What are interventions you can advise the parents of an infant with frequent colic?

Colic is a condition where there are repeated bouts of excessive crying in a baby who is otherwise healthy. Colic is common and can be very distressing for parents. It usually goes away by the age of 3-4 months. This leaflet discusses some of the colic remedies available, and gives some tips on coping.

What is colic?

Colic describes a common condition where a baby cries a lot for no apparent reason. It is impossible to know what the baby feels, of course, as they can't tell us. So we don't really know what the symptoms of colic are. But babies with colic appear to have a tummy ache. There are a number of possible medical definitions of colic - it can be difficult to make sense of the research on colic because the definitions vary. One definition used medically is 'episodes of irritability, fussing, or crying that begin and end for no apparent reason and last at least three hours a day, at least three days a week, for at least one week, in an infant up to 4 months of age with no evidence of faltering growth'.

Typically babies with colic:

• Are healthy from a medical point of view.
• Gain weight normally.
• Do not vomit abnormally.
• Have normal poo.
• Feed well.
• Cry the most in the evening or late afternoon.
• Are fine between the episodes of crying.

During episodes of typical colic, the baby:

• Cries inconsolably.
• Draws their legs up towards their chest.
• Goes red in the face whilst crying.
• May arch their back when crying.

How can you tell if your baby has colic?

This is a difficult one, because - as above - they can't tell us what they feel. Diagnosing colic, for both parents and health professionals, is as much about what the baby DOESN'T have as what they DO have. Typically, babies with colic fit the description in the section above. Most importantly, there doesn't seem to be anything else wrong. So colic is NOT the diagnosis if the baby:

• Has a rash.
• Has a temperature.
• Is not wee-ing and poo-ing normally.
• Is not gaining weight as expected.
• Is crying and unhappy all the time, with no settled periods.
• Vomits regularly or vomits green fluid or has 'projectile vomiting' (ie the vomit shoots across the room as if under pressure, rather than in a dribble out of the mouth down on to the bib).
• Has any difficulty breathing.
• Is not a normal colour (particularly if they turn blue when crying).
• Cannot feed well.

If you are not sure why your baby is crying a lot then see a health professional (such as your health visitor or GP). Usually a doctor will be able to diagnose colic by asking you questions about your baby, and by examining them. There are no tests for colic, but the doctor will check that there don't seem to be any other causes for the baby's crying. There are no specific signs for colic - just the typical picture as above, and the lack of signs of any more serious disease.

What else could it be?

Babies can only tell us something is wrong by crying, so first consider the obvious things that might be making them uncomfortable:

• Are they too hot or too cold?
• Does their nappy need changing?
• Are they hungry?
• Are they unwell? (Do they seem to have a temperature, or a runny nose, or a cough, or diarrhoea for example?)

Other common conditions in babies which might cause crying include:

• Wind (usually this causes crying after feeding, which is relieved by burping or passing wind).
• Reflux. Babies with reflux tend to vomit or posset more than other babies. Feeding seems to cause discomfort, as does laying them on their back. See the separate leaflet called Childhood Gastro-oesophageal Reflux.
• Constipation. Poo tends to be hard and not passed very often. Babies may cry and go red in the face when trying to pass a hard poo.
• Cow's milk allergy. There are usually other features, such as a rash or gut-related symptoms. See the separate leaflet called Cow's Milk Protein Allergy.

Uncommon conditions which might cause crying include:

• A twist in the bowels (volvulus).
• A part of the bowel telescoping into itself (intussusception).
• Strangulated hernia.
• A twisted testicle (torsion of a testis).

How long does colic last?

Episodes of colic can go on for a few minutes to 2-3 hours or more. Babies grow out of colic by the time they are 6 months old, and usually before that. In most babies it has improved by the age of 3-4 months.

What causes colic?

Despite the fact that colic is incredibly common, the cause is not known. A number of possible causes have been suggested. These include:

• Colic being just part of the normal spectrum of the crying behaviour of babies.
• Colic being caused by an excessive amount of movement of internal gut muscles, and oversensitive pain signals.
• Babies with colic may have an abnormal balance of germs (bacteria) in their gut, which gradually corrects itself over a few weeks.

Some studies have suggested that colic is more common in babies who are born to women who smoke or are older, and in first babies.

How common is colic?

Colic seems to be very common. It is thought to affect one in five babies. So, if you have a baby with colic, you are not alone! It is most common in the first six weeks of a baby's life. It is just as common in girls as it is in boys. It is just as common whether the baby is breast-fed or bottle-fed.

What is the treatment for colic?

