Colic: A pediatrician’s perspective

Being a new parent is difficult, but being the parent of a fussy infant is infinitely more challenging. An estimated 10% to 26% of infants experience colic, which was defined by Wessel in his classic 1954 article as occurring in an otherwise healthy infant who cries for >3 hours per day, >3 days per week, for >3 weeks in duration. Colic begins during the second week of life, peaks at 6 weeks, and resolves between 12 and 16 weeks. It is equally common in both breast-fed and bottle-fed infants.

If we understood the mechanism of infant colic, life would be so much easier for parents and pediatricians.

Is there a regular fussy period each day when it seems you can do nothing to comfort your baby? This is quite common, particularly between 6:00 p.m. and midnight, and is a characteristic of colic. These periods of crankiness may feel like torture, especially if you have the demands of other children or work to do, but fortunately they don’t last long. The length of this fussing usually peaks at about three hours a day by six weeks and then declines to one or two hours a day by three to four months.

Although crying is normal for all infants, averaging 2.2 hours per day, those with colic cry excessively, are more difficult to console, have disrupted sleep, and are the source of much parental anxiety. Mothers of colicky infants are at higher risk for postpartum depression and are more likely to stop breastfeeding early. Infants who are excessively fussy are also at higher risk for child abuse.

As long as the baby calms within a few hours and is relatively peaceful the rest of the day, there’s no reason for alarm. All newborns cry and show some fussiness.Here is a chart to identify the differences of “just crying” vs. colic in your baby:

***It is important to note that colic usually doesn’t have any medical significance and eventually goes away on its own.

 What causes Colic?

Doctors aren’t sure what causes colic. Intolerance to cow’s milk has been suggested as a possible culprit, but doctors now believe that this is rarely the case. Breastfed babies get colic too. Other theories are that colic is due to a baby’s temperament, that some babies just take a little bit longer to get adjusted to the world, and that infants of mothers who smoke are more likely to have colic.

Unfortunately, there is no definite explanation for why this happens. Most often, colic means simply that the child is unusually sensitive to stimulation or cannot “self-console” or regulate his nervous system (also known as an immature nervous system.) As the baby matures, this inability to self-console—marked by constant crying—will improve. Generally this “colicky crying” will stop by three to four months, but it can last until six months of age.

 Treating Colic

No single treatment is proven to make colic go away. But there are ways to make life easier for both you and your colicky baby.

Although you simply may have to wait it out, several things might be worth trying. First, of course, consult your pediatrician to make sure that the crying is not related to any serious medical condition that may require treatment. Then, consider any of the following strategies:

• If you’re nursing, you can try to eliminate milk products, caffeine, onions, cabbage, and any other potentially irritating foods from your own diet e.g. dairy, soy, egg, wheat. If you’re feeding formula to your baby, talk with your pediatrician about a protein hydrolysate formula. If food sensitivity is causing the discomfort, the colic should decrease within a few days of these changes.
• Do not overfeed your baby, which could make her uncomfortable. In general, try to wait at least two to two and a half hours from the start of one feeding to the start of the next one.
• Walk your baby in a baby carrier to soothe her. The motion and body contact will reassure her, even if her discomfort persists.
• Rock her, run the vacuum in the next room, or place her where she can hear the clothes dryer, a fan or a white- noise machine. Steady rhythmic motion and a calming sound may help her fall asleep. However, be sure to never place your child on top of the washer/dryer.
• Introduce a pacifier. While some breastfed babies will actively refuse it, it will provide instant relief for others.
• Lay your baby tummy-down across your knees, and gently rub her back. The pressure against her belly may help comfort her.
• Swaddle her in a large, thin blanket so that she feels secure and warm.

Colic is a challenging problem for pediatricians to address with parents. Parents come to the pediatrician asking for a remedy for the colic, and our response that the
colicky crying is ‘normal’ and that ‘it will go away’ is sometimes simply not enough for parents. Some parents try a different infant formula every few days, and this may not necessarily be needed. Sometimes, I just let the parents try switching formulas because the parents feel very actively involved in the problem-solving process, even if I am unsure that this will have results.

 In my experience, each baby has his/her own unique/idiosyncratic way of calming down. I have heard moms describe a wide variety of tricks- a baby may calm down only when held a particular way, rocked a certain way or when a particular song is sung to them. When my own baby had colic, the only way to calm her down was to take her outside into the fresh air. What works for one baby, may not work for another baby. Once you figure out what maneuver/action calms your baby, then you can use it to calm down your baby every day.

Caring for a colicky baby can be extremely frustrating. So, be sure to take care of yourself too. Don’t blame yourself or your baby for the constant crying — colic is nobody’s fault. Try to relax, and remember that your baby will eventually outgrow this phase.

In the meantime, if you need a break from your baby’s crying, take one. Friends and relatives are often happy to watch your baby when you need some time to yourself. If no one is immediately available, it’s OK to put the baby down in the crib and take a break before making another attempt at consolation. If at any time you feel like you might hurt yourself or the baby, put the baby down in the crib and call for help immediately.

This blog is our third part in a three-part series on infant care. Please read about breastfeeding and bonding with your newborn baby as well, for more information.