Colic

Definition

Colic is defined as when a baby cries for longer than three hours every day for more than three days a week. It is the extreme end of normal crying behavior. The condition is harmless, even though it is distressing for parents or caregivers.

Description

Almost all babies go through a fussy period, but when crying lasts longer than about three hours a day and is not caused by a specific medical problem, it is considered colic. Pediatricians will tell parents that babies do not exhibit colic symptoms until around three weeks of age, but there are many parents who would disagree. The physician may also tell the parents that it will be at its worst around six weeks of age and then usually stops around three or four months of age. Some parents might disagree with that, too. It can be acknowledged as a relatively short period of time in a baby's life, but it seems like an eternity to the parents. It frequently, but not always, starts at the same time of day, and for most babies that is in the evening. The inconsolable crying begins suddenly; the legs may be drawn up, and the belly distended. The hands may be clenched. It seems as if it goes on forever and winds down when the baby is exhausted or when gas or stool is passed. Some babies continue crying for longer than three hours.

Demographics

Anywhere from 20 to 25 percent of babies cry enough to meet the definition of colic. There are approximately 4 million babies born every year in the United States, so that means almost a million babies have symptoms of colic.

Causes and symptoms

The baby with colic tends to be unusually sensitive to stimulation. Some babies experience greater discomfort from intestinal gas. Some cry from hunger. Some cry from overfeeding. Fear , frustration, or even excitement can lead to abdominal discomfort and colic. The situation may become a viscous cycle: the people caring for the baby become worried, anxious, or depressed, and the baby can sense their emotions and cries more. There are two theories regarding the cause of colic, and the first is that it is due to an immature nervous system. The majority of babies with colic can be classified with this condition to some degree. A small percentage of babies with colic may have milk allergies , reflux, and silent reflux. Formula changes or changes in diet for the breastfeeding mother can contribute to the problem. One recent study noted that the babies of mothers who smoke have a higher incidence of colic. The culprit is likely nicotine, which increases blood levels of a gut protein involved in digestion, according to Brown University epidemiologist Edmond Shenassa. This situation could result in painful cramping that makes babies cry.

When to call the doctor

Parents should call the pediatrician if they are concerned. A careful physical exam is prudent to insure the baby does not have a medical problem that needs attention. It is imperative not to misdiagnose a serious condition and call it colic. Should the behavior pattern of crying suddenly change and be associated with fever, vomiting, diarrhea , or other abnormal symptoms, parents should call the doctor immediately.

Diagnosis

Diagnosis occurs mostly by elimination. If the physical exam demonstrates nothing else is wrong, the pediatrician may diagnose colic by the parent's description of the crying.

Treatment

Parents should remember that colic is a benign condition, and the only treatment is through a matter of experimentation and observation. If a trigger for colic can be identified, that is a big start. Possible triggers include:

Foods: Avoid stimulants such as caffeine and chocolate if breastfeeding.
Formula: Switching formula works for some babies but is not at all helpful for others.
Medicine: Medication that a breastfeeding mother takes may affect the baby.
Feeding: If a bottle feeding takes less than 20 minutes, the hole in the nipple may be too large. Avoid overfeeding the infant or feeding too quickly.

Other strategies that can be tried include:

movement and vibration
using an infant swing
rocking in a rocking chair
going for a car ride
holding the baby close in an upright position
swaddling in a blanket

Nutritional concerns

The primary nutritional concerns are related to the breastfeeding mother's diet by avoiding the intake of stimulants. For those who are bottle feeding, a switch in the formula may be beneficial.

Prognosis

Colic is a benign condition. The infant outgrows it. Moreover, in spite of apparent abdominal pain , colicky infants eat well and gain weight normally.

Prevention

Very little can be done to prevent colic, other than trying to discover triggers that cause the baby to cry and to not smoke.

Parental concerns

It is natural for parents to be concerned when a baby cries, and their concern only heightens if it seems they can do nothing to stop the crying. Once a physical exam has been performed and medical causes have been ruled out, parents can accept the fact that the baby has colic and try to work with it the best way possible. They may want to take breaks from the baby by dividing childcare between them. A parent can be more loving to a baby when the parent has a chance to refresh.

Resources

BOOKS

Seidel, Henry M., et al. Primary Care of the Newborn , 3rd ed. St. Louis, MO: Mosby, 2001.

WEB SITES

What Is Colic? Available online at http://www.colichelp.com/ (accessed December 8, 2004).

"Your Colicky Baby." Kids Health for Parents. Available online at http://kidshealth.org/parent/growth/growing/colic.html (accessed December 8, 2004).

Linda K. Bennington, MSN, CNS