Infantile colic

Signs and Symptoms

All babies get fussy sometimes, but colic is more severe. Colic symptoms include:

• Crying for more than 3 hours, at least 3 times a week, over the course of at least 3 weeks, although the baby is otherwise healthy
• Kicking a lot, pulling the legs up close, and making tight fists
• The baby's tummy seems hard, and the baby burps and passes gas often
• Crying that sounds like your baby is in great pain
• Spitting up frequently after feeding

What Causes It?

Babies with colic often look like their stomachs hurt, and some stop crying after they pass gas or have bowel movements. But no one knows what actually causes colic. Possible causes include:

• In the breastfed baby, a protein-rich maternal diet
• The baby's nervous or digestive system may be immature
• The baby needs comforting, or is over- or under-stimulated
• The baby swallows air, especially when feeding
• The baby reacting to something in the mother's diet (if the baby is breastfed)
• The baby has allergies to some foods, such as milk (if the baby is on formula)
• In utero, the baby was exposed to nicotine, smoking, or both
• Preliminary studies suggest that infantile colic may be associated with migraine.

What to Expect at Your Doctor's Office

The doctor will ask if your baby is eating well and gaining weight or has diarrhea, fever, or unusual stools. If you are breastfeeding, the doctor may ask about foods you have eaten. If the doctor thinks your baby has colic, you can work together to find ways to make your baby feel better.

The doctor will also encourage you to take care of yourself, take a break or get help if you are afraid you will harm your baby. Remember that colic usually disappears between 4 to 6 months of age. If the treatments you choose do not work, your child's pediatrician may check for other problems, such as a digestive problem or allergies.

Treatment Options

• If breastfeeding, nurse whenever your baby seems hungry, usually every 2 to 3 hours. Breast milk contains the natural sleep hormone, melatonin, which may help improve sleep and reduce colic in breast fed infants compared to formula-fed infants. Try avoiding caffeine, dairy products, citrus fruits, soy products, broccoli, cauliflower, cabbage, and spicy foods. Elevate your infant's head during and after feedings.
• If bottle feeding, ask your baby's pediatrician to recommend a formula that is not based on cow's milk and that is not iron fortified. Keep the baby in a sitting position when feeding, and massage her back to get rid of gas bubbles. Burp after every ounce or two of formula.
• Try the "colic carry" -- Place your baby, chest down, on your extended forearm, with his head supported by your hand and his legs on either side of your elbow. Use your other hand to provide additional support and walk around with the baby.
• Hold your baby close, offer a pacifier, try rocking or rubbing your baby's back or stomach, give your baby a warm bath, take a car ride with the baby, play soft music, or use an infant swing to ease the crying.

Drug Therapies

No drugs are recommended, although simethicone (Mylicon), an over-the-counter gas remedy, may be helpful.

Complementary and Alternative Therapies

Eliminating foods that cause gas and using supportive herbal or homeopathic therapies may help your baby's colic. In some cases, colic may be caused by a hidden food allergy and you may need to switch formula or food. A qualified natural health care provider can help you find nutritious hypoallergenic foods for your child. If you are breastfeeding, eliminating foods that may cause gas or allergies from your diet may help. In addition, playing soft music, rocking your baby, or using "white noise" (for example, a dryer or even a vacuum cleaner) may help soothe your infant. Placing your baby in a dim, quiet room may help calm the baby. Use alternative therapies only under the supervision of a trained provider, and always inform your baby's pediatrician of any dietary changes or therapies you may be considering. If you are using any supplements for your infant, make sure they are from a trusted source and a brand the doctor is familiar with.

Nutrition and Supplements

Probiotics. Some research suggests that these "friendly bacteria" may help reduce symptoms of colic. More research is needed to know for sure. Acidophilus (especially Bifidus spp.) can be given to both a breastfeeding mother and a bottle-fed baby. For a baby, make sure you use acidophilus products specifically formulated for babies; DO NOT use adult formulas. Some acidophilus products may need refrigeration. Read the label carefully and follow the directions.

Herbs

Herbs are a way to strengthen and tone the body's systems, although many herbs that may be safe for adults may not be suitable for infants. As with any therapy, you should work with the baby's doctor before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas) or glycerites (glycerine extracts). Because of the alcohol content, do not give tinctures (alcohol extracts) to infants unless directed by your baby's doctor.

Never give herbs to an infant unless your pediatrician tells you to.

