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Causes of Colic and Its Treatments
Colic affects up to 30% of babies usually between three weeks and thirteen weeks of age. It affects breastfed and formula-fed babies equally. A baby with colic has spells of unexplained irritability, agitation, fussing or crying. The main symptom is non-stop inconsolable crying, without any obvious cause. Not surprisingly colic causes a great deal of stress in families.
Babies with colic often cry at around the same time of day, usually after their afternoon or evening feeds. They may bring their knees up to their chest as if in pain, become tense, go red in the face and may also be windy.
Crying is one of the ways a baby communicates that they are tired, hungry, over-stimulated or simply want to release tension. However a baby with infant colic cannot be comforted during crying episodes. Sometimes a baby with colic will writhe in pain and cry inconsolably and it is important to check there is no medical cause for this by bringing your baby to the GP. A diagnosis of colic is usually made when no other problem can be found and the baby is otherwise well and growing normally. If you suspect your baby has colic it is a good idea to take him or her to the GP for a physical examination.
Try keeping a diary of crying episodes to check for a pattern. It is also worth remembering that most people experience abdominal pain before examinations or interviews – there is little doubt that stress felt by parents or caregivers is transmitted to babies.
Causes of colic
Medical research has failed to find the exact cause of colic, but a combination of factors is likely to be responsible. It is widely thought that painful contractions of the gut due to a build-up of wind may be a cause and that the baby’s crying, drawing up of legs and so are probably due to pain. Wind may accumulate if your baby swallows air when feeding or crying. Painful gut contractions may be also be caused by cow’s milk protein intolerance or lactose intolerance. Over-stimulation is another possible cause.
Treatment of colic
There is no single correct way to deal with colic. The only one proven treatment is time. Most colicy babies outgrow the problem between 4 and 6 months of age but this is of little consolation to parents of a young baby when a half hour of inconsolable crying can seem like an eternity. It’s worth trying the following:
* Check the baby is not hungry or thirsty.
* If you are bottle-feeding try making up bottles with 1 – 2 oz more than you think the baby will drink. This will allow feeding to appetite and you will know that the baby is full when he or she stops feeding.
* If you are breastfeeding don’t switch to the second breast too quickly while the first still has milk to give. Hind milk contains more fat than fore milk. Fat slows down stomach emptying and lactose is released more slowly into the small bowel thus aiding digestion.
* Carry and gently rock the baby. Sometimes babies get bored or simply want some extra attention and a cuddle.
* Try to reduce the baby’s wind.
* Offer feeds more often
* Offer the baby a soother. There are times when a baby is not hungry but wants to suck on something for comfort and soothers can be useful. (If you are breastfeeding it is best not to offer a soother until breastfeeding has been established.)
* Place a warm face cloth or hot water bottle wrapped in a towel on the baby’s tummy (make sure the hot water bottle does not feel too hot)
* Relax the baby by giving a warm bath.
* Try gently massaging your baby’s tummy in a circular clockwise motion about an hour before you think he or she is likely to start crying – but not just after a feed. Use a baby massage oil.
Note: It is best to work through these suggestions in a sequence over a few hours or days, deciding yourself which one to try first. Bear in mind none of them may work.
Steps to reduce over-stimulation
Babies can be over-stimulated by too much loud noise, bright lights or the presence of several people at the one time. Some babies are prone to over-stimulation due to an immature central nervous system. The following measures to reduce over-stimulation may be helpful in the management of colic:
* Minimise loud household noises
* Place the baby in a dark quiet room
* Swaddling the baby by wrapping snugly in a blanket or sheet. This technique is often used in hospitals and may also be helpful if the baby is over tired or needs to feel snug. If you’re unsure how to do it ask your public health nurse or an experienced friend. Most babies like to be swaddled up until 6 weeks of age and sometimes longer. If the baby becomes agitated and fights being so tightly wrapped you will know that the time has come to stop. It is also important to make sure that the baby is not too warm.
* Try rhythmic stimulation by placing the baby near a vibrating appliance such as a tumble drier or washing machine (when not on the spin cycle!), or in a bouncy chair or make a short car journey or push the baby repeatedly forwards and backwards in the pram.
