Colic

Colic is a common, but poorly understood, condition that affects babies. The most common symptom of colic is excessive and inconsolable crying in a baby that otherwise appears to be healthy and well-fed.

How common is colic?

Colic is a very common condition that affects around 1 in 5 of babies. Babies of both sexes are equally affected by colic.

The symptoms of colic usually begin within the first few weeks of life, and usually resolve by the time the baby is four months of age, and by six months at the latest.

The cause (or causes) of colic is unknown.

Outlook

The outlook for colic is very good. If your baby has colic, they may appear to be in distress. However, the condition is not harmful, and your baby will continue to feed and gain weight normally. There is no evidence to suggest that colic has any long-term adverse effects on your baby's health.

There is currently no cure for colic, so treatment usually involves using self-care techniques, such as bathing your baby in a warm bath to help soothe them. A small number of babies may also benefit from changes to their diet, such as adding lactase drops to breast milk or bottle milk. Lactase is a type of enzyme (proteins that cause chemical reactions to occur).

The most common and distinctive symptom of colic is excessive crying in a baby that it is otherwise healthy and well-fed.

Intense crying

The crying that is associated with colic is usually very intense. Your baby's face will be red and flushed, their crying will be severe and furious, and there will be little or nothing that you can do to comfort them.

You may also notice a distinctive change in your baby's posture. Your baby may clench their fists, draw up their knees, or arch their back.

Crying most often occurs in the late afternoon, or evening, and is usually persistent, lasting for at least three hours a day, for at least three days a week, and for at least three weeks duration.

When to seek medical advice

If your baby has colic, it is recommended that you contact your GP when the symptoms of excessive crying first begin.

While colic is not usually a sign of anything serious, it is important that your GP is aware of your child's symptoms in case they are the result of less common conditions. For example, they may be the result of eczema (a skin condition), or gastro-oesophageal reflux disease (GORD), which is a condition where stomach acid leaks back out of the stomach and into the throat.

When to seek immediate medical advice

A number of signs and symptoms may suggest that your baby is more seriously ill. It is recommended that you contact your GP immediately if your baby:

  • has a weak, high-pitched, continuous cry (the crying that is associated with colic is usually strong, with a normal sounding pitch)
  • seems floppy when you pick them up
  • takes less than a third of their usual amount of fluids, passes much less urine than usual, vomits green fluid, or passes blood in their faeces (stools)
  • has a high temperature (fever) of 38C (100.4F) or above (if they are less than three months of age), or 39C (102.2F) or above (if they are between three to six months of age)
  • has a high temperature, but their hands and feet feel cold
  • has a bulging fontanelle (the soft spot at the top of a baby's head)
  • has a fit (seizure)
  • turns blue, blotchy or very pale
  • has a stiff neck
  • has breathing problems, such as breathing fast, or grunting while breathing, or they seem to be working harder than usual to breathe (for example, sucking in under the ribcage)
  • has a spotty, purple-red rash anywhere on their body (this could be sign of meningitis)

If your baby develops any of these signs and symptoms, contact you GP straight away

The cause (or causes) of colic are unknown, but some researchers think that indigestion or wind may play significant a role.

A number of theories

Other researchers claim that babies who have colic may, for a few weeks while their gut is maturing, be sensitive to certain substances that are found in breast, or formula, milk, such as lactose (a natural sugar), or molecules that are found in cows' milk.

It is thought that these substances may be passed on to the baby through breast feeding. However, there is little in the way of hard evidence to support these theories.

Another theory suggests that some babies may be more emotionally sensitive than others, and have problems 'turning off' their crying response.

Smoking is a risk factor

The only real piece of hard evidence that is currently available about the possible cause of, or risk factors for, colic, relates to smoking.

Women who smoke during pregnancy double their chances of having a baby who develops colic, as well as increasing their own risk of developing much more serious complications, such as having a miscarriage or still birth.

It is thought that the risk may be due to the fact that smoking causes a rise in the levels of a type of hormone called motilin during pregnancy. The increased levels of motilin may lead to symptoms of indigestion and colic shortly after birth.

To assess whether your baby has colic, your GP will ask you about their pattern of symptoms. They will also probably carry out a physical examination to help determine whether there could be another cause of their symptoms, such as a skin rash.

Your GP may also ask you a series of questions, such as those listed below, to help determine whether your baby's crying could be due to another cause other than colic.

  • How are your baby's bowel habits? Constipation can often be a cause of crying in babies
  • Is there anything in your diet that may be passing through your breast milk and irritating your baby, such as caffeine, or spicy food?
  • Does your baby have frequent attacks of hiccups and often coughs or vomits up their milk? Both of these symptoms can be a sign of gastro-oesophageal reflux disease (GORD)

If no other cause of your baby's symptoms can be found, a confident diagnosis of colic can be made. Further testing is only usually required if:

  • your baby's symptoms are not improving after four months
  • your baby's symptoms suddenly get worse
  • your baby is failing to grow and develop at the expected rate
  • your baby has additional symptoms that suggest that they may have gastro-oesophageal reflux disease (GORD)

In these circumstances, it is likely that you will be referred to a paediatrician for a more detailed assessment. A paediatrician is a doctor who specialises in the treatment of babies and children.

Colic is a self-limiting condition, which means that it resolves on its own after a few months. There are not many treatment options for colic, but there are a number of self care tips that you may find useful for dealing with a colicky baby.

Comforting your baby

There is no single 'best' way of comforting your baby or reducing the symptoms of colic. Different babies respond to different methods, so you may have to try a few different ones to see what works best for you. You may find that the suggestions listed below are useful.

