Colic

Colic is when a healthy infant cries often, long and hard or is very fussy. Colic upsets parents because their baby's distress happens for no known reason. And no amount of consoling brings relief. Colic often happens in the evening when parents are likely to be most tired.

All babies cry more during their first 3 months than at any other time. If a baby has colic, most often it's at its worst when an infant is about 6 weeks old. The bouts of colic lessen after 3 to 4 months of age.

But even though the crying calms with time, managing colic adds stress to caring for a newborn. You can take steps that may lessen how bad bouts of colic are and how long they last. This also will ease your own stress and make you feel better about your parent-child link.

Babies fuss and cry, mostly during the first three months of life. It's hard to say what's typical. Mainly, colic is defined as crying for three or more hours a day, three or more days a week, for three or more weeks. But you don't have to wait three weeks to seek help.

Features of colic may include:

• Loud, hard crying that may sound like screaming or being in pain.
• Crying for no known reason. Colic crying is not like the crying a baby does when hungry or wet.
• Being fussy even after crying has lessened.
• Timing you can predict, which is often in the evening.
• Change of face color, such as skin flushing or blushing.
• Body tension, such as pulled-up, stiff legs, stiff arms, clenched fists, arched back or tense belly.

Bouts of long, loud crying that can't be soothed may be colic. Or they may be a sign of a condition that causes pain or discomfort. Make an appointment with your child's healthcare professional if your infant has symptoms of colic.

The cause of colic is unknown. Many factors might be a part of colic. But researchers don't know why it most often begins late in the first month of life, how it varies among infants, why it happens at certain times of day and why it resolves on its own in time.

Some factors that might be a part of colic include:

• The system in the body that helps break down and use food, called the digestive system, isn't fully formed.
• There's not enough healthy bacteria in the gut.
• The baby is sensitive to certain foods or not tolerating them.
• The baby is feeding too much, feeding too little or not burping enough.
• The baby has a form of childhood migraine.
• Family stress is affecting the baby.

Risk factors for colic are not well known. These factors have not been shown to increase risk:

• Sex of the baby.
• Early or full-term birth.
• Breastfed or formula-fed.
• Firstborn or later born.

Some studies have shown smoking to be a factor. Infants born to someone who smoked during pregnancy or after delivery might have an increased risk of colic.

Colic that goes away before 6 months of age does not cause short-term or long-term medical problems for a child.

Colic is stressful for parents. Research has shown a link between colic and the following for parents:

• Increased risk of depression after giving birth, called postpartum depression.
• Stopping breastfeeding early.
• Feeling guilty, worn out, helpless or angry.

Shaken baby syndrome

The stress of calming a crying baby has caused some parents to shake or otherwise harm their children. Shaking a baby can cause serious damage to the baby's brain and death. The risk of harming the baby is greater for parents who don't know how to sooth a crying child, haven't learned about colic and don't have the support they need for caring for an infant with colic.

Your baby's healthcare professional will ask for a detailed history and do an exam to diagnose your baby's colic. The healthcare professional will:

• Measure your baby's height, weight and the outside of the head, called the circumference.
• Listen to the heart, lungs and belly sounds.
• Look at arms, legs, fingers, toes, eyes, ears and genitals.
• See how the baby reacts to touch or movement.
• Look for a rash or other signs of infection or allergies.

Lab tests, X-rays and other diagnostic tests often aren't needed. But if it's not clear that the baby has colic, tests can help rule out other causes.

The goal of treatment is to find ways to soothe the baby as much as possible and make sure parents have the support and information they need to cope. As a parent, learn all you can about colic. That way you'll know it's common and not your fault.

Ways to soothe the baby

You may find it helpful to have a list of ways to soothe your baby. You may need to try more than one way. Some ways may work better than others. Some may work one time but not another. Some things to try:

• Set a feeding, sleeping and activity schedule for your infant and stick to it as much as possible.
• Use a pacifier.
• Put the baby in an infant swing.
• Take your infant for a car ride or on a walk in a stroller.
• Walk around with or rock your baby.
• Wrap your baby snugly in a blanket, called swaddling. Leave room for the legs to move.
• Give your baby a warm bath.
• Rub your infant's tummy or place your baby on the tummy for a back rub.
• Play an audio of heartbeats or quiet, soothing sounds
• Use white noise by running a white noise machine, a vacuum cleaner or a clothes dryer in a nearby room.
• Dim the lights and remove anything that might arouse or excite your baby during crying bouts and during sleep.

