Colic

What is colic?

Colic is the medical term for excessive, frequent crying in a baby who appears to be otherwise healthy and well fed. It is a poorly understood yet common condition, and affects around one in five babies.

If your baby has colic, they may appear to be in distress. However, the condition is not harmful, and your baby will continue to feed and gain weight normally. There is no evidence that colic has any long-term effects on a baby’s health.

A baby with colic may have several crying outbursts a day, a few times a week. The crying pattern usually begins within the first few weeks of life but often stops by the time the baby is four months old, and by six months at the latest. Read more about the

.

Typically, a baby with colic will scream and draw up their legs, and may refuse to be comforted. It can be very distressing for parents, especially as the

is unknown, but support groups such as Cry-sis may help.

Seeing your doctor

If your baby has colic, it is recommended that you contact your doctor when the excessive crying begins.

This is so your doctor can rule out conditions that may be causing your baby's crying, such as

(a skin condition) or (GORD), where stomach acid leaks back out of the stomach and into the throat.

Read about the

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When to call your doctor immediately

A number of signs and symptoms may suggest that your baby is more seriously ill. It is recommended that you contact your doctor immediately if your baby:

• has a weak, high-pitched continuous cry
• seems floppy when you pick them up
• takes less than one-third of their usual amount of fluid, passes much less urine than usual, vomits green fluid, or passes blood in their stools
• has a high temperature of 38C (100.4F) or above if they are less than three months of age, or 39C (102.2F) or above if they are three to six months old
• has a bulging fontanelle (the soft spot at the top of a baby’s head)
• has a fit (seizure)
• turns blue, blotchy or very pale
• has a stiff neck
• has breathing problems, such as breathing quickly or grunting while breathing
• has a spotty, purple-red rash anywhere on their body (this could be
  meningitis
  )

Advice for parents

Having to care for a baby with colic can be distressing for parents, particularly first-time parents. It is important to remember that:

• Your baby’s colic is not your fault. It does not mean your baby is unwell, or that you are doing something wrong, or that your baby is rejecting you.
• The symptoms of colic will pass. Colic is just a short-term phase that your baby is going through.
• You should look after your own wellbeing. If possible, ask friends and family for support as it is important that you can take a break and rest when your baby is asleep.

Read more information about

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Tips for helping your baby

There is currently no cure for colic. However, some techniques may help, such as bathing your baby in a warm bath and preventing your baby from swallowing air by sitting them upright during feeding.

A small number of babies may also benefit from changes to their diet, such as adding lactase drops to breast milk or bottle milk. Lactase is a type of enzyme that breaks down a sugar called lactose, which is found in milk. Your baby may have short-term problems digesting lactose.

Find out more information about

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Signs of colic

A sign of colic is excessive crying in a baby who is otherwise healthy and well fed.

The crying associated with colic is usually very intense. Your baby's face will be red and flushed, their crying will be severe and furious, and there may be little or nothing that you can do to comfort them.

You may also notice a distinctive change in your baby’s posture. Your baby may clench their fists, draw up their knees, or arch their back.

Crying most often occurs in the late afternoon or evening and usually lasts for at least three hours a day, at least three days a week, and for at least three weeks at a time.

What causes colic?

The cause or causes of colic are unknown, but some researchers think that indigestion or wind may play a significant role.

Other researchers believe that babies with colic may, for a few weeks while their gut is maturing, be sensitive to certain substances that are found in breast or formula milk, such as lactose (a natural sugar) or molecules found in cows' milk. It is thought that these substances may be passed on to the baby through breastfeeding. However, there is little evidence to support these theories.

Another theory suggests that some babies may be more emotionally sensitive than others, and have problems "turning off" their crying response.

Smoking

It is known that women who smoke during pregnancy double their chances of having a baby who develops colic.

This may be because smoking causes a rise in the levels of a hormone called motilin during pregnancy. Increased levels of motilin may lead to symptoms of indigestion and colic shortly after birth.

How is colic diagnosed?

To assess whether your baby has colic, your doctor will ask you about their pattern of symptoms.

They will also probably carry out a physical examination to help determine whether there could be another cause of their symptoms, such as a skin rash.

Your doctor may also ask you a series of questions, such as those listed below, to help determine whether your baby’s crying could be due to a cause other than colic:

• How are your baby’s bowel habits? (Constipation can often be a cause of crying in babies.)
• Is there anything in your diet that may be passing through your breast milk and irritating your baby, such as caffeine or spicy food?
• Does your baby have frequent attacks of hiccups and often coughs or vomits up their milk? (Both of these symptoms can be a sign of acid reflux.)

If no other cause of your baby’s symptoms can be found, a confident diagnosis of colic can be made. Further testing is usually only required if:

• Your baby’s symptoms are not improving after four months.
• Your baby’s symptoms suddenly get worse.
• Your baby is failing to grow and develop at the expected rate.
• Your baby has additional symptoms that suggest they may have acid reflux.

In these circumstances, it is likely that you will be referred to a paediatrician for a more detailed assessment. A paediatrician is a doctor who specialises in the treatment of babies and children.

Treatment for colic

Colic gets better on its own after a few months. There are not many treatment options for colic, but the following tips may help you deal with a colicky baby.

