What is colic? How do I know if my baby has colic? How do you treat colic? These are the most-asked questions by parents with babies who cry. By BYY’s expert paediatrician, Dr Marashin.
The Mayo Clinic defines colic this way: “Colic is when an otherwise healthy baby cries or fusses frequently for no clear reason. The baby cries for more than 3 hours a day at least 3 days per week for more than 3 weeks”.
The definition is known as Wessel’s Rule of Three. But if you are a parent of a baby with colic then you probably don’t need a medial definition right now. You could have come up with this yourself but what the definition does do is help us to acknowledge that colic or a baby that cries a lot is real. It also gives us guidelines on how to distinguish between colic and illness.
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Babies do cry a lot, especially in the first couple of months. Remember it is their only means of communication so they may need to let you know they are hungry, tired, wet, uncomfortable or ill. Crying is an activity that takes up at least 2 hours a day for any baby but when the crying is more prolonged or coupled with other symptoms then parents do need to take note.
Signs your baby may have colic:
- The crying starts suddenly around 6 weeks of age
- Baby cries for no obvious reason
- The crying usually starts at the same time each day. This is often around 5pm and can last as long as 3 hours
- The crying is high-pitched and more intense than other crying
- Baby clenches his or her fists and pulls the legs up to the tummy
- The tummy appears bloated and baby will often pass wind because he or she swallows so much air when crying
- Baby’s face gets red and flushed
- Nothing you do seems to soothe baby
What you need to exclude before diagnosing a child with colic:
If a baby comes into my practice there are a number of boxes I need to tick before I will call the crying colic. I need to exclude the following:
- Urinary tract infection Babies, and especially little girls, may develop urinary tract infections. This will cause a baby to cry a lot. The urine will need to be tested and treatment given if there is an infection.
- Illness A baby will cry if he or she is sick. Illness in a newborn is not something that should go unattended. A medical professional should assess your baby to make sure that the excessive crying is not due to illness.
- Reflux Is it colic or is it reflux? Reflux is very similar to colic in that the child cries a lot, is gassy but also vomits regularly. These babies are often unhappy throughout the day, particularly after feeds. Reflux does cause parents and babies a lot of distress but unless it is causing other worrying symptoms, the treatment for reflux is the same as the advice you will be given for colic.
- Milk protein allergy Some babies display symptoms that are very similar to colic or reflux. If there is a suspicion of milk protein allergy then breastfeeding mothers will need to remove all dairy from the diet for about 2 weeks to see if baby’s symptoms improve. If baby is formula fed then an appropriate formula will be advised.
- Pyloric Stenosis This is a condition which will make a baby cry. It also causes a baby to vomit large amounts of each feed. The condition requires surgery and needs to be addressed urgently.
- Failure to thrive A baby who crying a lot and is not gaining adequate weight does need to be investigated. There can be numerous causes for this.
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Causes of colic:
The honest answer is that we really don’t know why babies who are otherwise healthy have these intense periods of crying. Researchers looking into the causes of colic have suggested a few contributing factors:
- Heightened sensitivity In utero a baby experiences warmth, muffled sounds and the regular reassurance of the mother’s heartbeat. Out in the world things are very different. There are a large number of stimuli which cause noise and light. Babies who are oversensitive to such stimuli respond with excessive crying as they try to adapt. Removing excessive stimuli would help a child to adjust over time.
- Inability to self-soothe Certain babies require time for their immature nervous systems to develop. This allows them to soothe themselves when they experience excessive stimulation. As a baby gets older and the nervous system develops, so too will their ability to self-soothe. There are techniques which you as a caregiver can use to help baby along.
- Being overly sensitive to wind or gas Since colic babies do seem to have more gas from all the air they swallow while crying, it has been suggested that this causes the colic. Studies have, however, shown that colic does not respond to treatment for gas. In my own experience parents often want to try to help the baby with winds so I am not against trying a product which has been deemed safe for newborn babies. If no change is experienced then parents should stop giving the treatment. Please ensure that you get advice from a healthcare practitioner on which products are safe for this age group.
- Intolerance to the feed As discussed above, some children may have milk protein intolerance. If your healthcare practitioner advises a trial of exclusion of milk protein then go ahead with that for a two week period. If your child does not have an intolerance then this change makes no difference to the colic. Chopping and changing milks may have problems of its own so I would advise against this.
