Let’s Talk Colic
Colic is a topic that comes up at least once a week if not daily while I’m talking to parents. There’s often a big build up to the term. The dreaded colic.
We don’t quite know what causes it but by definition, colic is defined for scientific studies as crying in an infant aged 3 weeks to 3 months for greater than 3 hours a day more than 3 days a week. The rule of 3’s...kind of has a nice ring to it, right?
Reality is if your baby is crying, it’s one of the most distressing things for a parent, and you’re not sitting down, counting the rule of 3’s. Something is making your baby cry and what’s distressing to your baby is distressing to you. The alarm bells are going off in your head, as they are meant to be, and you’re thinking “Is my baby in pain? Am I doing something wrong?”
Often, colic usually occurs around the same time each day, most common in the late afternoon or evening. Usually, that’s also a time when mothers who are nursing may have a supply at the lower end of normal range so infant crying is often mistaken for hunger. Interestingly, the infant is highly unlikely to just take the breast or bottle and quiet down during a colic episode which just confuses parents more.
If it’s not hunger, then what causes colic? The truth is we really don’t know. There are multiple theories, either linked to the infant’s central nervous system (CNS) or the gastrointestinal (GI) system which I will explore more below.
The CNS theories:
Some experts theorize colic is due central nervous system immaturity... The fact that symptoms present late afternoon or early evening may have something to do with stimulation overload. All day long their senses are being stimulated with noise, movement, conversations, and older siblings arguing, and by crying they just block it all out and go back to being inside the womb again.
The CNS theory is interesting because a study by a neurologist of University of California San Francisco showed mothers who suffer migraine headaches are more than twice as likely to have babies with colic, than mothers without a history of migraines. Crazy!
The work raises the question of whether colic maybe an early symptom of migraine and therefore whether reducing stimulation may help infants, just as it can with older children and adults. As a mom of child who had colic, this tactic definitely didn’t work for us!
Babies with colic may be more sensitive to stimuli in their environment, just like migraine sufferers. They may have more difficulty coping with the onslaught of new stimuli after birth as their thrust from the dark warm muffled life inside the womb and into a world that is bright, cold, noisy, and field with touchy hands and bouncy knees.
While this doesn’t apply to every mother of a child with colic, it is a notable association to see maternal smoking or the use of nicotine replacement therapy like the nicotine patch during pregnancy, appears to also increase the risk of infantile colic. The association between prenatal exposure to nicotine and infantile colic aren’t known, but some speculations attribute the colicky symptoms to nicotine withdrawal. Nonetheless, this definitely doesn’t warrant contraindication for using nicotine replacement therapy for women who cannot stop smoking while pregnant.
The GI system theories:
In the past, the colic symptoms were often thought to be due to faulty feeding techniques: under feeding, over feeding, infrequent burping, cows milk protein intolerances, immature GI motility causing discomfort in babies. While these may still play a very large role in the causes behind colic, we are also seeing a link between the stress having a tremendous impact on the gut. Think about it-How often do we hear:
“I feel sick to my stomach.”
“I can feel it in my gut.”
“I just can’t stomach this.”
“I feel butterflies in my stomach.”
There is definitely a link, in my opinion, when the infant is stressed in relation to colic. Some infants are simply more sensitive to stress. And what stresses out an infant? So many things! For example, a completely new environment outside the womb, adjusting to circadian rhythms, noises and sounds, just to name a few!
I do want to pause here and point out that it’s somewhat easy to blame colic on stomach problems because when babies cry what do they do? They bear down, their belly tightens, they scrunch their legs into a ball. All of those things do point to a GI system link and perhaps they even pass gas when doing all of the above so that further instills the GI link. However, despite more than 50 years of research, no definitive link has been proven between infant colic and gastrointestinal problems.
Why Does This Matter?
This is a difficult time to go through! Unfortunately, excessive crying is one of the most common triggers for shaken baby syndrome which can cause brain damage, severe disability, and even death. I never minimize the parent’s concerns and as a mother of a child with colic and reflux, let me tell you-It’s so easy to feel discouraged.
Remind yourself this is not your fault. Whether you’re a first time mom or this is your 2nd or 3rd child, you have to remember something: This is not going to be the first time your child has pain or stress that you can’t fix. It’s easy to read this and tell yourself this now. It’s harder to grasp it in the middle of the night when you’re sleep deprived and anxious. When you begin to feel overwhelmed, take a moment-- Step away. If you’ve done all the calming techniques that are reviewed below and the baby does not have an elevated temp (>100.4 F) rectally, then it is ok to step away. Set a timer for 10 minutes. If 10 minutes seems too long, set a timer for 8 minutes. Go get some water. 8-10 minutes of crying is OK. If someone is nearby, you can ask them to stay with baby. If it’s just you in the house, place the baby in a safe place like the crib and stay in the house but step away for a few minutes. Feelings of anger, guilt, restlessness, exhaustion are normal, but can also be overwhelming. Infants really can sense their mother’s stress which can affect their disposition.
So what can you do?
Infant Massage: I’m a huge fan of infant massage. It’s a great bonding technique between parent and baby, and this is something dads can take on the role of! During a colic episode, not only does your infant seem angry. They’re difficult to console. They tense up their belly, drop their legs, clench their fists. Often times, their actions make us think gas is what’s causing the discomfort. Massage can help with that. You will quickly realize that sometimes, trying the massage during a colic episode, may not immediately alleviate so some parents prefer do it after feeds during the day- just make sure you are massaging belly in clockwise motion when you do. Again, I’m a huge advocate. The power of touch should not be underestimated. It helps to calm infants, and if you’re more of an active hands-on learner, infant massage is a great way to begin to feel more and more comfortable with your newborn.