This is the million dollar question! There is no very good evidence for ANY colic treatments used. Studies have been difficult because definitions of colic vary, because it is difficult to measure how effective treatment is, and because it gets better on its own anyway. Mostly, managing colic involves finding out what works best for you and your baby in a way that causes the minimum amount of stress.

Strategies which MAY be useful include:

• Checking with a health professional if you are in any doubt about the diagnosis. Worrying about the cause of your baby's crying is likely to add stress to an already difficult situation.
• Holding your baby when they are crying to soothe them. However, this does not mean you have to continually hold a crying baby. As long as you are sure your baby is not too hot/too cold/hungry/unwell and does not need a nappy change, it is OK to lay them down for a short time.
• Movement sometimes helps. You could try rocking them gently or taking them out for a walk in a pram, sling or baby carrier. A drive sometimes helps too, but only if you were planning to do this anyway - you don't want to find yourself driving round the neighbourhood for no good reason every time the baby cries.
• 'White noise' sometimes helps. Background noise, such as a vacuum cleaner, music, a washing machine or a hairdryer may in some cases be soothing.
• Bathing the baby in a warm bath.
• Make sure you 'wind' your baby after feeding. (Hold them upright and gently pat on the baby's back until they have burped.)

Colic drops for babies

There is no convincing evidence that any of the available colic remedies actually work. Some of the options available include:

• Simeticone (for example, the commonly used brand Infacol®). The idea of this is that it reduces the amount of gas in the baby's gut. Studies have found there is not much difference between simeticone and placebo drops. (Placebo drops are drops with no active ingredient.)
• Gripe water. This is a substance which has been around for over a century. Depending on the brand and country, it contains different ingredients. Originally, it contained alcohol and sugar and so perhaps it was no wonder that it helped babies go to sleep. Usually modern versions do not contain alcohol or sugar but there is no evidence that it is effective for colic. One commonly used brand contains dill, sugar substitute and sodium hydrogen carbonate (baking soda). Another contains a mixture of herbs. Internationally, feeding advice is generally that healthy babies don't need anything other than milk up to the age of 6 months. They should not be given any additional substances unless there is a medical indication. As there is no evidence for gripe water being effective, colic would not usually be considered a medical indication.
• Lactase (for example, the brand Colief®). This is sometimes used for lactose intolerance. Again, there is not yet any convincing evidence that it is helpful for babies with colic.
• Probiotics. These are 'good bacteria', thought to possibly balance the normal germs in the gut and help the gut function normally. Studies are ongoing but so far there is not enough evidence that probiotics are effective for colic, so they are not currently recommended.
• Herbal supplements. There is no evidence for these being effective, and they may cause side-effects. Remember 'natural' isn't necessarily the same as 'safe' - many poisons and drugs are made from 'natural' plants.

Formula for colic

Babies get colic whether they are breast-fed or fed with formula milk. Breastfeeding is known to be best for a baby, so if you are breastfeeding, do not stop because your baby has colic. There is not enough evidence to suggest that changing to a different formula milk might help. There is also no convincing evidence that if a breastfeeding mum alters her own diet it will help her colicky baby. If these strategies are helpful, it is more likely that the baby has cow's milk allergy rather than colic. If the crying is severe, it may be worth considering this as a possible alternative diagnosis. If this is the case, your health visitor or doctor may be able to advise on different formula milks. Only consider this with the help of medical advice. See also the separate leaflet called Cow's Milk Protein Allergy.

Other remedies for colic

Various physical treatments are sometimes promoted for colic. These include massage, cranial osteopathy, spinal manipulation and acupuncture. There is currently no evidence to back a recommendation for these treatments.

Some bottles and teats are sold as being specially for colic. Again there is no evidence for this. It does make sense that the shape of the feeding equipment might affect the amount of air being swallowed with the milk. This might make a baby less likely to have discomfort from wind. However, there is no evidence to suggest that wind is the cause of colic. Also, remember that where possible, breastfeeding is best for your baby.

Look after yourself too

Having a baby who cries a lot can be very wearing and stressful for parents. Make sure you keep yourself sane. Discuss your worries about your baby with your health visitor or doctor. Seek help from them if you feel very down or anxious. Take up offers from family or friends to help so you can take time out for rests and time for yourself. You and your partner will need to support each other, and take it in turns to spend time consoling a crying baby. Talking with others who have babies with colic may help, or contact a support group such as Cry-sis. Remember that colic does go away, and it is a phase your baby will come through.

What is the outcome (prognosis)?

All babies grow out of colic. Most do so by the age of 3-4 months and often much earlier than this. It is unusual for colic to go on past 6 months. You may feel that all the information above is rather depressing as there is nothing that has been proven to work. However take heart from the knowledge that your baby's colic will definitely get better just with the magic treatment of time. So hang on in there, and remember it is very common - you are not alone.

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