• Fennel (Foeniculum vulgare). Fennel tea is a traditional remedy for colic, and some research suggests that fennel tea may help reduce colic symptoms. A breastfeeding mother can drink it. Fennel helps relax the gastrointestinal tract and get rid of gas. There is a report, however, that two infants suffered neurological damage when their mothers used an herbal product that contained fennel, among other ingredients.
• Slippery elm (Ulmus fulva). Helps soothe the digestive system, and you can use it as a tea. You can also combine the powdered bark with water and make a slippery elm "gruel," similar in texture to instant oatmeal. Check with your child's pediatrician first before using slippery elm gruel in your child's diet.
• Some supplement manufacturers make products specially formulated for infants. These products often contain herbs like chamomile (Matricaria recutita), fennel (Foeniculum vulgare), and lemon balm (Melissa officinalis). Ask your child's pediatrician to determine the right dose for your child. DO NOT give these herbs to your child on your own. Some people are allergic to chamomile.
• Other herbs that may help calm the baby or reduce gas include linden (Tilia cordata), catnip (Nepeta cataria), peppermint (Mentha piperita), and dill (Anethum graveolens). Ask your child's pediatrician to determine the right dose for your child. DO NOT give these herbs to your child on your own.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for infantile colic based on their knowledge and clinical experience.

Viburcol, a proprietary homeopathic medicine often used in Europe, can be very effective for acute colic. It contains Chamomilla, Belladonna, Dulcamara, Plantago major, Pulsatilla, and Calcium carbonicum Hahnemanni in homeopathic dilutions.

• Aethusa. For infants who cannot digest milk, who vomit, and have diarrhea.
• Belladonna. For colic with spasms that come and go quickly. The abdomen may feel warm to the touch and symptoms may coincide with constipation. Bending forward may relieve pain.
• Bryonia. For pain worsened by movement and pressure. This remedy is most appropriate for irritable infants who lie still with knees drawn up.
• Carbo vegetabilis. For colic with a distended abdomen and burping or belching. The face may be pale, and hands and feet feel cold.
• Chamomilla. For excessively irritable and screaming infants who are relieved by constant holding and rocking. Infants for whom this remedy is appropriate are often teething and have green, foul-smelling diarrhea.
• Colocynthis. For restless, irritable infants whose symptoms of colic are relieved by firm pressure. In these infants, diarrhea and pain may occur after eating fruit. Infant tends to bring knees up to their abdomen.
• Lycopodium. For infants who cannot stand pressure on the abdomen (even diapers must be worn loosely). Symptoms tend to worsen between 4 and 8 p.m., and then again after midnight.
• Magnesia phos. For infants whose symptoms of colic are relieved with gentle pressure or warmth applied to the abdomen, or while they are bent over. Belching does not relieve pain.
• Natrum phos. For colic with no other distinguishing symptoms.
• Nux vomica. For colic that occurs when a breastfeeding mother eats rich food, drinks alcohol, or coffee. The infant may arch its back and appear angry.
• Pulsatilla. For infants with bloated abdomens after eating, and constipation alternating with diarrhea. May be aggravated by warm rooms, heat, or if the diet of the breastfeeding mother includes fruits, fats, pastries, or ice cream. Relieved by rocking.

Chiropractic

Although there is only preliminary scientific evidence that chiropractic may lessen crying in colicky babies, chiropractors frequently treat colic with a form of gentle spinal manipulation specially designed for infants. Usually treatment requires 3 to 4 visits over a 2 week period.

Physical Medicine

Warm baths may help relax and soothe colicky infants. Add 3 to 4 drops of essential oil of lavender or lemon balm to the water at least 10 minutes before bringing the child to the bath. Take great care not to get undiluted essential oils on the skin or in the eyes, mouth, or nose.

Gently squeezing the acupressure point between the baby's thumb and finger (on the webbing) may help to calm a fussy child.

Massage

Rubbing your baby's abdomen may help him feel better and get rid of gas. In one study, infants who received an aromatherapy abdominal massage using lavender oil had fewer colicky symptoms compared to those who did not receive a massage.

Following Up

Use whatever is safe and works. And remember that your baby will outgrow the colic in a few weeks or months. If you need a break, ask someone you trust to watch your baby for a little while.

Studies show an association between childhood migraine and infantile colic. Preliminary studies suggest an association between infantile colic and attention deficit hyperactivity disorder. Follow up closely with your physician.

Special Considerations

Never shake your baby. This can cause serious or fatal brain damage. If you are feeling overwhelmed, try the following steps:

• Have someone else watch your baby while you get away for awhile.
• Join a support group.
• Call your baby's doctor.

Supporting Research

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