Colic. Rarely have five letters elicited such torture. There are millions of parents with PTSD from having had a child with colic. Many a parent with a colicky child has questioned the existence of God and his benevolence when “blessed” with a colicky child.
Few things as a parent and as a pediatrician are as frustrating as colic. Let’s be honest, colic has no known cause and no known cure. It has been around forever and there is no end in sight. There is no vaccine or medication for colic on the horizon to offer hope for prevention or a cure.
Colic attacks us at our core. It can make parents feel inadequate, isolated, depressed, angry, and guilty in a vicious spiral. The stress of colic can spill over and erode our sense of self and our relationships with others. Colic is painful.
This article sounds encouraging, right? A bright light in a dark room? There can be hope, and there can be a happy ending. The importance is focusing on the right question. For me as a pediatrician, the question is not how do I fix colic, but how can I manage it in a way that when all the dust settles, my sanity and my relationship with my colicky child and the ones I love are intact. Colic will come, and it will mercifully go, but its effects on long term bonding are what I think are most crucial.
The Definition of Colic
But let’s back up a step. What is colic?
Colic is classically defined by the rule of threes. An infant meets the criteria of colic if they cry more than three hours a day, three or more days a week, and this persists more than three weeks. A more practical definition is that colic is frequent, prolonged and intense inconsolable crying, in an otherwise healthy infant. There is a spectrum of colic with some babies crying more than others. Crying is often predictably worse at certain times in the evening; is not relieved by feeding, changing a diaper, or consoling. And it is intense. Studies have shown that a colicky cry can be twenty-five percent higher pitched than a typical cry. An infant’s face is often red or purple, and their bodies tend to stiffen with tension. Crying tends to peak at six weeks, and markedly diminish by three to four months. Luckily, some infants seem to have a few rough weeks, while in others it persists for the entire three to four months.
The Causes of Colic
As mentioned earlier, no one really knows. There are a lot of interesting theories about colic:
- Immature digestive system resulting in increased gassiness
- Imbalance of healthy gut bacteria
- Food allergies or intolerances
- Feeding difficulties
- Hypersensitivity to surroundings/stimulus
None of these theories have fully panned out. Why the fussiness at certain times? Why does it go away without any intervention eventually? And why don’t any of the interventions work consistently? Some misguided individuals question whether parents’ stress before or after giving birth causes colic, making parents feel even more stressed that colic is somehow their fault. Studies have shown this is false. Certainly, colic causes stress, and stress makes you even more acutely aware of your child’s echoing cries.
Diagnosis of Colic
There are no specific tests for colic. Your provider’s job is to make sure at each well check that your infant is otherwise healthy and that your child’s symptoms are not caused by painful spitting up, milk protein allergy, or other conditions. Your provider will do a physical exam and look closely at weight gain and ask questions about painful spitting up, bloody stools, and other signs that there might be another underlying problem. They may consider a trial of medication for reflux or dietary changes to help clarify the diagnosis.
Treatment for Colic
Some of you may have skipped directly to this section, hoping for a cure. Sadly, there is no cure for colic, BUT there are management strategies. Remember, curing colic is not the focus, surviving it with your mental health, your relationships, and your desire to bond with your baby intact is the goal. Colic will last for less than 3-4 months (hopefully way less), but your ongoing relationship with your child is really what is at risk here.
Colic Management Strategies
- Maintain your own sanity and your future ability to bond with your child:
- After feeding/changing diapers, simple attempts to console — by all means, swaddle and put that baby down in their crib and take a break (preferably where you can’t hear the crying); you will both be in a safer space!
- Get help — schedule a break for yourself; this is your time to ask for help from friends and family. Even 1-2 hours a week can save your sanity and give you something to look forward to.
- Recognize that no one, and I mean no one, enjoys hearing or holding a screaming baby. There is no guilt if you are not “enjoying every moment” of parenting.
- Deliberately embrace your healthy coping mechanisms for stress or add some new ones to your list.
- Talk to a non-judgmental person about how you are feeling — a friend, your pediatrician, a counselor; you will realize you are not as crazy as you think.
- Focus on where you want to be as a person and as a parent in a few months when this is behind you. Focus on things you can control.
- Soothing strategies: binky, swaddling, baby carrier, white noise, car ride, walk, and infant massage
- Feeding practices: keep your infant upright during feeds, frequent burping. Try a curved bottle or bottle with a collapsible bag to reduce air intake; Elevate the head of the bed when your infant is laying down (blanket/towel underneath the firm mattress) to reduce spitting up.
- Dietary changes: if breastfeeding, consider a two week trial of eliminating dairy/soy/nuts/eggs and excessive caffeine or other trigger foods; if formula feeding, consider a week trial of extensively hydrolyzed formula like Alimentum / Nutramigen or similar — although expensive and smelly it makes a big difference for some infants.
- Probiotics: some studies demonstrate benefit, especially with the Lactobacillus Reuteri strain; consider a two-week trial.
- Gripe water: contains herbal extracts that can be calming.
Some women experience morning sickness, some women have horrible pregnancies, and some women have colicky babies. It is not fair. But those tough beginnings inherently have nothing to do with your child’s future well-being. Make sure you survive, make sure your child survives, and make sure your desire to bond with your baby thrives when colic is in the rearview mirror. Colic is not a destination.