone. (Incidentally, this medicine didn’t even help with the gassy babies assessed.)

One of the studies found that a few days after treatment with simethicone commenced, babies didn’t cry as often. However, this particular study didn’t divulge how colic was defined.

None of the studies noted negative effects associated with simethicone use.

Conclusion: There isn’t convincing evidence to suggest that simethicone is an effective treatment for infant colic. It does not appear to have negative effects should your doctor recommend you try it.

Dicyclomine

Dicyclomine is a muscle relaxant that is usually prescribed to patients that are affected by gastrointestinal muscle spasms.

Dicyclomine was tested in three studies. Each study reported a slight benefit to treating colic with the drug.

Some negative side effects were reported in two of the studies though they were not deemed statistically significant (this means that the side effects occurred rarely enough that they may have been coincidence or the result of an unrelated cause). The side effects reported included both diarrhea and constipation as well as drowsiness.

There have been reports outside of these studies of babies suffering more severe negative effects. These negative side effects were most commonly observed in babies younger than 7 weeks old. These side effects included apnea (where a person stops breathing for short periods of time), seizures and coma. The manufacturer of the product now advises that dicyclomine should not be given to babies aged less than 6 months of age. Infant colic has also been removed from the manufacturer’s list of conditions that might be treated by dicyclomine.

Conclusion: Dicyclomine appears to be mildly effective in treating colic but it is not deemed suitable for treating infant colic.

Methylscopolamine

Methylscopolamine is a medication that reduces the amount of stomach acid a person produces and is usually prescribed to treat peptic ulcers.

Only one study investigated the effectiveness of using methylscopolamine to treat infant colic. The study reported adverse side effects of the treatment with no significant positive impact on the symptoms of colic.

Conclusion: Methylscopolamine is not deemed to be either an effective or safe treatment for colic in babies.

Dietary modification

There has been a recent surge in interest in the effects of diet on human health. What’s more, we know that babies can become gassy as a result of the foods their breastfeeding mothers eat and/or various components in baby formula. As such, it is only logical that researchers investigate whether diet contributes to colic.

Low allergen diets

As one of the potential causes of colic is food intolerance or allergy, it is unsurprising that some researchers investigated whether a low allergen diet could be an effective treatment for colic. The results from these studies were mixed.

One study investigated both breastfeeding and bottle feeding mothers. Mothers that breastfed were required to stop eating milk, egg, wheat and nuts while bottle-fed babies were given a hypoallergenic baby formula. The results from these mother-baby pairs were compared with breastfed babies of mothers whose diets contained milk, egg, wheat and nuts and bottle fed babies that were fed with a baby formula that contained cow’s milk. The low allergen groups of babies had fewer colic symptoms and there was no difference between the breastfed and bottle fed groups of babies. There were some issues with the data and the way it was gathered in this study, but the results indicate that babies suffering from colic may benefit from having food allergens removed from their diet.

Another study investigated whether cow’s milk in a mother’s diet affected her baby’s colic symptoms. The study didn’t find removal of cow’s milk from the mother’s diet to be effective. It did, however, find that babies experienced more frequent symptoms of colic when their mothers ate fruit or chocolate. This was equally true of mothers who were eating the dairy-free diet and those that were in the control group (who ate their normal items). This indicates that there may be other foods that cause colic but this idea would have to be further tested as there weren’t any mothers in that study that didn’t eat any fruit or chocolate thus there wasn’t a control group to compare the results with.

While it was not part of the investigation, the researchers conducting this study also noticed that mothers who suffered from eczema, asthma or allergic rhinitis tended to have babies that suffered more colic symptoms on days when the mother drank cow’s milk. This implies that there may be other factors that affect whether a baby’s colic symptoms are related to his or her mother’s diet. Once again, this would need further investigation because the study wasn’t set up to investigate this.

Another study investigated whether soy-based formula reduced the symptoms of colic in bottle fed babies. The study found that babies suffered colic symptoms for a much shorter period of time when they were being fed a soy-based formula.

Conclusion: There isn’t enough evidence to prove whether or not a mother’s diet or the ingredients in a baby’s formula can affect whether a baby experiences symptoms of colic. However, there are promising signs dietary modification might provide some relief to colicky babies, especially for families where eczema, asthma or allergic rhinitis are present.

You should never make drastic changes to your diet or your baby’s formula without consulting a doctor. However, if your baby suffers from colic, it might be worth investigating diet as a possible treatment.

If your baby is breastfed, you (or the baby’s mother) can keep a diary of the foods and beverages you/she eats and drinks and you can then compare it to a diary in which you record all of the symptoms your baby experiences. If you notice any patterns, your doctor may be able to help you do an elimination diet to further investigate whether dietary modifications might help your baby.

If your baby is bottle fed you would just keep a symptom diary and record when each feed occurs and how much Bub drank to see whether there’s a pattern of symptoms that occur at a predictable length of time after a feed and whether symptoms are worse after a big feed when compared with a small feed. If you notice any such pattern, this may help your doctor to recommend an alternative formula or another course of action.

If your baby is fed breastmilk and formula, your diary will need to be a mix of the above.

