What is colic in babies?
In this comprehensive guide, we discuss everything parents should know about infantile colic in babies; e.g. symptoms, diagnosis, possible other illnesses, remedies, and frequently asked questions.
New parents are faced with the task of learning how to manage their newborn’s needs. Discovering the feeding, diaper changing, and sleep routine take time. After a few weeks, just when you think that you have figured it out, your baby begins to scream and cry for several hours. He or she is difficult to console despite your best efforts.
You soon realize that this is not just a one-time occurrence, but a new nightly pattern. This phenomenon is often called infantile colic or baby colic and can be a source of frustration and concern for many parents. Here, we will discuss everything a parent should know about colic in infants.
Infantile Colic And How To Deal With It
What is Colic?
The definition of infantile colic has been updated from its original description in 1954. Currently, it is defined as “recurrent and long periods of infant crying, fussing, and irritability reported by caregivers that occurs without obvious cause under the age of five months” (source).
Some infants develop colic as young as two weeks old, but the onset is later in others.
Symptoms of illness are absent, and the episodes may last for three or more hours a day (source). During them, infants appear to experience pain, and calming efforts are often unsuccessful. They can be particularly distressing when the crying begins at bedtime.
Colic symptoms ultimately self-resolve around the age of three or four months (source).
Globally, approximately 20% of infants experience colic, including six percent in the United States (source). Parental report of colic varies with lifestyle and cultural norms. A higher number of cases are reported in industrialized nations.
What Increases the Risk of Colic?
Despite how frequently colic occurs, no exact cause has been determined.
Prenatal nicotine exposure has been shown to increase the risk, however (source).
Some clinical studies have found higher reports of colic among mothers who experience anxiety during their pregnancies, or who have limited social support after their infant’s birth (source).
Other studies noted higher incidences in infants who are born prematurely (source).
More recent data indicates a link with the infant’s immature intestinal flora. Infants who experience colic have been found to have less “healthy bacteria” in their gastrointestinal tract (source).
Melatonin may also play a role. This sleep hormone is released by the brain, particularly during dark periods of the day, to help with sleep onset. It also assists with the function of the gastrointestinal tract and the development of its microbiome (source). At birth, melatonin levels are low but steadily increase by the age of three months. It has been proposed that initially low level of melatonin in the intestines may promote the symptoms of colic (source).
It is safe to say, however, that the etiology of infantile colic is multifactorial, and further research is necessary.
Possible causes of colic
While the exact cause of colic remains unknown, most of the focus has been on its gastrointestinal symptoms.
Excessive intestinal gas that is swallowed during feedings may contribute to these symptoms. This can be the result of “gassy” foods in the maternal diet for breastfeeding infants, or increased swallowed air from bottle feedings (source). Broccoli, cauliflower, beans, and caffeinated beverages are common “offending” maternal foods. Overfeeding may also be a factor.
Neuropsychological causes have been proposed. Overstimulation may contribute to colic. A day of multiple visitors wanting to “hold the baby,” for example, might result in a fussy baby later that evening. There is preliminary data indicating that colic may be associated with the development of migraine headaches later in life (source).
How Is Colic Diagnosed?
There is no specific test that can be used to diagnose colic. It is solely diagnosed based on the presence of the classic symptoms and the absence of others.
Babies with colic exhibit a high-pitched scream or cry incessantly during the colic episodes (source).
The skin of the face may look flushed or red (blue color is NOT consistent with colic).
Characteristic movements include clenching of the fists, stiffening of the arms, and pulling the legs or knees toward the chest.
The baby is alert and responsive, despite being difficult to console. Fever or other signs of illness are absent. The baby is happy, feeds well, voids and stools normally, and sleeps calmly at all other times of the day.
At the routine infant doctor visits, the baby’s exam and growth parameters are within normal limits.
Medical Conditions That Mimic Colic
There are a variety of medical conditions that present with fussiness and crying, but that indicate a more concerning problem. If your baby has any of the following symptoms, you should consult a doctor.
Note: There has been some discussion of an association of infant colic with the future development of autism. Despite parent perceptions, current research shows no link between these two entities (source).
An infant who is fighting an infection can exhibit irritability and crying, but lethargy is also common. Typical infant infections include meningitis, urinary tract infections, and common viral illnesses. Either a fever or very low temperature may be present. Under the age of three months, a temperature above 100.4 or below 96.7 degrees F is considered significant and warrants medical evaluation (source). If your baby is unexpectedly fussy or difficult to console, the first thing to check is a rectal temperature. True infant colic is never associated with a fever.
