Colic is a symptom complex of early infancy characterized by loud, unsoothable, and excessive crying ; apparent abdominal pain ; and irritability .
Causes, incidence, and risk factors
Colic in infants is common, occurring in about 1 out of 10 babies. First-born infants seem to be affected with colic more often than later children. It usually begins within 10 days to 3 weeks after birth, and lasts until 3 to 4 months of age, at which time it generally disappears on its own. In spite of apparent abdominal pain , colicky infants eat well and gain weight normally. The crying episodes may tend to occur around the same time each day, but a few infants will cry almost constantly.
The specific causes of infant colic are not known, but the following factors may play a role:
air swallowed during the process of crying, feeding or sucking on hands or fingers overfeeding with large amounts of formula or breast milk
family tension and parental anxiety
intestinal allergies to cow's milk
esophageal reflux Recent research suggests that colic may be related to reflux esophagitis , which is a condition that occurs when the esophagus becomes irritated by acid backed up from the stomach into the esophagus. A clue to this would be an infant who arches backward during crying spells, and spells that typically occur within an hour of the last feed. Other studies suggest that colic has nothing to do with stomach pain after all, but instead reflects the baby's inability to console itself when dealing with all the stimuli present in its new world. It is thought that such babies lag behind a few weeks developmentally. These studies also concluded that this has no bearing on the baby's intelligence or future development and is just as irrelevant to a baby's future as whether he or she starts walking a few weeks earlier or later than others.
Signs and tests
A physical examination is performed to rule out other causes of similar behavior. Infants also have been studied in the hospital setting with a pH meter in the esophagus overnight. This procedure is more common in infants whose problem is thought to be from gastroesophageal reflux. The procedure measures the amount of acid refluxed from the stomach up into the esophagus.
Treatment
There are no specific measures to treat colic., However, the following suggestions may help to alleviate pain and calm an irritable infant.
Keeping the baby in a slight head-up position may work in some cases. Wood blocks may be used to raise the head of the baby's crib. Avoid overstimulating the baby; an overattended baby may not get sufficient sleep. An active baby may respond to being swaddled (wrapped tightly) in a blanket.
If a bottle feeding takes less than 20 minutes, the hole in the nipple may be too large. Avoid overfeeding the infant or feeding too quickly. A pacifier may calm an infant with a strong sucking need who fusses soon after a feeding. Many babies quiet while riding in the car, or to the sound of a vacuum cleaner or hair dryer.
Apply warmth to the abdomen with a hot water bottle wrapped on a soft cloth (be careful not to burn the infant). Rhythmic movement such as walking or rocking can also help soothe the baby. Finally, as a last resort, colicky babies should be allowed to cry themselves to sleep if thirty minutes of holding and comforting have not been successful. Wrap your baby up and place him or her in the crib. Allow fifteen minutes of crying and restlessness. If the crying continues beyond fifteen minutes, pick him or her up and resume soothing activities.
Parents should do their best to avoid fatigue and exhaustion . To help them do so, they should be encouraged to take a break from the infant by having a friend, grandparent, other relative, or baby sitter stay with the infant on from time to time. Though it may seem as though colic will last forever, almost all babies outgrow it within several months. Occasionally a physician may recommend medications. A large variety of medications have been tried, ranging from paregoric (an opiate derivative), smooth muscle relaxants, antacids, anti-gas agents, mild sedatives, and antihistamines. Nothing has been consistently successful. Parents should not give infants less than six months old medications for colic without first consulting their physician.
Expectations (prognosis)
Colic is a benign condition that the baby usually outgrows at three to four months of age. Excessive crying is not harmful to the baby.
Calling your health care provider
Apply home treatment. Call your health care provider if you have concerns. The most important thing to keep in mind is not to misdiagnose a serious condition and call it colic. If your baby's behavior or crying pattern changes suddenly or if the crying is associated with fever, forceful vomiting, diarrhea, bloody stools, or other abnormal activity or symptoms, call your physician immediately. Do not be afraid to seek help immediately if you feel overwhelmed and are afraid that you may hurt your baby.
Prevention
Most cases of colic are not preventable. Avoiding related factors, when possible, may help. For example, changing the way the baby is held when fed, changing the type of formula (if there's a cow's milk allergy ), or other interventions may be beneficial in some cases. Consult your health care provider and other parents for other suggestions. In any event, colic is NOT the result of bad parenting, so do not feel guilty or blame yourself for not always being able to soothe the baby.