Colic

What is colic?

Colic is a problem that affects some babies during the first three to four months of life. It is defined by the "rule of three": crying at least three hours per day, more than three days per week, and for three weeks duration or more. It can be very stressful and frustrating to parents. Colic usually begins suddenly, with loud and mostly continuous crying.

What causes colic?

Health care providers are not certain what causes colic. There are several theories about why colic may or may not occur, including the following:

• Adjusting to each other. One theory about colic relates to the adjustments that a new baby and his or her parents have to make to each other. Until babies learn to talk, one way they communicate with adults is by crying. Parents have to learn to interpret the reasons their baby is crying, and then figure out what to do to make the baby happy. Is the baby hungry? Wet? Cold? Hot? Tired? Bored? A baby will cry for these reasons, as well as for other problems, and parents must try to determine what is causing their baby's stress, often by trial and error. New parents, especially, may have trouble reading their baby's cues and responding appropriately. The baby may continue to cry simply because its needs have not yet been met.
• Temperament and adjusting to the world. Newborns must also make adjustments to the world they are living in. Not all babies have the same temperament. Some adjust to lights, loud noises, and all the other stimulation around them with no trouble, while others are not able to adapt as easily. Just like adults, some babies are easy-going, and some are impatient. Crying may be one way for a baby to vent feelings as he or she is getting adjusted to the world.
• Oversensitivity to gas. Another possible reason for excessive crying in babies might be due to an oversensitivity to gas in the intestine. Doctors do not think that babies with colic produce more gas than others, but simply that the normal amount of gas that is produced as food is digested is uncomfortable for some babies. If a baby with colic seems to pass more gas than other babies do, it is probably due to swallowing more air while crying for prolonged periods of time.
• Milk allergy. Milk allergies may cause abdominal pain, but usually also cause diarrhea. A baby who cannot tolerate cow's milk and responds to a change in formula may have a milk allergy.

What are the symptoms of colic?

A child who is otherwise well, who cries or is fussy several hours a day, especially from 6 pm to midnight, with no apparent reason, may have colic. Also, babies with colic may burp frequently or pass a significant amount of gas, but this is thought to be due to swallowing air while crying, and is not a cause of colic. The face may be flushed. The abdomen may be tense with legs drawn toward it. The hands may be clenched and the feet are often cold.

The symptoms of colic may resemble other conditions or medical problems. Always consult your child's health care provider for a diagnosis.

Who is at risk for colic?

Infants who are either under or over fed may be more susceptible to colic. Those who are allergic to formula or are sensitive to something in the mother's diet (if breastfed) are prone to colic symptoms. Infants in the 0 to 3 month age range who are started on cereal or other high carbohydrate food are also likely to develop colic as a result of excessive fermentation resulting in gassiness. Lastly, an emotionally unstable environment may contribute to colic symptoms in an infant.

Why is colic a concern?

Colic may become a concern due to the following reasons:

• Frustrating and stressful to parents
• Parents and infant lose sleep
• Infant may be overfed in an attempt to stop the crying

Babies with colic usually grow and gain weight appropriately, despite being fussy or irritable, being gassy, and losing sleep.

How is colic diagnosed or evaluated?

A health care provider will examine your baby and obtain a medical history. Questions might be asked about how long and how often your child cries, if you have noticed anything that seems to trigger the crying, and what comfort measures are effective, if any. Blood tests and X-rays or other imaging tests may be done to determine if there are other problems present.

When should we contact a doctor?

Before assuming your child has colic, you should look for other signs of illness. These may include, but are not limited to, the following:

• Not sucking or drinking a bottle well
• Drinking less milk than usual
• Vomiting
• Diarrhea
• Becoming more irritable when held or touched
• Strange sounding cry
• Change in breathing rate or effort
• Being more sleepy or sluggish than usual

Call your child's health care provider if you note any of these symptoms, or if your baby is crying excessively. Your child's health care provider will examine your child to make sure other problems are not present that might be causing colic-like symptoms.

How can parents deal with colic?

Learning how to interpret your baby's cry can be helpful in dealing with colic. It does take some time for parents and babies to become accustomed to each other. Remember, babies will cry for a certain length of time every day under normal circumstances.

Other suggestions include the following:

• Make sure your baby is not hungry, but do not force feed if he or she is not interested in the bottle or breast.
• Change your baby's position. Sit him or her up if lying down. Let your baby face forward if you are carrying or holding him/her facing your chest. Babies like to see different views of the world.
• Give your baby interesting things to look at: different shapes, colors, textures, and sizes. Talk to your baby. Sing softly to your baby.
• Rock your baby.
• Walk your baby.
• Place your baby in an infant swing on a slow setting.
• Let your baby lay on his or her belly on your lap or on the bed, and rub his or her back. Never leave your baby unattended on a bed, sofa, or other soft surface.
• Go for a ride in the car. The motion of the car often soothes babies.
• Try using something in your child's room that makes a repetitive sound, like a wind-up alarm clock or heartbeat audio tape.
• Hold and cuddle your baby. Babies cannot be spoiled by too much attention. However, they can have problems later in life if they are ignored and their needs are not met as infants.
• Let an adult family member or friend (or a responsible babysitter) care for your baby from time to time so that you can take a break. Taking care of yourself and lowering your stress level may help your baby as well.

What is the long-term outlook for a child with colic?

The symptoms of colic usually resolve by the time a baby is about 4 months of age. Consult your child's health care provider for more information.