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In my previous blog post, Crying Babies: Why Do Babies Cry?”, I wrote about my own experience and viewpoint on infant crying. What I touched on, but didn’t go into, was this thing we refer to as “colic”.

 

What is colic?

If a baby cries for more than 3 hours a day, 3 days a week, for at least 1 week, they may be described as having “colic”. This is the definition according to NICE Guidelines, although you may be more familiar with the Wessel’s Criteria “Rules of 3s” traditionally used that includes a requirement of crying for at least 3 weeks rather than 1 week. Some people may use the term colic without specifying a particular duration. Essentially, it is used to describe a healthy baby under the age of 4 months that cries a lot with no apparent cause.

 

How long does colic last?

Colic typically begins several weeks after birth, improves by 3-4 months, and resolves by 6 months.

 

What are the symptoms of colic?

  • Inconsolable crying
  • Fussing
  • Drawing up of knees to the tummy
  • Back arching when crying
  • Symptoms tend to begin in the late afternoon or evening

What might suggest that it isn’t colic?

You should always seek advice from your doctor if you are concerned about your baby’s symptoms. Some of the symptoms and signs that might suggest a possible other cause include, but is not limited to:

  • Slow weight gain
  • Not reaching developmental milestones
  • Worsening symptoms after 4 months of age
  • Symptoms starting after 4 months of age
  • Vomiting
  • Changes to a baby’s stools (poo) such as the presence of blood or mucus, change in colour, or consistency 
  • Refusing to feed
  • More lethargic than usual
  • Has a rash
  • Has a swollen or tender tummy
  • Feels hot / has a fever
  • Has breathing difficulties
  • Appears dehydrated
  • Has a chronic cough

How is colic diagnosed?

Colic is diagnosed when typical symptoms are described in the absence of any other symptoms or signs that would warrant consideration of a medical cause. A doctor can make an assessment about whether any further tests or referrals are necessary before giving a diagnosis of colic.

baby-examination

What are the causes of colic?

Unfortunately, we still don’t know what causes colic for certain. There are different theories about what may cause colic which raises questions such as:

 

  • Is colic normal infant behaviour and just on one end of the spectrum of normal infant crying?
  • Could colic be the result of abnormal gastrointestinal motility (the movement of food from the mouth through the oesophagus “food-pipe”, stomach, intestines, and out of the body)?
  • Could colic be a form of infant migraine?
  • Is colic the result of change to the gut flora (bacteria normally present that do not cause disease)?
  • Is colic due to psychosocial factors (social and mental health issues)?
  • Does colic just reflect a baby’s temperament?
settled-baby

How can we make colic better?

There are products available commercially marketed as treatment for colic, but the evidence for their effectiveness is currently lacking.

The NICE guidelines recommendation for management are:

  • Using an optimal winding technique when winding your baby (I found the optimal winding technique for my babies was to be seated on my lap sideways in a supported position by supporting their chin with my hand, and gently patting the back a few times times in an upwards motion starting from the lowest part of the upper back, and then repeating).
  • Support for parents
  • Support to continue breastfeeding
baby-massage

What about other colic treatments?

Currently, none of them are recommended in the UK as the conclusions from studies don’t support their use. The studies look at a number of people with the same problem, in this case babies with colic, and see if that particular management has an impact on their symptoms, then ideally compare it to a similar group of babies that don’t receive the treatment.

 

We often try things based on a recommendation from someone we know, particularly if they say that it worked for them. Studies allow us to look at these treatments on a larger scale, aim to remove any bias, and try to keep other factors that may influence the result similar across the group that receive it and the group that doesn’t receive the treatment so we can say with greater certainty that something does actually work. Studies can have their own shortcomings which is why even if something may look promising, it doesn’t mean necessarily that it is an effective treatment for sure.

Having said that, research is always moving forwards. So, let’s take a look at how things stand right now:

inspecting-closely

Friends recommended several over-the-counter products (Infacol, Colief, and gripe water). In my own experience, none of these had any effect for the unsettled periods with my first baby.

I had a look at the research looking at the effectiveness of various treatments. 

Simeticone (E.g. Infacol) is used to act on gas bubbles formed in the gut and is widely used for treating infant colic. Although it is widely used, there isn’t any evidence that it is effective at treating infant colic which still remains the case to date.

There was insufficient evidence to support the use of lactase (e.g. Colief), herbal teas, switching infant formulas, gripe water, baby massage, reducing stimulation, crib vibration, or making changes to mum’s diet if breastfeeding.

A lot of the studies had limitations of having a small sample size which affects the reliability of the result. If you are looking at the effectiveness of a treatment but only observe a small number of babies, there is higher chance that any positive effect you see is due to chance. Ideally, you would want to look at the effect when it is applied to lots of babies to be sure that it is a true positive effect. 

What was interesting was that there appeared to be some evidence emerging for the use of probiotics for breastfed babies, in particular Lactobacillus reiteri.

A number of studies found a lower level of the gut flora like lactobacilli and bifidobacteria and higher numbers of another bacteria called proteobacteria. One review suggested that a finding in a study of higher inflammatory markers in colicky babies may be due to inflammatory lipopolysaccharides (LPS) by these proteobacteria.

 The studies found reduced crying time in babies that received probiotics compared to the group of babies with colic that did not receive probiotics. The other question this raises is would this reduction in crying time be significant enough for parents to consider it a benefit? The evidence overall is not yet strong enough for us to recommend as a treatment, but it is certainly an area to explore further.