Have you heard of the 5 S’s by Dr. Harvey Karp? I do like a good number of these soothing techniques, but I do recommend sticking to 2-3 techniques that you’ve found work. Create your own checklist. If you know that side holding has never helped, then trying it at 2am for the 10th time will likely not work! It’ll only frustrate you more. So what are the 5 S’s?
Swaddle-The pressure of swaddling, similar to what babies felt in utero, comforts babies and can lengthen their sleep. It often works best with white noise. When swaddling, make sure the blanket is not near his or her face, and hips are slightly bent. Again, if your baby doesn’t like swaddling, then no need to chase it, but most babies are comforted from it.
Side holding- Infants don’t have to be on their backs when they are awake or when you are holding them. Some find it comforting to be on their sides-particularly the left. It’s worth a try. I never found this technique to help me personally as a parent, but I’ve had other parents who tell me it’s helped. Just remember, this is only while holding the baby; do not put baby to sleep on his or her side.
Swaying-Gently rocking or swaying baby lightly is so instinctive that I scarcely even mention it, but it does calm newborns. This is why infant swings are so popular. I recommend trying to not let it swing napping become a habit or try to phase it out after two months.
Shhh- The gentle, rhythmic “sh-sh-sh” noise is said to mimic the sound of blood flow in the umbilical vessels while baby was in utero. Interesting, right? I actually feel like this technique can help greatly. There is even a white noise machine called “The Shusher” which can help when you get tired of making the noise-so neat!
Suck- The sucking reflex is normal and comforting to the infant. When it comes to nursing, be aware that it’s normal for infants to not take breast or bottle during these colic episodes. Occasionally, nursing can help, but infants also suck on their hands or pacifiers for comfort. If you are going to introduce a pacifier, I recommend doing it after breastfeeding is established, which is usually after the first 4-6 weeks of life. If your baby spits out pacifier, don’t automatically replace it! If you keep plugging his or her mouth with the pacifier, you may be hindering early attempts at communicating hunger or discomfort. Pacifiers are associated with a decreased risk of SIDS, but I think it’s wise to not use it every time the baby is awake and fussy so he or she can become familiar with other self-soothing techniques.
Again, please know that you can go through all of these and the baby can still cry, and that’s ok. It’s not your fault. This is a large part of adjustment to life outside of the womb.
Diet: Colic or excessive crying in an otherwise healthy infant has long been associated with gastrointestinal problems presumably caused by something the mom and hence the baby digested. Here’s the thing: Moms eliminating food has not been shown to make a difference. Milk protein allergy or colitis can benefit from mom cutting out dairy, but colic alone is not a milk protein allergy. I do recommend speaking with your child’s pediatrician before deciding to cut out foods, even dairy. It’s important that mothers keep up their caloric intake to not just keep up milk supply but also overall health and energy after such a huge undertaking by the body. So hear me now-cutting out spicy foods, gluten containing foods, all of it makes no difference. My advice when looking at your diet is to keep a food journal. So rather than cutting out foods without caution, keep a journal and notice. Does your baby’s symptoms worsen with broccoli? You should give yourself at least three tries before creating a solid correlation. Again, please use caution and talk to your child’s pediatrician before cutting out entire foods from your diet.
Probiotics: I’m actually a big fan of probiotics if the situation is appropriate. Some small studies show that giving mom probiotics in last trimester can perhaps make a difference in baby getting colic, but the bacterial strains do matter. We are seeing that Bifidobacterium strains are the most beneficial. At the end of the day, probiotics can often take 10-14 days at minimum to take effect. Our gut microbiome has changed greatly, and infants need to develop the enzymes and bacteria to promote good gut health. I did start my infant on a probiotic during her colic, but to be honest, I’m not sure it helped. At the time, she improved, we were starting to move out of the dreaded 4th trimester so it’s hard to say if it was the probiotic or the tincture of time. For parents who do begin a probiotic, I recommend running it by your pediatrician first and then administer every day until infant is 6 months, and you begin solids.
Home remedies-I’m by no means an herbologist. I’m a Western trained allopathic physician, but I do believe some home remedies can help. Skin to skin and bodily warmth across infant’s abdomen has been shown to comfort during a colic episode. We’ve also seen chamomile, fennel,and ginger help in IBS patients, but none of these have been studied in infants. I don’t advocate for feeding infants any of these herbs, but an old remedy which many moms and grandmas recommend is gripe water. Gripe water can contain some of these herbs, but it’s safety is questionable. It’s not a FDA regulated product and depending on where it’s purchased, it can contain other compounds. A few years back, an off label gripe water brand was also shown to contain alcohol which is incredibly harmful to an infant so if parents do choose to use gripe water, I advocate for caution.
One last piece of wisdom, if you have a young baby who is very fussy at home — this is important — don't just assume it's colic. It may very well be, but there are other medical conditions that result in fussy babies, some of them life-threatening. So, fussy babies need to see a doctor. Let the doctor diagnose colic. Don't make the diagnosis by yourself at home. It’s ok to go to the pediatrician-check weight to make sure not overfeeding or under feeding, make sure there are no underlying medical issues. As pediatricians, we want to know about fussiness in a baby with a temperature. We are going to want to know about fussiness in a baby with few diapers.
So what are the take home points for moms and dads:
Know that colic is common, and we still don’t know what causes it.
Three hours of crying each day is frustrating. Frustration and anger are normal responses, but you got to be smart about this. Put your baby in a safe place when they’re crying like this and walk away. Parents need respite care.
In the end get a babysitter, go out, have a date night once a week, it’s really important to take care of yourself. The other thing, too, is the end is in sight, most cases of colic do resolve by four months of age.
Make sure to trust that parental instinct. It’s there for a reason! Your pediatrician wants you to keep them in the loop. If you’re concerned, ask. A fussy baby may have colic, but we want to rule out anything else.