Living with a Colicky Baby
What is colic?
Colic is defined by inconsolable crying on and off for 3 or more hours a day, 3 or more days a week, and 3 weeks in a month. Your baby may cry or scream at the same time each day, usually in the late afternoon or evening.
Colicky symptoms usually begin in the second week after birth, peak at about 6 weeks, and decline at 3 to 4 months. Colic rarely persists longer than 6 months.
Do all babies suffer from colic?
Colic occurs in approximately 30% of breast and bottle-fed babies, and equally in both sexes. Although first-born babies seem to be affected with colic more than later siblings, they are just as likely to suffer from the condition. Colicky babies gain weight and are otherwise healthy.
What are the symptoms?
One or more of the following may suggest that your baby has colic:
- Crying an hour or more after a feed.
- High pitched, intense cry.
- Incessant, inconsolable crying at a regular time each day or night.
- Pulling knees to chest.
- Abdominal bloating.
- Excessive flatulence.
- Frequent, explosive, watery stools.
If your baby suffers from chronic constipation, diarrhoea with blood or mucus, a high temperature, vomiting, weak sucking or poor weight gain, see your GP to rule out other illnesses.
What are the causes of colic?
One or more of the following may cause colic or exacerbate symptoms.
- Lactase deficiency.
- Intestinal hormone imbalance.
- Lack of beneficial bacteria.
- Maternal diet.
- Formula milk protein intolerance.
- Skull misalignment.
- Lack of exercise or carrying.
- Tight clothing.
- Parental stress.
Cells lining the small intestine produce the enzyme lactase. Lactase breaks down milk sugars (lactose), which fuel metabolism and promote rapid brain growth. Insufficient lactase production can cause undigested lactose to ferment in the large intestine leading to excessive gas production, flatulence and abdominal bloating.
Foremilk (watery milk at the beginning of a feed) contains more lactose than hindmilk (high-fat milk at the end of a feed). The high-fat content of hindmilk increases the capacity of the intestine to digest lactose. If your baby is unable to nurse long enough during breast feeds, he or she may not receive the high-fat milk needed to aid digestion.
- Express some foremilk from both breasts before a feed to ensure that your baby receives hindmilk.
- Let your baby finish one breast before offering the other so that more high-fat milk (hindmilk) is consumed.
When breastfeeding and milk production are fully established, a pacifier can help satisfy the need to suck when your baby is not hungry.
Although it may be tempting to give your baby gripe water or natural remedies to relieve colic between feeds, they may contain potentially harmful chemicals, which can have adverse side effects.
Intestinal hormone imbalance
Muscular contractions of the intestinal tract are stimulated by motilin, a hormone secreted by cells lining the small intestine.
Motilin in breast milk has a nocturnal peak, which may explain why breastfed babies become colicky in the evening or at night (motilin is also found in formula milk). High levels of motilin can lead to painful muscular contractions. However, close physical contact increases melatonin (a hormone that induces sleep), which suppresses painful intestinal contractions.
Motilin levels also increase when babies are exposed to environmental smoke and/or nicotine in breast milk. Exposure can be minimized by restricting smoking in the home or near the baby.
Lack of beneficial bacteria
Beneficial or ‘friendly’ bacteria in the intestinal tract play a vital role in protecting your baby from harmful microorganisms that cause inflammation and bloating.
Babies born by Caesarean section may miss out on beneficial bacteria naturally passed on during vaginal birth. Bacterial colonisation may also be delayed if your baby has been exposed to antibiotics. This may explain in part, why your baby suffers from colic.
Probiotics (live beneficial bacteria) occur naturally in breast milk. There is some evidence (http://pediatrics.aappublications.org/content/126/6/1217) that formula milk enriched with probiotics may reduce colicky symptoms in healthy bottle-fed babies, but more studies are needed to substantiate this.
Many breastfeeding mothers have found that excluding cabbage, cauliflower, broccoli, onion, wheat, eggs, soy, caffeine-based foods and drinks, orange juice, and dairy products from their diet reduces colicky symptoms.
Foods not associated with colic include unsaturated vegetable oils, garlic, Brussels sprouts, beans, avocado, bananas, carrots, potatoes, beef, sardines, salmon, and low-fat yoghurt.
Formula milk protein intolerance
If your baby has been recently introduced to formula and presents the symptoms of colic, an allergic response to one or more proteins in cow’s milk could be responsible. Colic may also be accompanied by other allergic symptoms such as an itchy skin rash, vomiting and diarrhoea.
If an allergy is suspected, formula milk that has been specially treated to change the proteins, or contains no milk proteins, can be given as an alternative on the advice of your healthcare professional. Soy formula milk is just as potentially allergenic as cow’s milk, and there is no evidence to suggest that it reduces colicky symptoms.
Misalignment of the skull due to childbirth can put pressure on the vagus nerve, which passes through the neck and thorax to the abdomen. Compression of the vagus nerve can cause intestinal spasms and pain. Cranial osteopathy has been shown to be successful in treating colicky symptoms (http://www.ncbi.nlm.nih.gov/pubmed/16648084). Treatment involves applying very light pressure to the affected area until tension is released.
A snug-fitting nappy can push against your baby’s tummy, especially after a feed. If you cannot easily slide 2 fingers inside the nappy, it may be too tight. Tight clothing can restrict the movement of food through the intestines leading to bloating and discomfit.
Overstimulation can irritate the nervous system and lead to uncontrollable, high-pitched crying at the end of the day. A daytime routine that includes frequent rest-breaks or naps, and short play episodes when your baby is alert and responsive will help avoid overstimulation.
By the end of the third month, the nervous system has adjusted to environmental stimuli, which is one reason why colic usually stops.
Lack of exercise or carrying
Lack of exercise or overuse of a baby bouncer, car seat or other restraining device may reduce intestinal contractions and lead to bloating. However, regular exercise and tummy time improves intestinal mobility and helps force out excess gas.
“The relative lack of carrying in our society may predispose to crying and colic in heathy babies.”
In many cultures, babies are carried by their mothers, grandmothers or siblings in a sling or pouch on their backs, fronts or hips almost constantly. The baby experiences continual physical comfort and an intimate and secure environment. Colic is rare in babies who are constantly held or cuddled.
Research shows that carrying the baby in a carrier, for at least 3 hours during the day (in addition to feeding), reduces colic in the first 3 months of life by as much as 45%. (http://pediatrics.aappublications.org/content/77/5/641). Close physical contact, carrying and walking are undoubtedly the best ways to comfort a distressed baby. Skin-to-skin contact is especially effective in reducing stress.
Parental tension and anxiety do not cause colic. However, colic can increase parental stress, which in turn leads to increased bouts of fussiness and crying in babies.
Continuous crying and maternal fatigue can have serious implications for the mother-baby relationship. It can also trigger postnatal depression, Shaken Baby Syndrome, and early termination of breast feeding.
Parents with a colicky baby need support, particularly in the early months when it is important to establish a strong bond with the baby. Baby Foundations parenting classes can help by empowering parents with information and practical advice on how best to manage colic (http://www.babysensory.com/en/babyfoundations).
If further help is needed, Cry-sis (www.cry-sis.org.uk) provides support to families with excessively crying, sleepless and demanding babies. The helpline (08451 228 669) is open 7 days a week from 9 am to 10 pm.
By Dr. Lin Day: www.babysensory.com