What Is Colic?

All babies cry — it's one of the main ways they communicate. But some babies cry more than others. And some, although they're healthy, well-fed and cared for, seem to cry inconsolably. If your baby cries about the same time each day and nothing you do seems to comfort him or her, your baby may have colic.

Colic is not a disease, but a pattern of excessive crying with no apparent cause. This frustrating and largely unexplained condition affects up to one-third of all infants. Colic usually starts a few weeks after birth, peaks at about 6 weeks of age and often improves markedly by your baby's third to fifth month.

Although colic can be extremely distressing for both you and your child, you can take comfort in the fact that it's not permanent. In fact, in a matter of weeks, when your baby is happier and sleeping better, you'll have weathered one of the first major challenges of parenthood. (You'll also be better prepared to take on some upcoming challenges, such as the "terrible twos").

Children's Conditions Center

Signs and Symptoms

Although some people use the word colicky to describe any fussy baby, a truly colicky baby is an otherwise healthy, growing infant under 4 months of age with very specific symptoms. These include:

• Predictable, recurring crying episodes. A colicky baby cries around the same time each day, usually in the late afternoon or evening. Colic episodes may last anywhere from a few minutes to 3 hours or more on any given day, although babies with colic are likely to cry as long as 2 to 3 hours several days a week. The crying usually begins suddenly and for no clear reason. Your baby may have a bowel movement or pass gas near the end of the colic episode.
  
  
• Activity. Many colicky babies draw their legs onto their abdomens, clench their fists, tense their stomachs or thrash around and appear to be in pain during crying episodes.
  
  
• Intense or inconsolable crying. Colic crying is intense, not weak or sickly. Your baby's face will likely be flushed, and he or she will be extremely difficult, if not impossible, to comfort.

If your baby is premature and develops colic, the crying episodes will likely start about 6 to 8 weeks after your original due date. Because premature infants tend to be quiet and sleepy at first, you may worry that your baby is developing a serious problem. That's possible but not likely. It's more likely that your preemie is just becoming more mature — and that sometimes includes developing colic.

Causes

No one really knows what causes colic. Researchers have explored a number of possibilities, including:

• Milk allergies or intolerance
  
  
• An immature digestive system that causes unusually strong intestinal contractions
  
  
• Food backing up into the esophagus (the passage connecting your baby's mouth and stomach)
  
  
• Increased intestinal gas
  
  
• Hormone changes in your baby
  
  
• Your baby's temperament
  
  
• Maternal anxiety
  
  
• Postpartum depression
  
  
• Differences in the way your baby is fed or comforted

Yet it's still unclear why some babies have colic and others don't. If your baby does have colic, it's important to remember that it's not your fault and you're not alone.

Risk Factors

There are many theories about what makes a child more susceptible to colic. None of these seem to be consistently true. Colic does not occur more frequently among firstborns or bottle-fed babies. And girls and boys — no matter what their birth order or how they're fed — experience colic in similar numbers. Other factors that don't seem to increase your baby's risk for colic include:

• First-time parents. If you're a first-time parent, you're nomore likely to have a colicky baby than experienced parents, although colic may be especially stressful for new parents.
  
  
• Breast-feeding. If you're breast-feeding, your baby's colic probably isn't the result of something you're eating.
  
  
• Formula feeding. Formula is usually not the cause of colic, although special formulas can help some babies.
  
  
• Lactose intolerance. Almost all babies have some degree of lactose intolerance, but the connection to colic isn't clear-cut.

When to Seek Medical Advice

Currently, no medications, either prescription or over-the-counter, always relieve colic safely and effectively. In general, consult with your doctor before giving your baby any medication to treat colic.

Also be sure to contact your baby's medical caregiver if you're concerned that your baby isn't gaining weight, if your baby develops bloody or very hard stools and anytime you feel your baby is seriously ill. Seek medical attention right away if you think your baby's crying might be the result of a fall, injury or vigorous shaking.

If you feel you're running out of ideas for handling your baby's colic, consider asking your county health department or visiting nurse association to recommend parenting support resources in your community.

And if you or others caring for your baby are becoming angry or frustrated because of the crying, call your doctor or bring the baby to your physician's office or a hospital emergency room right away. Remember: It's extremely important not to ever shake a baby — Serious and even life-threatening brain injury may result.

You can also talk to a professional and caring counselor by calling the CHILDHELP USA National Child Abuse Hotline at 800-4-A-Child (800-422-4453). They provide crisis intervention and information 24 hours a day, 7 days a week, with technology to interpret in 140 languages.

Screening and Diagnosis

Your doctor will likely diagnose colic on the basis of your baby's symptoms. He or she may also perform a general physical exam to see if other reasons exist for your baby's distress. Doctors consider colic a "diagnosis of exclusion," which means other, less common medical conditions need to be ruled out before determining your baby has colic. These conditions might include intestinal or urinary infections, intestinal obstruction, cardiac problems or a corneal abrasion or other injury.

In general, pediatricians advise against subjecting most babies — even those with severe colic — to laboratory or X-ray tests.

Corneal abrasion (scratch)

Complications

Although you may find colic to be dramatic and stressful, you don't need to worry that it will harm your baby. Children with colic still grow and develop normally. No evidence suggests that colic has any lasting medical consequences. Colic doesn't increase the chances your child will develop sudden infant death syndrome (SIDS) or umbilical or inguinal hernias.

Also don't worry about "spoiling" your baby. It's fine to respond every time he or she cries. Right now, your baby is really too young to be "spoiled." In fact, colicky babies bond with their parents just as other babies do.

Treatment

Your baby's doctor may not be able to fix colic or make it go away sooner. But medical caregivers can assist by checking to see whether your baby is otherwise healthy. They can also help you take care of a colicky baby.

