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Baby colic (also known as infantile colic) is defined as episodes of crying for more than three hours a day for more than three days a week for three weeks in an otherwise healthy child between the ages of two weeks and four months. The cause of the colic is generally unknown. Less than 5% of infants with excess crying have an underlying organic disease.
It is present in between 5 and 25% of infants. Treatment is generally conservative with little to no role for medications, either conventional or alternative. It often disappears when the baby is three to four months old, but can last up to one year. There are no long term problems associated with the condition.
Signs and symptoms
Colic is defined as episodes of crying for more than three hours a day, for more than three days a week for a three week duration in an otherwise healthy child between the ages of two weeks and four months. By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks. With colic, periods of crying most commonly happen in the evening and for no obvious reason. Associated symptoms may include legs pulled up to the stomach, a flushed face, clenched hands, and a wrinkled brow. The cry is often high pitched (piercing).
Effect on the family
Persistent infant crying has been associated with severe marital discord, postpartum depression, early termination of breastfeeding, frequent visits to doctors, maternal smoking and over a quadrupling of excessive laboratory tests and prescription of medication for acid reflux. Babies with colic may be exposed to abuse, especially shaken baby syndrome.
The cause of colic is generally unknown. Less than 5% of infants who cry excessively turn out to have an underlying organic disease, such as constipation, gastroesophageal reflux disease, lactose intolerance, cows' milk allergy, anal fissures, subdural hematomas, or infantile migraine. While previously believed to be related to intestinal causes, this does not appear to be the case. Psychological and social factors also appear to play little role. There is some evidence that cigarette smoke may increase the risk. It seems unrelated to breast or bottle feeding with rates similar in both groups.
Birth complications may have a direct impact on the infant. Researchers have found correlations between childbirth complications and amount of infant crying. More stressful deliveries were linked to more crying.
Most babies have mild acid reflux, often referred to as "spitting up." Several studies indicate that gastroesophageal reflux rarely causes infant crying. Even crying during feeding and crying accompanied by writhing and back arching is rarely related to acid reflux, unless the baby also has poor weight gain (less than 15 g/day), vomiting more than 5 times per day, or other significant feeding problems.
Colic is diagnosed after other potential causes of crying are excluded. This can typically be done via a history and physical exam, and in most cases tests such as X-rays or blood tests are not needed. Babies who cry may simply be hungry, uncomfortable or ill.
Cause for concern include: an elevated temperature, a history of breathing problems or a child who is not appropriately gaining weight.
"Red flag" indicating that further investigations may be needed include:
- Vomiting (vomit that is green or yellow, bloody or occurring more than 5/day)
- Change in stool (constipation or diarrhea, especially with blood or mucous)
- Abnormal temperature (a rectal temperature less than 97.0 °F (36.1 °C) or over 100.4 °F (38.0 °C)
- Irritability (crying all day with few calm periods in between)
- Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over 6 hours)
- Poor weight gain (gaining less than 15 gram a day)
Problems to consider when the above are present include:
- Infections (e.g. ear infection, urine infection, meningitis, appendicitis)
- Intestinal pain (e.g. food allergy, acid reflux, constipation, intestinal blockage)
- Trouble breathing (e.g. from a cold, excessive dust, congenital nasal blockage, oversized tongue)
- Increased brain pressure (e.g., hematoma, hydrocephalus)
- Skin pain (e.g. a loose diaper pin, irritated rash, a hair wrapped around a toe)
- Mouth pain (e.g. yeast infection)
- Kidney pain (e.g. blockage of the urinary system)
- Eye pain (e.g. scratched cornea, glaucoma)
- Overdose (e.g. excessive Vitamin D, excessive sodium)
- Others (e.g. migraine headache, heart failure, hyperthyroidism)
Persistently fussy babies with poor weight gain, vomiting more than 5 times a day, or other significant feeding problems should be evaluated for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).
Management of colic is generally conservative and involves the reassurance of parents. Calming measures may be used and include: swaddling with the legs flexed, holding the baby on their side or stomach, swinging the baby once gently back and forth while supporting the head, making a shushing sound, and breast feeding or the use of a pacifier. Eye contact, talking, and holding an infant are also reasonable measures, though is not entirely clear if these actions have any effect beyond placebo. No medications have been found to be both safe and effective. Simethicone is safe but does not appear to work, while dicyclomine works but is not safe. Evidence does not support the use of cimetropium bromide, and there is little evidence for alternative medications or techniques.
Dietary changes by infants are generally not needed. In mothers who are breastfeeding a hypoallergenic diet by the mother; not eating milk products, eggs, wheat, or nuts may improve matters. If symptoms are due to a cow's milk allergy switching to a soy-based or hydrolyzed protein formula may help. Evidence of benefit is greater for hydrolyzed protein formula with the benefit from soy based formula being disputed. Additionally both these formulas have greater cost and are not as palatable. Supplementation with fiber has no benefit.
No clear beneficial effect from spinal manipulation or massage has been shown. Various kinds of gripe water (a home remedy based on sweet-tasting concoctions of herbs, sometimes with alcohol) have been claimed to improve symptoms, but there are potential safety issues with their use. Evidence does not support lactase, or probiotics.
Infants who are colicky do just as well as their non colicky peers with respect to temperament at one year of age.
The word "colic" is derived from the ancient Greek word for intestine (sharing the same root as the word "colon").
It has been an age-old practice to drug crying infants. During the second century BC, the Greek physician Galen prescribed opium to calm fussy babies, and during the Middle Ages in Europe, mothers and wet nurses smeared their nipples with opium lotions before each feeding. Alcohol was also commonly given to infants.
In past decades, doctors recommended treating colicky babies with sedative medications (e.g. phenobarbital, Valium, ethanol), analgesics (e.g. opium) or anti-spasm drugs (e.g. scopolamine, Donnatal, dicyclomine), but all of these are no longer recommended because of potential serious side-effects, including death.
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