Today on the blog we will be discussing one of the most challenging parts of having a newborn – colic. It can be very confusing to diagnose colic and often during the diagnostic process parents make many unnecessary changes thinking that these changes will help with their child’s fussiness.
What is colic? Colic comes in all shapes and sizes but the key feature among them all is increased fussiness. Colic is more broadly defined as crying for no apparent reason (i.e. NOT hunger, soiled diaper, etc) that lasts for ≥3 hours/day and occurs on ≥3 days per week in an otherwise healthy infant <3 months of age. The “rule of 3’s” so to speak. Stricter definitions include criteria for minimum duration (i.e. three weeks). Other terms that are interchangeable with colic include “cry-fuss behavior,” “excessive crying,” “unsettled infant behavior,” and “period of PURPLE crying.” Clinical features that can distinguish colic from regular crying are: louder and more high pitched cry, facial flushing and clenched fists, and difficulty consoling the baby. Colic often occurs in the evening hours. Colic will resolve with time. Colic resolves in 90% of infants by 8-9 weeks of age and, in almost all babies, colic is gone by 3 months of age.
The cause of colic is largely unknown, although it is likely that there are several contributing factors. Gastrointestinal (gassiness), biologic, and pyschosocial etiologies have all been proposed. It is important to remember that even though colic can be extremely trying on the parents, babies with colic have normal growth and development.
How do we treat colic? For the most part – there is no pharmacologic therapy for colic. Offering the breast or bottle to make sure the infant is not hungry would be the first step and then we recommend different soothing techniques including:
●Using a pacifier.
●Taking the infant for a ride in the car or a walk in the stroller/buggy.
●Holding the infant or placing him/her in a front carrier.
●Rocking the infant or standing and gently bouncing the infant.
●Changing the scenery (or minimizing visual stimuli – dark quiet room).
●Placing the child in an infant swing.
●Providing a warm bath.
●Rubbing the infant’s abdomen.
●Providing white noise (white noise machine, fan, vacuum cleaner, etc.) can sometimes be helpful as well.
Of note, it is NOT suggested to change a mother’s diet or to switch formulas, as there is ZERO evidence to support that this helps and often can lead to worsening symptoms because of the change. However, there are certain cases where a patient could have a milk protein allergy (suggested with blood in the stool among other findings). If you think your child could have this, please make an appointment with your doctor to discuss this. Common over the counter products such as Simethicone (gas drops) or other herbal remedies are not shown to be any better than a placebo medicine. However, since they are often harmless they may be tried on a case-by-case basis after a discussion of potential risks and benefits with your child’s PCP. Probiotic drops can also be used but there is again a lack of any convincing evidence that they help.
To summarize, colic can be extremely frustrating for new parents and can certainly affect the pleasure involved with raising a newborn baby. Severe colic can also lead to postpartum depression. It is important, if your child has colic, to try and maximize support from other family members and friends around you so that you are able to rest occasionally during the day. If both parents are home, pass the child back and forth to give each parent a well deserved break. If you are feeling frustrated and nothing is able to soothe your baby it is fine to put the baby in a crib or bassinet and take a 10 -15 minute break in another room or outside. We always recommend a visit with your PCP if you are concerned that your baby is crying excessively and inconsolable. The good news is – colic always resolves! Perhaps if you know that it WILL eventually get better it will be easier to handle the loud cries and continue to provide love and affection to your precious little one.