Gastroesophageal Reflux Disease (GERD)
Some infants experience more than the usual “spit-ups” after feedings. They feel intense pain from stomach acid regurgitation. The first signs of GERD may be evident as young as two weeks of age, and symptoms peak by four months old (source). Premature infants, however, may experience it much earlier (source). The distress that this pain causes can mimic that of colic, but there is a difference: GERD is most often associated feeding difficulties. Infants stop feeding every few sips of milk due to the discomfort, cough or exhibit a “back arching” motion in an attempt to relieve the pain (source). Other infants will cough and vomit entire feedings. Weight gain is impaired due to failure to consume enough calories. Because the reflux of stomach acid is more intense when infants lie flat, placing them in this position elicits a shrill cry due to pain. This makes sleeping difficult, both for infants and parents.
Cow’s Milk Protein Allergy (CMPA)
Two to seven percent of infants suffer from CMPA (source). It may develop as young as two weeks old, noted by streaks of blood mixed within the stool during a diaper change. Fussiness between feedings is common. Despite normal feeding schedules, these infants fail to gain weight. Cow’s milk exposure occurs via breastmilk due to maternal consumption, or from a cow’s milk-based infant formula (source). In these situations, restricting cow’s milk from the diet if breastfeeding or giving a hydrolyzed infant formula remedies the situation.
Note: Many parents believe that colic symptoms in infants are a sign of lactose intolerance. Except for in premature infants, the presence of a gastrointestinal infection, or cases of a rare hereditary type, lactose intolerance is not present in the majority of infants (source).
Occasionally, a strand of hair catches around an infant’s finger or toe, and manages to wrap around it. The skin becomes compressed under the hair, causing the surrounding area to swell. If unnoticed, finger or toe pain develops, resulting in a crying, inconsolable baby (source). Less tangled hair tourniquets may be loose enough to be removed at home, but emergency medical intervention is necessary when the swelling is significant. Once the hair has been removed, the infant’s demeanor returns to happy and calm.
Crying with a distended belly in the presence of bilious (green colored) vomiting or decreased stooling are signs of a bowel obstruction. This occurs in 1:2000 infants each year (source). A bowel volvulus or malrotation is characterized by intestines that are twisted in a way that prevents normal passage of the intestinal contents. In other cases, the intestines may not have developed properly in utero, and there is no outlet to the rectum. Most of these situations are detected within the first few days of life.
Intussusception is a condition where one portion of the intestines folds into itself, similar to how a telescope would function. This tends to occur intermittently and produces severe stomach pain. Occasionally, bloody stools are passed. Intussusception, however, is rare under the age of 6 months (source).
Any fall or impact onto an infant’s abdomen can cause internal organ trauma, eliciting pain and unconsolable crying. In severe cases, there may be obvious abdominal bruising (source).
There is no question that colic symptoms are stressful for parents and caregivers. Hearing an infant scream is often heartbreaking, and can create feelings of helplessness. Managing colic is even more difficult in the presence of postpartum depression (source). Because there is no easy solution for colic, it is important to ask for help. Enlisting the assistance of extended family and friends can allow parents to get a much-needed “break.”
Sadly, colicky babies are more likely to be the victims of shaken baby syndrome and other injuries (source). Colic symptoms and parenting challenges should be discussed with a doctor. This can both rule out other medical conditions and allow for discussion of ways to reduce the symptoms. Postpartum depression screening is conducted during the initial well infant visits, and resources are provided when necessary.
Feeding and Gas Management
Making sure not to feed your infant too much or too frequently may help to reduce colic symptoms. In general, young infants are hungry every two to three hours and take up to three ounces if feeding from a bottle (source). Efforts to reduce the accumulation of excessive stomach and intestinal gas can help. Although breastfed infants tend to swallow less air during feedings than those who bottle-feed, taking a “burp break” halfway through feeding can reduce gassiness. In clinical practice, I recommend “over the shoulder” or “belly down, on the lap” positions for burping.
There are a variety of over-the-counter colic relief remedies on the market. Unfortunately, many of them are not clinically proven to be very effective. Simethicone is often recommended, but research has shown similar results from placebos (source).