In general, prescription medications have not proven very helpful for colic. Some medicines, such as dicyclomine (Bentyl), can have serious side effects. Even antacids with bicarbonate can be dangerous if used for long periods of time or in high doses.

Self-Care

Experiment to discover what works best to ease your child's colic. Remember, what works at one time may not work at another. Here are some ideas to try:

• Offer food. Sometimes a colicky baby is really just hungry. Although it's possible to over feed your baby, it isn't likely — babies usually spit or throw up what they don't need. If you think your baby may be hungry, it's fine to offer a feeding.
  
  
• Offer a pacifier. Even if you're breastfeeding, it's probably okay to try a pacifier; some babies have a more intense urge to suck as a self-soothing activity.
  
  
• Try sugar water. For some babies sugar water can be soothing. (Dissolve about a half-teaspoon of sugar in an ounce of water). Don't use honey, however. It may contain bacteria that can be dangerous for infants, though not for older children and adults.
  
  
• Hold your baby. Cuddling helps some babies. Other infants quiet when they're held closely and swaddled in blankets. Don't wrap your baby too warmly at bedtime though; sometimes colicky babies wake up because they're too warm. Most of all, don't take it personally if your baby doesn't seem to want to be held.
  
  
• Keep your baby in motion. Gently rock your baby in your arms or in an infant swing. Or lay your baby tummy-down on your knees and then sway your knees slowly. Take a walk with your baby, or go for a drive with your baby in an infant car seat.
  
  
• Sing to your baby. Even if lullabies don't stop your baby from crying, they can keep you calm and help pass the time while you're waiting for your baby to settle down.
  
  
• Try constant background sound. Some infants with colic cry less when they hear a background sound that stays at a low, steady volume. When holding or rocking your baby, try making a continuous "shssss" sound. Other tricks to try include running a vacuum cleaner, turning on a kitchen or bathroom exhaust fan or buckling your infant in a car seat placed next to a running clothes dryer. (Never put the car seat on top of the dryer because it may fall off.) A fish tank motor or blowing hair dryer turned away from the baby may also help. Or try playing a tape or CD of environmental sounds such as ocean waves, a waterfall or gentle rain. Some babies even seem to respond to classical music. When your baby finally does fall asleep, a steady background sound makes it less likely you'll accidentally wake your baby up. Some sounds, such as a ringing telephone, are too jarring. Turn the ringer off if a phone is in the room where your baby sleeps, and put a "Baby is sleeping" sign on the door.
  
  
• Try helping your infant pass a stool or gas. Rocking your baby face down on your lap may help him or her pass stool or gas. Sometimes gently massaging your baby's stomach also works. It's best to avoid giving an enema, but taking your baby's temperature rectally can occasionally provide relief
  
  
• Use gentle heat. Try giving your baby a warm bath.
  
  
• Use gentle touch. Softly massage your baby, especially around the tummy.
  
  
• Experiment with feeding. Diet changes can sometimes be helpful, but it's best to work out a plan with your doctor. If you breast-feed, you might try eliminating certain foods from your own diet, such as cow's milk, caffeinated drinks and vegetables in the cabbage family, including broccoli. Nursing mainly on one breast for a single feeding may also help. If you feed your baby formula, ask your physician about trying a different formula. Feed your baby more often and in smaller amounts. Switch to a new type of bottle — one with a different nipple, a different shape or a collapsible bag. Finally, adjust your baby's feeding routine and position. Holding your child more upright may help. Burp your baby more often and try to feed more slowly. Adding rice cereal to your baby's diet probably won't help colic, even if you've heard otherwise. Parents with a strong history of allergies should be especially careful about introducing new foods. Stay in touch with your pediatrician, especially if your baby develops allergy symptoms such as eczema.
  
  
• Allow your baby some private time. Sometimes it helps to let your baby stay alone in a crib for at least 5 to 10 minutes. If nothing else seems to be working, maybe a brief timeout will help.
  
  
• Call your doctor if your child's condition seems to change. If you're worried that your baby has a problem other than colic, trust your intuition and contact your primary care provider. You can help your physician by noting in a diary what times your baby cries. Also record your child's sleeping and eating patterns. Or you may want to call your doctor's office every week to let them know how you and your baby are doing.

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Coping Strategies

Caring for an infant, especially a colicky one, can be exhausting and stressful, especially for first-time parents. These suggestions may help:

• Get backup care. Ask for support. Arrange for someone else to care for your child periodically so that you can have a break. Call on relatives, neighbors, friends and baby sitters. Spend some time away from the baby, either with your spouse or partner, or with friends. You also should try to get some badly needed rest! Get backup care well before you feel you're reaching a breaking point. If no one is available, take your child to your doctor or an urgent care center and ask for temporary help. Single parents can find support and information at local chapters of Parents Without Partners. To locate a chapter near you, call 800-637-7974.
  
  
• Express your feelings. It's normal for parents in this situation to feel helpless, depressed or angry. Seek out a good listener and talk about your feelings. If you don't feel comfortable discussing your baby's colic with your friends, you might find it easier to talk to a doctor, nurse, social worker or parent support group.
  
  
• Try to stay positive. Remember, colic will end-usually by your baby's third to fifth month. For now, don't measure your success as a parent by how much your baby cries. The fact that you're trying to figure out what might help means you're a good parent. So does having someone else watch the baby occasionally so you can rest.
  
  
• Try not to think of your baby's crying as a cry for help. Sometimes infants cry from anger or frustration.

Complementary And Alternative Medicine

Alternative therapies for colic haven't been proved to be consistently helpful. Specifically, herbal teas, chiropractic treatments, acupuncture, massage therapy and vibrating cribs all need more study before it's known whether these approaches are helpful or safe.

— July 17, 2001 —