One review found possible positive results for manual therapy (e.g. osteopathy), although there were study limitations and would need to be looked into further. 

breastfeeding-baby

If breastfeeding, it is worth seeking breastfeeding support to check positioning and latch. If there are issues with latch, your baby may be checked for tongue-tie. Oversupply and fast let-down may also result in swallowing more air.

I am writing this blog post during the Covid-19 2020 pandemic and so I am aware that access to breastfeeding support has changed since I had my babies. This article HERE is a useful read on breastfeeding positioning and attachment. THIS article is helpful if you have oversupply, and I found this article a helpful read when I realised that I had fast-let down when breastfeeding my baby.

Although there is no great evidence in support of baby massage as a treatment for colic, let’s face it, looking after a baby with colic is tough regardless of what the underlying cause is and can have a negative impact on the baby-parent relationship. Some time spent together doing something relaxing like baby massage is great for bonding time and has been shown to benefit the mum-baby relationship, so I am a fan of it and did baby massage for all my own babies. 

There are other causes of crying such as reflux and cow’s milk protein allergy amongst other medical causes, but there are usually other symptoms that may point to these diagnoses.

 My second and third baby never got colic but they did want to be held a lot, which is part of the reason why I used a sling as they were always settled when carried. I also managed the fourth trimester differently. My own feeling is that sometimes if a baby (or a toddler/older child even) get’s quite worked up and over distressed they can be even more difficult to settle than if they are responded to earlier.

Finally, I looked at some studies that sought to answer whether colic was linked to any particular longer term outcomes. One Australian study looked at toddlers who had a history of infant colic and  found that there were no medium-term adverse effects on child behaviour,  temperament, regulatory abilities, temperament, or family functioning.

holding-hands

Support for parents with colicky babies

supportive-hug

Looking after a baby with colic can be stressful and can lead to loss of confidence in parenting abilities. There may be feelings such as a sense of failure, sadness, helplessness, frustration, guilt or rejection. Colic is also a risk factor for shaken-baby-syndrome, something that may be uncomfortable to mention but needs to be mentioned. 

It is better to seek help than to try to struggle on. If you feel stressed, it is better to put baby down in a safe place like their cot and leave the room for a breather. 

If someone else is with you, ask if they can take over for a bit if they feel able to or call someone for support. Call friends or family, speak to your doctor, health visitor, or midwife. The charity Cry-sis can offer support for parents who are struggling with infant crying and have a helpline you can call (at the time of writing this helpline is open 9am-10pm 7 days a week on 08451 228 669.

Take turns in looking after the baby if you have a partner or another person that is able to help to allow you to have time to yourself. Consider using that time to do something positive for yourself such as relaxation, exercise, or something else you enjoy doing.

Lastly, remember that it is temporary and usually improves by 3-4 months.

References:

1) Bell G, Hiscock H, Tobin S, Cook F, Sung V. Behavioral Outcomes of Infant Colic in Toddlerhood: A Longitudinal Study. J Pediatr. 2018 Oct;201:154-159. doi: 10.1016/j.jpeds.2018.05.010. Epub 2018 Jun 7. PMID: 29887386.

2) Biagioli E, Tarasco V, Lingua C, Moja L, Savino F. Pain-relieving agents for infantile colic. Cochrane Database Syst Rev. 2016 Sep 16;9(9):CD009999. doi: 10.1002/14651858.CD009999.pub2. PMID: 27631535; PMCID: PMC6457752

3) https://cks.nice.org.uk/topics/colic-infantile/

4) Ellwood J, Draper-Rodi J, Carnes D. Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines. BMJ Open. 2020 Feb 25;10(2):e035405. doi: 10.1136/bmjopen-2019-035405. PMID: 32102827; PMCID: PMC7202698.

5) Gordon M, Biagioli E, Sorrenti M, Lingua C, Moja L, Banks SS, Ceratto S, Savino F. Dietary modifications for infantile colic. Cochrane Database Syst Rev. 2018 Oct 10;10(10):CD011029. doi: 10.1002/14651858.CD011029.pub2. PMID: 30306546; PMCID: PMC6394439.

6) Harb T, Matsuyama M, David M, Hill RJ. Infant Colic-What works: A Systematic Review of Interventions for Breast-fed Infants. J Pediatr Gastroenterol Nutr. 2016 May;62(5):668-86. doi: 10.1097/MPG.0000000000001075. PMID: 26655941

7) Karkhaneh M, Fraser L, Jou H, Vohra S. Effectiveness of probiotics in infantile colic: A rapid review. Paediatr Child Health. 2020 Apr;25(3):149-159. doi: 10.1093/pch/pxz007. Epub 2019 Apr 3. PMID: 32296276; PMCID: PMC7147696.

8) Lindensmith R. Interventions to Improve Maternal-Infant Relationships in Mothers With Postpartum Mood Disorders. MCN Am J Matern Child Nurs. 2018 Nov/Dec;43(6):334-340. doi: 10.1097/NMC.0000000000000471. PMID: 30339579.

9) Lucassen P. Colic in infants. BMJ Clin Evid. 2010 Feb 5;2010:0309. PMID: 21729336; PMCID: PMC2907620.

MedicMum101
MedicMum101

Amal is a paediatrician and mum/step-mum to four wonderful children. She started MedicMum101 to share tips and experiences on all things motherhood. She enjoys writing about parenting, health, and wellness, as well as other life musings from time to time. When she is not working, writing, or running after the kids, you can often find her working on a new piece of art.

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