Coping with colic

Colic affects up to one in five babies, making it one of the most common gastrointestinal (GI) complaints in babies

The first bout of colic usually occurs within a few weeks of birth and episodes can continue until around three to four months of age. It can be very distressing and difficult for parents to cope with.

Symptoms

To be classed as colic, an infant must display all of the following symptoms from birth to four months of age:

  • Bouts of irritability, fussing or crying that starts and stops without obvious cause
  • Episodes lasting three or more hours a day and occurring at least three days per week for at least one week
  • No failure to thrive.

Symptoms can also include a red, flushed face and babies may clench their fists, draw their knees up towards their chest or arch their back.

Causes

The exact cause is unknown, but there are a number of theories:

  • An immature digestive system can lead to irregular gut motility, excessive wind or an imbalance in gut flora
  • Babies may be sensitive to substances in breast or formula milk, or they may have a reduced ability to digest lactose
  • Excess gas and taking in too much air during feeds
  • Mothers who smoke during pregnancy may increase the risk of their babies developing colic.

The first bout of colic usually occurs within a few weeks of birth and episodes can continue until around three to four months of age

Formula milks for colic

Parents need reassurance that colic will resolve itself. If the symptoms are not caused by an allergy, a healthcare professional may recommend a special infant formula milk to manage colic (such as Aptamil Comfort or Cow & Gate Comfort). These products:

  • Contain partially hydrolysed (broken down) whey protein to make them easier to digest
  • Are thicker in consistency to help babies take in milk more evenly with less air
  • Have a reduced lactose content to aid digestion
  • Are suitable from birth until 12 months of age
  • Should only be used in infants who are already being formula-fed and have been identified as suffering with colic.

Top tips for easing colic

To help ease colic, parents can try the following:

  • For breastfed babies, the mother could try removing caffeine and spicy foods from her diet
  • For bottle-fed babies, ensure the bottle is always tipped up during feeding so that the teat is full of milk rather than air
  • For bottle-fed babies, a vented bottle, fast-flowing or anti-colic teat may help
  • Check the size of the teat as holes that are too small can increase the amount of air taken in during feeds
  • Wind the baby during and after a feed (see When breast milk isn't an option for winding tips)
  • Try a warm bath or a cuddle with a blanket to comfort the baby
  • Provide the baby with a distraction (e.g. a dummy)
  • Rock the baby, or take them for a walk or a ride in a car
  • Try having white noise in the room (e.g. a vacuum cleaner or washing machine) as this has been shown to ease crying
  • Enlist the help of family or friends to allow for regular breaks
  • Contact CRY-SIS, a national support group for families with excessively crying, sleepless and demanding children.

Treatment

Treatment is only necessary if parents are struggling to cope and if the baby is not feeding or not gaining weight. Treatments that may help breast and bottle-fed babies include:

  • Simeticone or dimeticone drops (e.g. Infacol, Dentinox). These drops act on small, trapped bubbles of air which cause the baby pain and discomfort, and combine them into bigger bubbles that are easier for the baby to bring up as wind
  • Lactase enzyme drops (e.g. Colief) help break down the lactose in the milk.

N.B. If a baby has severe colic that has not responded to first line treatment, it may be due to a cows’ milk allergy. In this case, an extensively hydrolysed formula, (e.g. Aptamil Pepti 1), may be recommended by a healthcare professional. Symptoms of diarrhoea, vomiting and a fever of 38ºC or above (if under three months of age) or 39ºC or above (if aged three to six months) are not associated with colic, and in this case, further investigation would be needed.

Clinical summary:

Colic should be suspected in any baby from birth to around three to four months of age who cries excessively and inconsolably in the late afternoon or evening. Symptoms typically include simultaneously clenching the fists, arching the back or drawing the knees up to the abdomen, and a red flushed face.

Differential diagnoses include:

  • Discomfort, for example due to hunger, thirst, the temperature of the environment, wind, the mother’s diet (too much caffeine, alcohol or spicy food) or another condition such as nappy rash
  • Constipation, though this is usually obvious when asking about symptoms
  • Gastro-oesophageal reflux, which can be distinguished from normal infantile reflux by the fact that there will usually be more than five episodes of regurgitation a day, feeds are often refused, and there is little or no weight gain
  • Cows’ milk protein allergy, though other symptoms will often be present, i.e. skin reactions, cough, wheezing, runny nose, nausea, vomiting
  • Parental depression, anxiety or bonding issues.

According to the National Institute for Health and Care Excellence (NICE) guidance on postnatal care, there is little that can be done. The most useful intervention is support and reassurance for parents that colic will resolve. Soothing strategies should be tried first, such as holding the baby during the episodes, bathing, rocking or pushing in a pram, and using white noise as a distraction. Parents should be reassured that colic rarely continues beyond three or four months of age, and encouraged to look after their own wellbeing by asking friends and family for support.

Nutritional solutions for formula-fed infants include partially hydrolysed formula with reduced lactose content and a thicker consistency.

Treatments are only recommended if parents are struggling to cope despite trying the above. A one week trial of simeticone or lactase drops can be tried, but only continued if the baby seems to respond. If the treatment does seem effective, it should be stopped by the age of six months at the latest.

Over-the-counter antimuscarinic dicycloverine is not licensed for those 12 years and younger, and should be used with caution as it can cause side effects such as breathing difficulties and coma.

 



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