Comforting your baby

There is no "best" way to comfort your baby or reduce the symptoms of colic. Different babies respond to different methods, so you may have to see what works best for you. Here are some suggestions:

• Holding your baby during a crying episode can sometimes help, as can wrapping them snugly in a blanket.
• Sit your baby upright during feeding to prevent them from swallowing air.
• Don't drink too much tea, coffee and other caffeine-containing drinks if you are breastfeeding. Some women also find that spicy food and alcohol can aggravate colic.
• Holes in bottle teats that are too small may cause babies to swallow air along with their feed. "Fast flow" teats with larger (or several) holes are available and may be a useful alternative.
• Always burp your baby after a feed. To do this, sit your baby upright or hold them against your shoulder, making sure you support their neck and head. Gently rub their back and tummy until they burp. They may vomit a small amount of milk when you do this.
• Overstimulating a baby, by continually picking them up and putting them down, may aggravate the crying, according to some research. Gently comforting your baby in a quiet, darkened room may be more beneficial. If you are satisfied that your baby is not hungry, tired, too hot or cold or in need of a nappy change, it may help to leave them in their cot for a short while.
• Babies like movement, so pushing them around in their pram or pushchair or going for a drive can be comforting. Rocking them over your shoulder or carrying them around the house may also be helpful.
• Some babies find "white noise" soothing. This is the background sound of a washing machine or vacuum cleaner.
• Gentle stomach or back rubs or a warm bath may also help to relieve colic.

Parenting style

There has been some debate in recent years about whether different parenting styles have an effect on colic.

Traditionally, parents have been advised to encourage their baby to stick to a fixed eating and sleeping schedule. However, another approach known as "infant-demand" parenting involves feeding or holding babies when they want it.

A study that compared the two approaches found that each one has its own benefits and disadvantages. Babies who were brought up using the traditional approach cried more over a 24-hour period but slept better during the night. Babies who were brought up using infant-demand parenting cried less over a 24-hour period but woke more often during the night.

Medical treatment

As colic always improves on its own, medical treatment is not usually recommended. However, if you have problems coping, contact your doctor for advice about possible medical treatments.

Most treatments for colic only have limited effectiveness. However, some babies respond better to certain treatments than others, so it may be worthwhile giving them a try (one at a time) for about a week or so. These treatments are described below.

Simeticone drops

Simeticone drops are a supplement that you can add to your baby’s bottle or breast milk before a feed. The drops are designed to help release bubbles of trapped air in your baby’s digestive system, so they may be of some use if symptoms of indigestion are contributing to their colic.

A one-week trial of simeticone drops is usually recommended. If your baby’s symptoms do not improve within this time, it is usually felt that there is little point carrying on with the treatment.

Babies can tolerate simeticone drops, and there have been no reports of any side effects from the treatment.

Removing cows' milk

It's possible that your baby may have developed a short-term intolerance to proteins that are found in cows’ milk and other dairy products.

If you are breastfeeding, you can try removing all dairy products from your diet for a week to see if your baby’s symptoms improve.

If you are bottle feeding, switch to a hypoallergenic milk formula. These types of milk have low levels of the protein that may be causing intolerance. Again, you can try using them for a week to see if your baby’s symptoms improve.

Your doctor can advise you about the most suitable hypoallergenic milk formula for your baby. The use of soya milk formula is not usually recommended because it contains hormones that may interfere with your baby’s future physical and sexual development.

If your baby’s symptoms do not improve after using hypoallergenic milk formula for a week, it is usually felt that there is little point carrying on with the treatment.

If you are breastfeeding and you decide to continue with a diary-free diet, you will need to take additional calcium supplements. Dairy products are an important source of calcium, which is needed for good bone health.

Lactase drops

Lactase is an enzyme that helps break down a sugar called lactose, which is found in milk (both breast and bottle milk). Your baby may have short-term problems digesting lactose, which could contribute to their symptoms.

Lactase drops can be added to your baby’s feed to make digesting the lactose easier. As with the other treatments described above, using lactase drops for more than a week if symptoms do not improve is not usually recommended.

Alternative and traditional therapies

There are many alternative and traditional therapies for colic, but there is little evidence that they are effective, and some may harm your baby. Some of these therapies are described below.

Dicycloverine

Also known as dicyclomine, dicycloverine is a medication used to control stomach cramps. In the past, dicycloverine was widely used as a treatment for colic. However, it is now regarded as unsuitable for infants under the age of six months because it can cause serious side effects including:

• breathing difficulties
• seizures
• loss of consciousness
• muscle weakness
• coma

Star anise tea

Star anise tea is a herbal tea that has traditionally been used to treat colic. However, its use is no longer recommended because certain types of star anise are highly toxic and could poison your baby.

Chiropractic and massage therapy

Some people suggest that a series of massages or chiropractic manipulation of a baby's spine may be effective in preventing colic. However, detailed medical trials have failed to find any convincing evidence of the benefit of such therapies.

Self-help tips

If your baby has colic, it is important that you do not forget about your own wellbeing.

Coping with a colicky baby can be exhausting and distressing, and it is common for parents to sometimes feel depressed, angry or helpless. You may find the following tips useful:

• If you feel you cannot cope with your baby's crying, it is best to put the baby down somewhere safe and take a few minutes as a "time out".
• Ask your friends and family for support. All parents need a break, and even an hour of rest on your own can help you cope better with the situation.
• Rest when your baby is asleep.
• Try to meet other parents with babies of the same age for support and advice.

Talking to other people about your problems can often help. A support group called Cry-sis provides help and advice to families with babies that cry excessively and have problems sleeping.