Ways to feed

Changes in the way you feed your baby also may give some relief. Stick to either feeding your baby on demand, which is when the baby is hungry, or on a fixed schedule.

Hold your baby upright while bottle-feeding. Burp the baby often during and after a feeding. Use a curved bottle. A bag that caves in as it empties can reduce the intake of air.

Trial changes in diet

If soothing attempts or changes in feeding practices don't help the crying, your baby's healthcare professional may suggest a short-term change in the baby's diet.

Changes in the diet may include:

• Formula changes. If you feed your infant formula, the baby's healthcare professional may suggest a one-week trial of extensively hydrolysate formula (Similac Alimentum, others). The proteins in these formulas are broken into smaller sizes.
• Breastfeeding changes. If you're breastfeeding, you may try changing your diet to leave out common food allergens. These include dairy, eggs, nuts and wheat. You also might try not eating foods that could upset your baby's stomach. These include cabbage, onions and drinks with caffeine.

Parent self-care

Caring for an infant who has colic can wear down any parent. To help you take care of yourself and get the support you need, try to:

• Take a break. Take turns with your spouse or partner or ask a friend to take over for a while. Give yourself a chance to get out of the house if you can.
• Use the crib for short breaks. It's OK to put your baby in the crib for a while during a crying bout to help you calm yourself.
• Talk about how you feel. It's typical for parents with a baby who has colic to feel helpless, depressed, guilty or angry. Share your feelings with family members, friends and your child's healthcare provider.
• Don't judge yourself. Don't measure your success as a parent by how much your baby cries. Colic isn't a result of poor parenting. And the crying doesn't mean your baby rejects you.
• Take care of your health. Eat healthy foods. Make time for exercise, such as a brisk daily walk. If you can, sleep when the baby sleeps, even during the day. Don't drink alcohol or use illicit drugs.
• Remember that the colic will end. Colic often improves after age 3 to 4 months.
• Have a rescue plan. If you can, ask a friend or relative to step in when you need relief. If needed, contact your healthcare professional, a local crisis service or a mental health help line for more support.

Potential future treatments

One factor that may add to colic is that the good bacteria in an infant's gut is out of balance. One treatment being studied is the use of good bacteria, called probiotics. Probiotics might help the bacterial balance to improve overall gut health.

Some studies have shown less crying time when babies with colic were treated with a bacterium called Lactobacillus reuteri. The studies have been done with small groups, and results have been mixed. Most experts agree that the study results don't support the use of probiotics to treat colic at this time.

Several small studies have shown some benefits or mixed results for alternative treatments. But there's not enough evidence to judge the potential benefit over the risks. Alternative treatments being studied include:

• Herbal teas.
• Herbs, such as fennel oil.
• Sugar water.
• Fennel extract.
• Gripe water, a mix of water and herbs.
• Baby massage.
• Acupuncture.

Known risks include the following:

• Regular use of herbal teas or other liquids may lead to less milk intake or a drop in salt levels in an infant's blood.
• Herbal products aren't regulated. So you don't know what's in an herbal treatment and whether it has something that can harm your baby.

Talk to your baby's healthcare professional before using any alternative medicine.

Here's some information to help you get ready.

What you can do

To prepare for your appointment, make notes about:

• When your baby cries and how long it lasts. If you have a smartphone, use it to record a crying episode.
• The age of your infant when the crying pattern began.
• What you know about your baby's behavior or other factors before, during and after a bout of crying.
• Your baby's feeding and sleeping schedule.
• What you've done to try to soothe your child.
• The people involved in caring for your infant, such as the other parent, grandparents, babysitters or child care providers.

Write down questions you have about your baby's health or growth. Ask all the questions you have

What to expect from your doctor

Your baby's healthcare professional might ask questions, such as:

• What's a typical crying bout like?
• What does your baby's cry sound like?
• Does your baby's body tense up?
• How well do the things you use to soothe your baby work?
• Does your baby have trouble eating?
• Does the crying happen right after eating?
• What do you feed your baby, and how often?
• How often and how much does your baby spit up?
• How long does your baby sleep at a time? Have there been recent changes in sleep patterns?
• Does your baby ever seem to have trouble breathing while crying?
• How do you cope when your baby is crying? What about the rest of your family?

Your answers to these questions can help your baby's healthcare professional know what might be causing your baby to cry.