  • Holding your baby during a crying episode can sometimes help, as can wrapping them snugly in a blanket. 
  • Prevent your baby from swallowing air by sitting them upright during feeding.
  • If you are breastfeeding, avoid drinking too much tea, coffee, and other drinks that contain caffeine. Some women also find that spicy food and alcohol can aggravate colic.
  • Holes in bottle teats that are too small may cause babies to swallow air along with their feed. 'Fast flow' teats with larger, or several, holes are available and may be a useful alternative.
  • Always burp your baby after a feed. To do this, sit your baby upright, or hold them against your shoulder, making sure that you support their neck and head. Gently rub their back and tummy until they burp. They may vomit a small amount of milk when you do this, which is normal.
  • Some evidence suggests that 'over-stimulating' a baby by continually picking them up and putting them down may aggravate the crying. Gently comforting your baby in a quiet, darkened room may be more beneficial. If you are satisfied that your baby is not hungry, tired, too hot or cold, or in need of a nappy change, it may help to leave them in their cot for a short while.
  • Babies like movement, so pushing them around in their pram or pushchair, or going for a drive, can be comforting. Rocking them over your shoulder or carrying them around the house may also be helpful.
  • Some babies find 'white noise' soothing. This is the background sound of a washing machine or vacuum cleaner. Gentle stomach, or back, rubs, or a warm bath, may also help to relieve colic.

Medical treatment

As colic always improves on its own, medical treatment is not usually recommended. However, if you find that you are having problems coping, you should contact your GP for advice about possible medical treatments

Unfortunately, most treatments for colic only have limited effectiveness. However, some babies respond better to certain treatments than others, so it may be worthwhile giving them a try (one at a time) for about a week or so. These treatments are discussed below.

Simeticone drops

Simeticone drops are a type of supplement that you can add to your baby's bottle, or breast, milk before a feed. The drops are designed to help release bubbles of trapped air in your baby's digestive system, so they may be of some use if symptoms of indigestion are contributing to their colic.

A one week trial of simeticone drops is usually recommended. If your baby's symptoms do not improve within this time, it is usually felt that there is little point in persisting with the treatment.

Babies are able to tolerate simeticone drops, and there have been no reports of any side effects arising from the treatment.

Removing cows' milk

There may be a possibility that your baby has developed a short-term intolerance to proteins that are found in cows' milk and other dairy products

If you are currently breastfeeding, you can try removing all dairy products from your diet for a week to see if your baby's symptoms improve.

If you are currently bottle feeding, you should switch to a hypoallergenic milk formula. These types of milk have low levels of protein that may be causing intolerance. Again, you can try using them for a week to see if your baby's symptoms improve.

Your GP will be able to advise you about the most suitable hypoallergenic milk formula for your baby. The use of a soya milk formula is not usually recommended because it contains hormones that may interfere with your baby's future physical and sexual development.

If your baby's symptoms do not improve after using hypoallergenic milk formula for a week, it is usually felt that there is little point in persisting with the treatment.

If you are breastfeeding, and you decide to persist with a diary-free diet, you will need to take additional calcium supplements. Dairy products are an important source of calcium, and it is needed for good bone health.

Lactase drops

Lactase is an enzyme that helps break down a sugar called lactose that is found in milk (both breast milk and bottle milk). It may be the case that your baby is having short-term problems digesting lactose, which may be contributing towards their symptoms.

Lactase drops can be added to your baby's feed to make digesting the lactose easier. As with the other treatments that are described above, persisting with lactase drops for more than a week if symptoms do not improve is not usually recommended.

Alternative and traditional therapies

There are many alternative and traditional therapies for colic, but there is little evidence to suggest that they are effective, and some may harm your baby. Some of these therapies are discussed below.

Dicycloverine

Also known as dicyclomine, dicycloverine is a medication that is used to control stomach cramps. In the past, dicycloverine was widely used as a treatment for colic, but it now regarded as unsuitable for infants under the age of six months because it can cause serious side effects including:

  • breathing difficulties
  • seizures
  • loss of consciousness
  • muscle weakeness
  • coma

Star anise tea

Star anise tea is a herbal tea that has traditionally been used to treat of colic. However, its use is no longer recommended because certain types of star anise are highly toxic and could poison your baby.

Chiropractic and massage therapy

Some people suggest that a series of massages, or chiropractic manipulation of a baby's spine, may be effective therapies to prevent colic. However, detailed medical trials have failed to find any convincing evidence of the benefit of such therapies.

Parenting styles

There has been some debate in recent years about whether different parenting styles have an effect on colic.

Traditionally, parents have been advised to encourage their baby to stick to a fixed eating and sleeping schedule. However, another approach known as 'infant-demand' parenting is where babies are fed or held as and when they want it that is, on demand.

A study that compared the two approaches, found that each one has its own benefits and disadvantages. Babies who were brought up using the traditional approach cried more over a 24 hour period, but slept better during the night. Babies who were brought up using 'infant-demand' parenting cried less over a 24 hour period, but woke more often during the night.

Looking after yourself

If your baby has colic, it is important that you do not forget about your own well-being.

Coping with a colicky baby can be exhausting and distressing, and it is common for parents to sometimes feel depressed, angry or helpless. You may find that the tips outlined below are useful.

  • If you feel that you cannot cope with your baby's crying, it is best to put the baby down somewhere safe and take a few minutes as a 'time-out'.
  • Ask your friends and family for support. All parents need a break, and even an hour rest on your own can help you to cope better with the situation.
  • Rest when your baby is asleep.
  • Try to meet other parents with babies of the same age for support and advice.