Boca VIPediatrics: Colic

My 6 week old baby cries a lot and the doctor said she has colic. What can I do to make her feel better?

Infant colic, otherwise known as excessive crying, is a very common concern for parents. Affecting up to 1 out of every 4 babies, colic is defined as crying in an otherwise healthy infant lasting for at least 3 hours per day, 3 or more days per week, for at least 3 weeks.

· Any parent who has experienced a child with colic knows that you don’t need to (or want to) wait 3 weeks until you do something about your baby’s crying.

o Note: It is normal for ALL babies to cry. On average, babies will cry around 2 hours and 15 minutes per day. (Yes, that is the average, and it’s normal!)

The good news! Colic most often resolves by 12-16 weeks old.

When crying becomes excessive (all parents have different thresholds for excessive crying) there are some steps that can be taken to help lessen the crying, making it easier on you and the baby.

The most important thing for parents is to have help when they need it. Crying infants can be an extreme source of parental anxiety.

· Studies have shown that mothers of colicky infants are at a higher risk for postpartum depression and often stop breastfeeding sooner as a result of the colic.

· Parents can take turns holding, rocking, and soothing a colicky baby to allow the other to get some much needed rest.

· Responsible family members or friends can also help hold, rock, and soothe, or can provide help by bringing over dinner for mom and dad or helping to clean the house.

Does my baby need to have blood tests?

Colic is known as a diagnosis of exclusion. This means that other reasons for crying have been ruled out. Blood tests, x-rays, or ultrasounds are not required to make a diagnosis of colic.

· Colicky babies most often have periods of inconsolable crying, commonly occurring in the late afternoon and evening.

o A colic question list that parents should go over each time the infant has a crying spell:

§ Is there something hurting them? (i.e. tight clothing, clips on the swing pinching their skin, piece of hair wrapped around their finger or toe, etc.)

§ Are they hungry?

§ Do they have a wet or dirty diaper?

§ Are they too hot? Too cold?

§ Do they want to be swaddled? Are they swaddled too tight?

§ Do they simply want to be held?

What else can cause an infant to cry a lot?

Constipation, reflux, infection, or feeding disorders can also be a reason for excessive infant crying.

**Fever is always an emergency in a newborn. Any newborn with a fever (more than 100.4) needs prompt evaluation by a pediatrician or emergency room physician.**

· Additionally, a less common reason, but still important to consider is whether or not a medication (whether prescription, natural, or herbal) that is taken by the mother may be contributing to the crying. A baby can be affected by the medication’s passage through the breast milk.

o Always discuss with your pediatrician any medications or supplements that you are taking while breastfeeding.

What is the cause of colic?

Unfortunately, the reason why some babies have colic is unknown. There are many proposed theories, but none that have been shown to repeatedly be the cause. It is likely that there are multiple causes and each infant with colic can be affected by one or many causes.

Avoid the smoke! Infants who are exposed to secondhand smoke have an increased incidence of colic.

What can I do to treat my baby’s colic?
The most important thing to remember is that infants are allowed to cry. Before using any medications, whether prescription or over-the-counter, parents should first utilize behavioral interventions.

· Behavioral interventions should include effective swaddling, gentle rocking, decreased stimulation, white noise, vibration, and/or motion.

o Note: just because one of the behavioral techniques above does or does not work once or twice, does not mean that you should abandon it. It is important to stick with the techniques and attempt to develop a routine.

· Another option for treatment is an elimination diet by the breastfeeding mother and/or formula changes. However, the benefits from changing a mother’s diet or formula are not seen in all infants.

o Diet changes most often involve eliminating milk, eggs, and soy from a mother’s diet. This can be very difficult for mothers and should always be discussed with your pediatrician.

o Mothers are encouraged to keep a food journal to see if the baby reacts better or worse after a mother eats a certain type of meal.

§ Soy or lactose-free formulas have not been shown in studies to reduce the incidence of colic and are not recommended as a treatment.

· Simethicone, commonly sold as Mylicon, Little Tummys Drops, or known as Gas-X for adults is a medication that works by preventing gas buildup in the intestines and thus improving any belly pain from gas that an infant may have.

o Studies have repeatedly shown that this medication has not been better than a placebo. However, some parents will swear by it and it is often recommended by pediatricians.

o Even though it is available over-the-counter, always talk with your pediatrician prior to giving this medication.

· Probiotics, also known as good bacteria, are another treatment option for colicky babies. They are thought to help restore and promote the growth of “good” bacteria in the intestines and help to soothe colicky babies.

o The exact way it reduces colic is unknown. There are some studies that show that it helps to reduce crying time and other studies showing that it does not work any better than a placebo.

o Not all probiotic supplements are created equal and they are not regulated by the FDA.

§ Prior to giving a probiotic to your infant, you should consult with your pediatrician for the type of probiotic that has been best studied for colic treatment.

There is a laundry list of other treatments for infant colic. These include using chiropractic manipulation, sugar water, herbal extracts and teas, and natural supplements, among others. These treatments are not well studied and their use is not currently supported.

· Note: It is of utmost importance that parents and caregivers realize that just because an item is sold over-the-counter or that others parents have used it without issue does not make it safe for all infants.

· There is no regulation of these over-the-counter natural products, their dosing amounts, or their purity. Additionally, the amounts in each dose may not be consistent between companies or even batches.

o Prior to starting any medication, supplement, vitamin, or other natural product, always consult with your pediatrician.

Colic is a significant source of stress and anxiety for parents. Any treatment that is tried will not typically work over night and the behavioral techniques or treatments may differ for each baby. It most often takes time and regardless of treatments, the colic will improve as the baby gets older.

Your pediatrician should be a great resource on colic treatments and also should be used to ensure that there is no underlying medical condition that may be the reason for a colicky baby.