Treatment of colic:
From the definition we saw that babies with colic cry for no apparent reason and are usually difficult to console when the crying begins. As caregivers, we desperately want to help but keep in mind that there isn’t a medicine or treatment for colic. There are just some tips which may make it easier for you and the baby to cope. These include:
- Breastfeeding moms may find that lying back and putting pressure above the areola for the first couple of minutes of the feed will slow the milk flow down. The letdown reflex ensures that the milk comes squirting out when baby first starts drinking and your baby may swallow a lot of air while gulping the milk. Controlling the initial part of the feed may help.
- Bottle-fed babies may benefit from a curved bottle. It allows you to feed baby in an upright position. A collapsible bag or liner reduces the amount of air that a baby swallows during a feed.
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- Since these babies may be overstimulated, taking baby away from the noise of television and other people may create a more peaceful environment. Sitting quietly in a darkened room while stoking baby’s back and talking softly or singing may calm baby down. Using a fan or playing a CD which has white noise may also help.
- The motion of the car may soothe baby.
- A warm bath is always relaxing. You can get into the bath and hold baby in the warm water or simply make bath time around this crying time so that baby gets soothed by the water.
- Babies receive their nurturing, comfort and nourishment through the mouth. A dummy can therefore be a source of comfort. You may need to pull the corner of a soft muslin cloth through the hoop at the back of the dummy to prop the dummy into baby’s mouth while they learn to suck on the dummy.
- Ask for help. The saying that “it takes a village to raise a child” is especially true in the case of a baby with colic. Asking a reliable family member, friend or babysitter to look after baby for a while will give you a break. Taking care of yourself is just as important as taking care of baby.
What is purple crying?
The phrase “Period of PURPLE crying” was coined by an expert in infant crying called Dr Ronald Barr. The PURPLE helps parents to understand what this crying is and to assure them that it is normal and that the majority of babies experience this to a greater or lesser degree. The assurance is that there is nothing wrong with your baby and you are not doing anything wrong. It appears to be a normal physiological process. He describes it this way:
P Peak of crying. Your baby may cry more each week peaking around 6 weeks of age and becoming less by 5 to 6 months of age.
U Unexpected crying. Your baby suddenly starts crying for absolutely no reason. Baby is fed, winded, comfortable and yet starts to cry. This can be extremely distressing for a parent who is doing everything to make baby happy.
R Resists soothing. Your baby may not respond to any of the advice I gave earlier in the article. Baby may cry despite all your efforts.
P Pain-like face. The baby goes red in the face and appears to be in pain even if he or she isn’t.
L Long lasting. A baby can cry for many hours a day, at any time of the day.
E Evening. Babies usually cry in the late afternoon or early evening. At this stage both parents are usually exhausted from a full day and the crying can be extremely stressful.
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In my experience this Period of PURPLE crying defines a situation that every parent will experience at some point of their babies life, in the age group described. Colic seems to be a term that we attribute to certain babies. In fact we should see these two terms as being interchangeable as the important feature is that the baby is not ill and has no apparent reason for crying.
Both cause a huge amount of stress to the caregivers but are not harmful to the baby in any way. Your baby will be absolutely fine when this period passes. What we need to ensure is that you are absolutely fine as well.
The most common cause for shaken baby syndrome is colic or PURPLE crying. If you are at your wits end then take a break. You are not a bad parent, just a parent dealing with a situation which has no medical cure and you just have to ride the tsunami until it passes. It will pass, I promise.
In the meantime surround yourself with people who can support you. Have a look at the YouTube videos which explain exactly what you and your baby are going through and seek help if you are unsure of anything. An article published in the American Journal of Paediatrics puts it this way: “authors have shown that parental counselling may be more effective than changes in infant nutrition”. As always, knowledge is power. If your baby has been cleared of any illness then know that this is just a physiological phase that medical science hasn’t quite found many answers for.
References:
https://pedsinreview.aappublications.org/content/33/7/332
https://www.youtube.com/watch?v=XAGGAYRpPCE
https://journals.lww.com/jpgn/Fulltext/2013/12001/Treatments_for_Infant_Colic.10.aspx
http://purplecrying.info/sub-pages/crying/what-is-colic.php
https://pedsinreview.aappublications.org/content/33/7/332
https://www.healthline.com/health/baby/purple-crying
