Baby colic

Infant colic (also known as baby colic and three month colic) is a condition in which an otherwise healthy baby cries or screams frequently and for extended periods, without any discernible reason.

The condition typically appears within the first two weeks of life and almost invariably disappears, often very suddenly, before the baby is three to four months old ^[1]. It is more common in bottle-fed babies, but also occurs in breast-fed infants. The crying frequently occurs during a specific period of the day, often in the early evening.

Since the cause is not conclusively established (see below) and the amount of crying differs between babies, there is no general consensus on the definition of "colic". Having ruled out other causes of crying, a common rule of thumb is to consider a baby "colicky" if it cries intensely more than three days a week, for more than three hours, for more than three weeks in a month.

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Causes

There is no commonly accepted explanation for colic. Traditionally, colic was ascribed to abdominal pain resulting from trapped gas in the digestive tract. This theory is not yet discredited, and some recent scientific evidence seems to support it, yet it is no longer universally accepted as the general cause.

There is solid and mounting evidence that the causes are related to gut flora, from multiple studies which have shown that colicky babies have different gut flora patterns, which includes a lack of Lactobacillus acidophilus.^[2][3][4] Some of these studies suggest the administering of a probiotic, such as Lactobacillus acidophilus, will improve the condition. Probiotics have been shown to improve other conditions associated with colic, such as lactose intolerance^[5], necrotizing enterocolitis^[6], and gastric inflammation.^[7] In addition to that probiotics have been shown to generally improve the health of children who take them.^[8]

Some doctors claim that it is a combination of a baby's sensitive temperament, the environment, and its immature nervous system which makes him/her cry easily and without control. Others believe that it originates in problems in the baby's digestive system, specifically because of the buildup of gas which cannot be released. New studies at the Colic Clinic at Brown University demonstrate that nearly half of babies with colic have mild gastroesophageal reflux. Some cases may be the result of lactose intolerance.^[9]

Recent research raises a number of hypotheses including the onset of melatonin production by the pineal gland (which does not begin until 12 weeks of age, about the time colic seems to disappear),^[10] circadian rhythms,^[11] and smoking and stress of the mother in the third trimester.^[12]

Because of the links between prenatal stress, birth trauma, maternal stress etc, and colic, it has also been suggested that some 'colic', or excessive crying may actually be a healthy stress release requiring support and facilitation rather than suppression or 'cure'.^[13]

Treatment

There is currently no generally-accepted medical treatment for colic, and the approach taken by medical professionals varies substantially from country to country and indeed from doctor to doctor. Many believe that the condition is currently untreatable, and is best left to run its course. Other doctors prescribe simethicone, which treats trapped gas; some parents report that this is effective, but for many others it is not, and research suggests that it is not useful.^[14]

One study showed a moderate success when infants with colic were treated with dicyclomine, an anti-spasmotic drug commonly found in some anti-diarrheal medications.^[15]

Other studies have found success with probiotics such as Lactobacillus reuteri, which were intended to reduce gas.^[16]

Gripe water is believed by some to relieve the symptoms associated with baby colic, teething and baby's gas^{[citation needed]}.

In addition to herbal teas it is believed that the organoleptic effects of certain herbs can help calm and relieve colic symptoms.

Scientists warn that further studies are necessary before any specific cure should be recommended.^[16]

There is general agreement that soothing measures, such as pacifiers, listening to white noise and rocking, are often effective in calming the baby during crying periods. Also known as the "cuddle cure",^[17] the five S's are known as Swaddling, placing the baby on their Side or Stomach, Swinging the baby, making a Shhh sound in the baby's ear, and giving the baby something to Suck on. Some parents take turns holding the baby upright (which may reduce the pain and crying) to enable the other parent to catch up on sleep. Babies with lactose intolerance or reflux cry harder and longer when left to lie on their backs, but parents are not advised to put the baby to sleep on their front as it is considered a risk factor for Sudden Infant Death Syndrome.

Various tactics, such as changes in diet or routine, an increase in fresh air or certain herbal teas, are popularly believed to cure colic. There is also the theory that rubbing warm olive oil on the hands and feet, then rubbing the stomach with olive oil in a clockwise motion will cure colic. While some of these may help in certain cases, none of them is known to be universally effective. The widespread belief in them may be partly due to the suddenness with which colic naturally resolves itself. Many parents keep trying different approaches until the colic suddenly stops, at which point they presume that the last thing they tried was the cure.

In cases where 'colic' or excessive crying is possibly the infants innate healing mechanism helping them to recover from birth trauma or other past or current stress, appropriate holding and facilitation techniques may be able to increase the effectiveness of the release process and reduce the overall amount of crying time needed. In any case parents may benefit from learning these techniques, as this can help them to cope better psychologically with their child's distress, and to feel more empowered in the midst of an extremely trying situation. ^[18]

Effect on the family

Colic can place an enormous strain on parents and other family members. The feeling that they are not providing something their child desperately wants or needs can induce stress, depression, feelings of helplessness, and low self-esteem. If crying is prevalent during nighttime hours then these problems can be aggravated by the resulting sleep deprivation or interruption to sleep patterns; exhaustion may also result. Where people live in dense housing such as apartment blocks, persistent crying can also strain relationships with neighbors and landlords.

The stress on parents is often compounded by well-meaning but misguided people who believe that the parents must be doing something wrong. This attitude is quite common among people who have raised colic-free children themselves. Even those who have had children who suffered from colic, and who found a "cure" (see above), can be reluctant to believe their own suggested approach does not work for somebody else.

In some areas, support groups have been set up for parents of children with colic.

References

1. ^ Boyd, D & Bee, H (2006). Lifespan Development 4th ed. London: Pearson
2. ^ Bacterial counts of intestinal Lactobacillus species in infants with colic.
3. ^ Intestinal microflora in breastfed colicky and non-colicky infants.
4. ^ Long-term consumption of infant formulas containing live probiotic bacteria: tolerance and safety.
5. ^ Lactobacillus acidophilus as a dietary adjunct for milk to aid lactose digestion in humans.
6. ^ Probiotics for infants: two studies, two successes
7. ^ Supplement: Effects of Probiotics and Prebiotics
8. ^ Probiotics for infants: two studies, two successes
9. ^ Colic and lactose intolerance
10. ^ Sivan, Yakov; Laudon, Moshe; Tauman, Rivi; and Zisapel, Nava. 2001. Melatonin production in healthy infants: evidence for seasonal variations. Pediatric Research 49(1): 63-68.
11. ^ Colic and circadian rhythms
12. ^ Colic and maternal stress
13. ^ Solter.1998
14. ^ University of Michigan clinical trial for simethicone used for colic
15. ^ Colic and anti-diarrheal medication
16. ^ ^{a b} Study Offers Hope for Treating Colic
17. ^ Colic and the 'cuddle cure'
18. ^ Aletha J. Solter, Ph.D "Tears and Tantrums: what to do when babies and children cry" Shining Star Press (1998)