Lactase deficiency
Your baby may develop a temporary milk lactase deficiency so that the lactose in the formula or breastmilk will not be properly digested and may cause colicky pain. It is not possible to test for lactase deficiency as a cause of colic but if your baby has colic it is worth trying a low-lactose formula such as Enfamil O-Lac or SMA Lactofree or giving Colief lactase drops A trial period of 4 – 5 days is recommended. If a low lactose feed fails to reduce colic then the final option for treatment is a 1 – 2 week trial on a hypoallergenic formula such as Nutramigen (by Mead Johnson) or Cow and Gate Pepti.
Cow’s milk protein allergy
In a small number of cases colic may be caused by a cow’s milk protein allergy. This is more likely if there is a family history of allergy. Try a hypoallergenic formula such as Nutramigen (by Mead Johnson) or Cow and Gate Pepti for 1 – 2 weeks.
If the baby responds to the formula discuss with your doctor, public health nurse or dietitian how long to continue with it. Breastfeeding mothers should consider a week’s trial on a dairy-free or low-allergen diet i.e. a diet containing no cow’s milk, wheat, egg or peanuts. However removing foods from the diet significantly increases the risk of nutritional deficiencies so should only be done under medical supervision. Ideally you should obtain advice from a dietitian especially you are going to continue on a milk free diet for a number of weeks or you have to avoid more than one food type.
Dairy products are a very valuable source of calcium, protein and vitamin B12 and you will need to find alternative sources of these nutrients if you go on a dairy-free diet.
Other treatments for colic
A number of treatments for colic are available from pharmacies, including Infacol, Dentinox and gripe water. These have not been scientifically proven to help in cases of infant colic. However, some parents have found them beneficial and there is no evidence that they cause any harm.
Infacol contains the active ingredient simeticone. Simeticone is a deflatulent which helps bring up wind or air trapped in the tummy. It makes small gas bubbles join into bigger bubbles which are easier to burp. It is given before each feed and is suitable from birth onwards.
Dentinox Infant Colic Drops work in a similar way to Infacol. Unlike Infacol the drops can be added to the baby’s bottle or they can be taken from a spoon either with or after a feed. It should not be given more than six times per day. It is suitable from birth onwards.
Gripe water Alcohol free gripe water is no longer available in the Republic of Ireland but continues to be sold in the UK including Northern Ireland. It can also be bought on line from the UK website http://www.auravita.com. Gripe water contains sodium bicarbonate, which helps neutralise stomach acids, and dill seed oil, which helps dissipate trapped air. It is not suitable for infants under 4 weeks. Gripe water is given from a spoon either during or after each feed.
Herbal remedies
Some mothers have reported herbal remedies such as fennel, chamomile and balm mint drinks to be helpful. These herbs have been shown to have an anti-spasmodic activity. However, not all herbal remedies are safe and they should be used with caution.
Many people mistakenly believe that because herbal remedies are ‘natural’ they must automatically be safe. Some herbal remedies work in the same way as licensed drugs but do not have to undergo any rigorous safety checks before they are sold to the public. It is best to speak with your doctor or public health nurse before trying a new product. It is important to ensure that any herbal drinks given to babies are sugar free. Alternatively you can make your own herbal drink by adding some fennel and mint leaves to water, bring to the boil for a few minutes and strain. Offer this drink to the baby once it has cooled to lukewarm. It is best to make it up fresh each time and give no more than 30mls (1oz) twice a day.
Rest and relaxation
It is important for parents to take a break from time to time. Where possible ask friends or family to take care of your baby for brief periods to give you some time to refresh and recharge the batteries. Look for help if you have trouble coping. It can be very hard caring for a baby who cries for long spells every day.
Kindly contributed by Therese Dunne, Phyllis Farrell, Valerie Kelly – Paediatric Dietitians from Temple Street Children’s Hospital
all the thanks should really go to Therese Dunne, Phyllis Farrell, Valerie Kelly – Paediatric Dietitians from Temple Street Children’s Hospital 
