Colic is uncontrollable crying in an otherwise healthy infant. The classical criteria for calling it a colic are often termed the “rule of 3” – at the age of about 3 weeks or more, crying lasts for about 3 hours or more and occurs about 3 days a week. This goes on for about 3 weeks or more. Colic is not a disease and will not cause any harm to the infant, but it creates a lot of anxiety in the parents.
Usually all babies cry when hungry, scared, tired, etc. But, an infant with colic will cry excessively, usually at around the same time of the day – commonly late afternoon or evening. Additionally, the cry of the child is louder, shriller, and may start and end suddenly for no apparent reason. During a crying episode, the child may clench his fists, arch his back, or even draw up his legs to pass gas. Eating and sleeping are disrupted by crying: the baby seeks the nipple only to reject it once sucking has begun, or, dozes for a few moments only to reawaken screaming. Colic can have several causes.
Common theories on the cause of colic
Newborns have an inbuilt mechanism for turning out sights and sounds around them, thus allowing them to sleep and drink feeds without disturbance. Around the age of one month, this disappears – leaving the infant more sensitive to stimuli. With multiple new sensations like sound, smell, sight, touch coming at them, some infants get overwhelmed by evening. To release the stress, they cry a lot. Colic attacks end when the infant learns how to filter out some stimuli thereby decreasing the sensory overload.
Immature digestive system:
Swallowing and digesting oral feeds is a big task for the brand-new gastro intestinal system of a baby. Thus, the food may pass too fast or not break down completely cause formation of gas within the intestines. When the baby cries out due to pain caused by the gas, he swallows air and adds to the gas already produced leading to colic.
Weak lower esophageal sphincter:
Infants are known to have gastro esophageal reflux, which acts as a trigger for colic. Infants normally have a weak lower esophageal sphincter which allows the feed to regurgitate from the stomach into the food pipe (esophagus) and into the mouth. This usually disappears as the child grows to about 6 weeks of age. Colic gradually stops around the same time, or, at least, starts decreasing in frequency and severity.
Food allergies or sensitivity:
Some infants are allergic to milk proteins while some formula fed babies have lactose intolerance which could cause colic. Rarely, colic may also be caused by reaction to specific food in the mother’s diet, and this can cause tummy pain in the infant, which can set off the colic.
Studies have shown that mothers who smoke during and after pregnancy are more likely to have babies with colic; even second-hand smoke exposure to the infant can precipitate a colic. Hence, smoking should not be allowed in the house to avoid stimulating colic.
Colic tends to peak at around 6 weeks of age, 80% of the cases disappearing by the age of 4 months. Parents need to learn how to comfort their baby during the colic or take help from others to avoid getting stressed.
Colic remedies based on the possible cause
Respond by picking up the child – Comfort and calm the child. Prompt response may help.
Decrease the excitement – Limit visitors and exposure to new stimulating environment. Provide your baby with a separate room that has dim lights, less or no noise, soothing soft music and not much distraction.
Apply pressure to tummy – Either face down on the bed or against the arm of the mother. Rub the back gently to provide relief.
Antigas drops may be tried – Not always helpful, but could be tried after consulting a paedatrician.
Consider probiotics – Probiotics are natural bacteria present in our gut. Consult your pediatrician before you start on this.
Gripe water – Though not a proven remedy, a lot of grandmothers would vouch for this. Again, this should be given to the baby only in consultation with the doctor.
Diet restrictions for the mother – Avoid cabbage, cauliflower, citrus fruits, dairy products, eggs, soy, etc.
Changing the formula – Switching the type of formula after checking with your pediatrician.
Other tips for calming a colicky baby
Cuddle – Carrying the baby gives a sense of security and physical closeness and may help.
Swaddle – Warm a blanket or cloth and wrap the infant in this.
Music – Play soothing music near the infant, even soothing voice of the mother may be adequate.
Offer a pacifier – Sucking is soothing for the infant, so give her something to suck on.
Get out of the house, enclosed environment – The infant may be bored of the same surroundings, so go out into the garden or take a walk. Change of place and fresh air may help calm the baby.
We also have a word of caution for parents. Crying may indicate some other organic disease or condition. Colicky crying should not be ignored and dismissed as colic. Look out for other symptoms like vomiting, distension of abdomen, fever, constipation, refusal of feed, loose stools, blood in stools, etc. In case any of these is present, consult the pediatrician for a correct diagnosis and specific therapy for the infant.
The author is a Consultant Paediatric Surgeon and Paediatric Urologist at Bhatia Hospital, Mumbai.
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