CRYING AND COLIC

WHAT IS COLIC??

The definition of colic has changed over the years, but essentially colic can be defined as sustained, inconsolable crying in an otherwise well baby. As I said last week, it doesn’t really matter whether it’s officially colic or *just* that your baby cries a lot.  The impact of a crying baby that you can’t console is devastating, whether it lasts for 30 minutes, or 3 hours.  

Reassuringly, only 5% of babies that cry a lot have an underlying medical condition. (Freedman et al, 2009) Colic affects around 20% of babies, peaks at around 5-6 weeks and usually disappears by around 3 months (Zeevenhooven et al, 2017).  So some babies will be colicky, grow out of it, and you’ll never know what actually caused it.

SO… WHAT CAUSES COLIC?

Well… we’re not entirely sure.  There may be one big reason that we haven’t identified yet, or it may be caused by several different things, and therefore one colicky baby has a different cause from another.  

IMMATURITY

As colic presents most often in the first few weeks, I think an immature nervous system might be a really good explanation for colic.  Remember, babies have a very underdeveloped brain when they are born and therefore are more susceptible to dysregulation of their nervous system in the early weeks.   

There is a strong brain-gut connection, so what happens in the brain can affect the gut. Think of it this way… imagine the last time you got really stressed out about something (moving house, an important job interview).  How did it affect your gut?  Now imagine you’re a tiny little baby, helpless to meet any of your own needs, and you’ve realized that you’re never going back to that lovely environment you were in for 9 months, where you were always the right temperature, always gently rocked, with dim lights and muffled sounds.  You have to adapt to this new environment and it’s not quite right for you sometimes, and your brain gets under-stimulated or over-stimulated.  As a result, your gut becomes affected. (Douglas, 2014).

WHAT MIGHT HELP:

Carrying and holding your baby more (it has been proven to reduce length of crying) either in arms or a sling, aiming for at least 10 hours a day.  This often provides a steady level of gentle stimulation for babies.

Spend loads of time just being with, and watching your baby, learning to read his/her cues and provide the stimulation he/she needs.  

Is your baby alert and looking round?  Go for a walk and let your baby experience something new.  

Is he/she engaged and making a lot of eye contact?  Talk and sing to your baby.  

Does your baby have a glazed expression and looking away?  Cuddle them in close, rock them to sleep, don’t engage them in eye contact.  

Is your baby fussy and irritable?  Try the following, but don’t chop and change, try something for a few minutes, before moving on to something else: skin to skin contact, cuddles and rocking, tiger in the tree pose, let them breastfeed or suck on a clean finger, a massage, a change of scenery (walk, car ride, dark room, a different set of arms, a warm bath)…

And the weirdest tip I ever read (but it works wonders sometimes with a fussy baby):  strip them off and lightly scratch them all over (the lightest of scratches, absolutely no marks visible).  I don’t know if babies have an itch that they can’t scratch, or if it just provides a different layer of tactile stimulation, but it has settled both my babies on different occasions when nothing else worked. 

WIND

Colic may indeed be as “simple” as being caused by trapped wind. Careful positioning if you’re breastfeeding may help, and if you’re bottlefeeding, using a paced bottlefeeding technique and feeding on cue may help too.  There are also over the counter remedies (eg Infacol, Gripe water). There’s no real evidence that they help with with colic symptoms, so perhaps save your pennies on that one. (Shel Banks, Infantile Colic, Reflux and Allergies Course)  If you didn’t watch my winding video last week, you can see it here.

TEMPORARY LACTOSE IMBALANCE

Colic may also be caused by a temporary lactose imbalance.  This may be caused by antibiotics, a tummy bug, not making formula up correctly, or either from an oversupply of breastmilk, or latch issues that mean the baby isn’t draining the breast effectively. (Shel Banks, Infantile Colic, Reflux and Allergies Course)  If this is the cause, you might see your baby get very crampy and windy, and possibly have regular green stools that have a lot of mucous in them. There are over the counter remedies that contain lactase enzymes (eg Colief), which may help down break the lactose in the baby’s milk.  It’s always worth chatting to your GP, Health Visitor or an IBCLC, if you think this might be an issue, and before giving any medication.

ALLERGIES

Colic may also be caused by allergy (Minchin, 2015).  In this case, babies never grow out of the discomfort they’re feeling, they just learn to live with it.  We know that breastfed babies are less likely to have colic than formula fed babies, so allergy or intolerance may play a part for some babies.  If you think there are other symptoms of allergy, this may be something you want to consider.  If you’re bottlefeeding, you need to talk to your GP before changing from stage 1 formula to a specialist formula, and if you’re breastfeeding, it would be a really good idea to talk to an IBCLC and/or dietician before eliminating foods from your diet.

GUT FLORA

There is some evidence that certain strains of bacteria may reduce crying.  Makes sense, right?  We know that a good gut flora (or microbiome) helps us digest food well.  An imbalance could cause gut discomfort.  This may also explain why breastfed babies have less colic – their microbiome has a very different profile of bacteria to formula fed babies, and breastmilk contains HMO’s (human milk oligosaccharides) which are there purely to feed the good bacteria in a baby’s gut. (Minchin, 2015) The big problem is… unless you know what the gut bacteria is that is missing, it’s not a good idea to go adding in random bacteria to your baby’s gut (even “friendly” or “good” bacteria is still bacteria!). (Shel Banks, Infantile Colic, Reflux and Allergies Course)  

We are learning so much about the microbiome that it really is an inexact science at the minute.  So giving your baby a probiotic to help with colic may have unintended consequences.  Instead, if you’re breastfeeding, you could try taking a broad-spectrum probiotic, as your gut flora will have an impact on your baby’s.

LOOKING AFTER YOU

Dealing with colic is tough.  Believe me, I’ve been there.  In spite of carrying two babies in slings and breastfeeding, the evenings were really hard work, and often nothing seemed to help with the crying, apart from waiting and cuddling and rocking.  Get support and help.  

If you’re on your own and you need an emotional break, you can put your baby down in a safe place, walk away for a few minutes to compose yourself and then go back to them.  There is a support page for parents here for parents struggling with colic.

You can also contact me if you’d like a feeding assessment, or to explore the potential causes for colic in your baby.

REFERENCES:

Banks, Babyem Infantile Colic, Reflux and Allergies Course, accessed July 2020

Douglas (2014) The Discontented Little Baby Book, University of Queensland Press, Queensland

Freedman et al (2009) The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics 123:841-8.

Minchin (2015)  Milk Matters:  Infant Feeding and Immune Disorder, Milk Matters Pty Ltd

Zeevenhooven et al (2017) The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers, Pediatr Gastroenterol Hepatol Nutr, 20(1) 1-13