Probiotics, however, appear more successfully to treat colic, especially in breastfed infants (source). Their effects in boosting intestinal gut flora may be the colic mitigating factor.
Simple measures such as soothing sounds or white noise may help calm a fussy, crying infant. Motion from rocking, walking, or even a car ride can be soothing (source). For other babies, offering a pacifier works. Gently massaging the arms and legs with calming baby oil or lotion can also provide relief.
A warm bath or warm washcloth draped over the belly helps to relax tight stomach muscles.
Moving the infant’s legs in a “bicycle motion” may help him or her pass more of the accumulated gas. Doing some “tummy time” can reduce some of the abdominal pressure as well.
Fennel tea is a common cultural colic remedy that shows efficacy in some clinical trials (source). If given in small amounts and not in place of feedings, fennel may provide relief. Excessive ingestion, however, has been found to cause adverse effects, particularly when transmitted via breastmilk (source).
Chiropractic care for infants has become increasingly popular among parents. Studies regarding its use for colic have been inconclusive (source). In addition, current research has shown that acupuncture is an ineffective colic remedy (source).
Common Questions About Colic
Is my colicky baby in pain?
Yes, your baby is experiencing pain, but he or she cannot verbally express it. It is important to check your infant for any other sources of discomfort, including the conditions that can mimic colic. If all seems to be fine, you may wish to try some of the suggested soothing techniques and remedies.
2. How do I know if my baby has colic?
The key point to remember is that there should be no signs or symptoms of illness. According to the current criteria, a baby with colic has recurring episodes of crying, fussiness, and irritability that self-resolve by four months old. There are no apparent triggers for the episodes, but you see the characteristic clenched fists, stiff arms, and pulling the knees toward the chest. At all other times of the day, your baby is interactive and feeds, stools, and sleeps normally.
3. How can I get my colic baby to sleep?
Soothing your baby by swaddling, cradling, and offering a pacifier can help. When this doesn’t work, a warm bath or a brief practice of “tummy time” can help the baby to relax. Some parents choose to take their baby for a ride in the car, however, he or she often wakes again upon arriving home.
4. Is colic a sign of autism or other neurological developmental disorder?
Colic is not a sign of autism or other neurological disorders. If an infant is born with or develops a neurological condition within the first three months of life, there will be other signs. The expected newborn reflexes are diminished or the baby may have seizures. In other cases, there may be asymmetry of movement of the arms or legs.
Many of the diagnostic signs of autism cannot be seen or assessed in young infants. However, at each well visit, babies are examined to be sure they are achieving the appropriate developmental milestones for their age. 12 months old is when the earliest signs of autism can be recognized such as delayed speech or loss of previously achieved developmental skills (source). Most pediatricians do formal assessments for autism at the 18 and 24-month-old visits.
5. Can a toddler get colic?
No. Colic self-resolves no later than four months old. If your toddler is experiencing crying with belly pain, you should call a doctor. The reason for the discomfort could be a simple as constipation, or as serious as appendicitis or intussusception.
6. Can colic go away and come back?
Colic symptoms can wax and wane over the first few months of life, but completely resolves by four months old. It does not return after this age.
7. What should I do if I can’t cope with my baby’s colic?
Although the months your infant is experiencing colic may be stressful and difficult, it is important to remember that colic is temporary. It will end after the baby is three or four months old.
Sometimes, it just helps to place your infant in a safe location and step away for 10 minutes.
However, if you are feeling overwhelmed, it is ok to ask for help. Discussing your situation with a doctor can provide information on ways to soothe your baby and resources for you as a parent.
You and your spouse or partner should take turns soothing the baby during the colic episodes. Asking a trusted friend, family member, neighbor to stay with the baby so you to take a break can help you to survive this difficult phase.
If you are sad and feel that colic is affecting your feelings about your baby, seek help from a mental health professional or parent support group.
Having a baby that experiences infantile colic is hard. If you suspect colic, make sure a doctor rules out all other illnesses that may mimic colic. If your baby is healthy, this WILL pass within a few months. Experiment with the colic management strategies suggested in this article and never hesitate to ask for support.
You will get through this!
Parents’ tips and experiences
To hear what has worked and not, and how other parents have endured the colic times, can be very valuable. Quite a few parents have shared their tips and feelings below in the comment section.
I am so grateful to all of you who take your time to share and thereby help a fellow parent! <3
Please share your thoughts and experiences by leaving a comment below!