COLIC

The term colic has been used in various ways over the years. Our definition of colic is a condition in which babies, typically under four months old, experience periods if unexplainable extreme fussiness without any other health issues. These episodes often follow a predictable pattern, occurring between 3:00 p.m. and midnight, when both the infant and parents are likely fatigued.

Colic is marked by sudden bouts of loud, continuous crying. During these attacks, the baby might suck on their fist, want to feed every 15 to 30 minutes, pass gas, draw their legs to the abdomen, flail their limbs, and have a flushed face. However, in between these bouts, the child appears fine. Parents often suspect stomach pain or even worse that something is dreadfully wrong with the infant.

The exact cause of colic is unclear. Many people assume that the baby is experiencing cramping abdominal pain because the infant is pulling its knees up to its chest. However, babies will demonstrate this same pattern of movement with crying to anything in their environment that upsets them, like being startled by a loud noise. This suggests that colic is more complex than just abdominal pain. It might result from a combination of factors such as the infant's temperament, dietary adjustments, environmental changes, fatigue, perceived parental stress, potential formula intolerance, or increased awareness as the baby develops.

Said a different way, the differential diagnoses (causes) of irritability in infancy are:

1. Infant temperament
2. Parenting issues: anxiety
3. Cow's milk protein intolerance
4. Gastroesophageal reflux (rare)
5. Brain abnormalities (rare) like meningitis, an infection of the brain
6. Inborn errors of metabolism (rare). We do a screening test for this in the newborn period.

Given the uncertain understanding of colic, treatments vary widely. In the past, sedatives like paregoric (tincture of opium) and even alcohol were used. We do not recommend any of these measures because they are dangerous to the infant.

Thankfully, colic is temporary and usually resolves by four months of age. Babies with colic develop normally and do not have long-term psychological or personality issues. The following approaches may be helpful in managing colic in your child:

1. Check your baby to make sure there is no obvious reason for the crying. This should be done with baby completely undressed. Is the child’s clothing pinching the baby? If there is nothing physically wrong? Make sure your baby is well fed, adequately burped and appropriately dressed, including a clean, dry diaper. Your infant should have a normal temperature with nothing obviously hurting him.
2. Swaddle the baby. Your baby can be wrapped snugly in a blanket and possibly rocked for several minutes to see if this calms the child. However, swaddling the baby should cease by three months of age when your baby begins to try to roll over. If your child continues to cry, then place the baby in the crib and leave him or her alone for several minutes. Almost always in a little time your infant will fall asleep and get the rest that he needs. 
3. Simethicone drops (Mylicon) are possibly helpful in decreasing the amount of gas in the stomach. The dose is one dropperful (0.3 ml) every three hours. Again, the most effective way of decreasing intestinal gas, however, is adequate burping and this should always be done.
4. If the baby is breast fed, you should consider any recent changes in your diet which might be affecting your baby. For both breast fed and bottle fed infants, attempts at frequent burping may have dramatic effects in decreasing the symptoms of colic. 
5. If your baby is bottle fed, try changing the type of bottle to a Dr. Brown bottle to see if that improves the crying. Change to Gentlease formula to see if that helps. 
6. Sometimes formula intolerance or food allergies can contribute to colic. This is generally due to cow's milk protein intolerance. Symptoms of cow's milk allergy may include: diarrhea, constipation, blood in the stools, spitting up blood, irritability and vomiting. It's important to discuss this possibility with us during an office visit so we can evaluate and address it appropriately. This is created by first switching from a milk-based formula to a hydrolysate formula, such as Nutramigen LGG. Hydrolysate formulas contain predigested cow milk protein (casein), which broken down into smaller pieces for easier digestion and reduced risk of allergic reactions. For more severe cases of formula allergy, amino acid formulas like Puramino, which are even more hypoallergenic, may be recommended. In breast fed infants, the mother should stop all dairy products.

If the above measures are not helpful and your infant continues to scream, it is possible that your child has another problem besides colic. He or she should be brought to the office for an appointment. Unusual screaming which is inconsolable and persists for more than two hours should prompt a call to our office or a trip to the emergency room at Arkansas Children’s Hospital.

Note: We consider infant formulas to be like medications and advise any changes only under our guidance. Always consult our office before changing your baby’s formula.