Lactase

Lactose intolerance has been suggested as a possible cause of colic, probably because it’s a fairly common cause of digestive upset in adults. A person with lactose intolerance doesn’t produce enough of the enzyme ‘lactase’ to properly break down the lactose sugar present in cow’s milk. The lactose then travels to the wrong part of their digestive system where it is broken down by the wrong kind of bacteria, which produce gas. This results in pain and can give the intolerant person diarrhea. A person with lactose intolerance can avoid symptoms of their intolerance by eating some lactase enzyme to help them digest the lactose in their diet or they can drink/eat lactose-free dairy products to avoid ingesting any lactose in the first place. Lactose-free dairy might consist of products that are naturally lactose-free or normal lactose-containing dairy products that have had lactase added to them to digest the lactose before the person eats them.

Two studies that were included in the first review investigated whether giving colicky babies lactase could reduce their colic symptoms. In one study, breastfed babies wear given lactase. In the other study, lactase was added to cow’s milk and expressed breast milk. Neither study showed a significant improved in colic symptoms as a result of the lactase.

Conclusion: There is no evidence that lactase is useful for treating baby colic.

Fibre-enriched formula

Irritable bowel syndrome is a fairly common digestive complaint in adults that is sometimes alleviated by adding extra fiber to one’s diet. As an immature digestive system is a possible cause of baby colic, one study investigated whether adding extra fiber to a baby’s diet could improve the colic.

Babies in the study did realize benefits to their digestive system when they were given extra fiber but this did not reduce the amount of crying.

Conclusion: Increasing fiber in a baby’s diet may have positive side effects but it does not appear to alleviate colic.

Behavioural treatments

A couple of studies included in the first review investigated whether carrying colicky babies more might reduce their colic symptoms. Neither study showed any benefit to carrying colicky babies more than one might normally carry them. One of the studies also investigated whether increased carrying coupled with decreased stimulation might improve colic. This didn’t appear to have any effect on the colic.

A separate study investigated whether decreased stimulation by itself could help colicky babies. The research indicates that this may have had a positive effect on colicky babies, though the study had many flaws.

In one study, parents were told to put their colicky baby in a car ride simulator when Bub cried or became fussy. This did not appear to have any effect on the babies’ colic.

Conclusion: The only behavioral treatment for colic that is supported by science is decreased stimulation. The evidence is severely limited but if you have a colicky baby, it may be worth a shot.

Naturopathic treatments

Many people who wish to avoid medication will investigate whether naturopathic options might be effective treatments for their issues. Parents, in particular, are, understandably, often keen to avoid medication for their babies. As such, it is unsurprising that a few naturopathic treatments have been investigated.

Herbal tea containing chamomile, vervain, licorice, fennel and balm-mint was investigated to see whether it could ease colic in babies. High amounts of tea seemed to improve colic symptoms overall (though it didn’t reduce the number of times babies woke during the night). However, the authors of the first review expressed concern that giving babies such a large amount of tea would mean they don’t drink enough milk or formula.

Two studies investigated whether sucrose (table sugar) could reduce colic symptoms. While both studies reported a small improvement, the benefits were only realized for very short periods of time. Glucose (another sugar sometimes used in cooking) was tested by other researchers but very little positive benefit was observed. While the reviews didn’t comment on this, I have to wonder whether the observed improvements were purely because the babies were momentarily distracted by the sweetness of the sugar. I also worry about the health ramifications of giving such young babies sugar.

Six studies included in the second review investigated whether probiotics could be used to treat baby colic. This type of treatment seemed to have a significant positive impact on colic, resulting in babies spending a lot less time crying. The probiotic strainLactobacillus reuteri seemed to be most effective.

Three studies looked at whether fennel oil can help colicky babies. The results indicate that fennel oil is quite effective at reducing the amount a baby with colic cries. Given that the herbal tea used in one of the other studies contained fennel, I have to wonder whether any of the other ingredients in the tea helped at all or whether the positive effects were all associated with the fennel.

Conclusion: While herbal tea and sugar seem to offer some relief to babies with colic, there are health concerns associated with both treatments. If you are interested in trialing such a treatment, it would be best to consult your doctor first. Treatments with probiotics or fennel appear to be effective but again you should consult your doctor before attempting to treat your child with either remedy.

What should you do if you suspect your baby has colic?

If your baby cries a lot, your first port of call is to try to identify a cause for your baby’s crying. First, check that all Bub’s basic needs are met - meaning that Bub has a clean nappy, is well fed, isn’t tired, isn’t bored and doesn’t need to be burped. Once these potential causes of crying are eliminated, move on to the more advanced needs such as pain from teething, illness or constipation. If all these can be ruled out and Bub still cries enough to meet the criteria for colic, then I would recommend you start keeping a symptom diary for Bub and a food diary for Mom (if Bub is breastfed) and for Bub (if Bub is formula fed). You could also keep a parental mental health diary as well to see if any bouts of anxiety or depression in a parent coincide with increased crying in Bub.

Once you’ve gathered all this information, head to your doctor to discuss any patterns or lack thereof. You can then discuss possible treatments such as dietary modification if the food diary indicates that might help. You might also discuss possible naturopathic treatments, especially if you haven’t been able to identify any patterns.

You might also like to check out our blog post on how Minbie teats can help prevent colic.

Have your say

Have you found a treatment that worked for your baby with colic? Share it in the comments and you might just help another family in a similar situation.