COLIC – sorting the myths and misconceptions, while learning to cope
Colic… We’ve all heard about it; many of us have researched it, and some of us will have second guessed whether our child has it. Of those, some will actually have a child who does.
The research says that 20% of infants have colic, and it’s most common in the first six weeks of a baby’s life. The good news is that the prevalence drops as our babies get a bit older; only 11% of 7-9 week olds have colic, and by 10-12 weeks old the prevalence is only 0.6%. And even those unlucky last cases resolve within a few more months. The six month mark is the longest that any evidence has seen colic carry on.
However, for something that starts off relatively common, misconceptions abound. Some define colic as inconsolable crying, but the challenge with this is that inconsolable carries different definitions.
A lot of the parents I have worked with who thought that their child had colic didn’t; sometimes new parents simply need more tools or methods in their toolbox. When they get those, and the requisite confidence these bring, their child calms.
However, this is not to discount or diminish the cases where colic genuinely does affect children. Colic is said to occur when an infant cries for three or more hours continuously, on three or more days of the week, for three or more weeks in a stretch. It’s defined as a functional gastrointestinal disorder and while the causes are largely unknown, I will cover some of the possibilities soon.
First, however, I need to make some distinctions. The first thing to understand is that babies cry; it’s normal and the way they tell us they’re hungry, tired, and the rest.
The other important factor to understand about colic is that it’s not reflux. Reflux causes babies to cry from pain, but this is not the same thing. In fact, only 0.5% of babies who have colic also have reflux; most of the time it’s just reflux. A hard distinction to make, but an important one because reflux is far more treatable.
Possible causes of colic
There’s no specific test for colic; often it’s a diagnosis of omission, when there’s nothing else that can be done to stop a baby crying. And as I mentioned, a definitive cause for colic is unknown. However, research has found that there is no correlation between colic and what a baby is fed (breastmilk or formula), a baby’s gestational age at birth, or socioeconomic status.
The current list of possible causes acknowledged by the medical community includes:
- Alterations in microflora which result in an unbalanced gastrointestinal microbiome. This is basically the scientific way of saying that the bacteria in their gut is out of whack.
- Cows’ milk protein allergy or intolerance
- Lactose intolerance
- Gastro immaturity (an underdeveloped gastrointestinal system)
- Inflammation in the gastrointestinal system
- An increase in serotonin secretions, the majority of which comes from our gut
- Increased intestinal permeability
- Poor feeding techniques, i.e. not getting a very good latch
- Maternal smoking
- Under or overstimulation, i.e. too much different visual input, swapping parents constantly etc.
Sorting through the solutions
There’s no shortage of anecdotal solutions, or so-called cures for colic out there, so it can be tricky to know what to try. For example, there has been no evidence of pain relief working for colic, even though it appears the child is in pain. Here we’ve compiled the complete list of evidence-based (i.e. not prone to bias) solutions for parents who are struggling with a colicky child.
- Removing possible allergens from the baby’s milk
This step can consist of a mum removing possible allergens from her diet while breastfeeding, or switching to a hydrolysed formula if they are formula-fed. Different from a lactose-free formula, a hydrolysed option has the cow’s milk protein broken up, which hides the protein so that it can’t trigger a reaction, while being easier to digest.
Every time you feed an allergenic food, the gut environment gets upset and falls out of balance, triggering inflammation. When you get rid of that allergen, it takes some time for the inflammation to die down and then balance to restore; this can take around 3 weeks, so this approach requires some patience.
- The pros of probiotics
Research has found a particular strain – Lactobacillus reuteri DSM17938 – of probiotic that has been proven to result in a 50% reduction in crying time in infants suffering from colic. Not all probiotics are created equally, so the important thing to note is that it absolutely has to be this specific strain.
Probiotics in real life: I saw the power of this probiotic with a client and her 4 week old who was failing to thrive. We introduced the probiotic and switched the (already being formula fed) baby to a hydrolysed formula and had a 70% reduction in crying plus the baby gained 400g in a week!
- Reducing parental stress
Far from being a parent-blaming scenario in the slightest, research shows that parental stress is one of the reasons babies cry. Them crying then stresses us further and a vicious cycle is created.
Evidence shows that parental reassurance and encouragement – taking the time to explain the causes of colic (or the fact that it can have no cause!) and supporting parents with settling strategies – can reduce symptoms in babies by 50%.
This is a large part of the reason we feel so passionate about empowering parents and giving them confidence. When parents feel inadequacy and anger, it’s more challenging to bond with their babies, which increases risk factors later in life. Not only that, but colic has been found to be a risk factor for child abuse, so as a society we have a responsibility to empower and support parents, especially those with a colicky child.
- The five S’s for settling – and the right balance of stimulation
We often talk about the five S’s, which research have linked to less crying. Swaddling, side or stomach holds, ssshhhing, swinging or rocking, and sucking (either on a breast or pacifier) are proven, practical ways to settle an infant.
I mentioned before about the right amount of stimulation, which is vital because to calm a crying baby, we have to trigger their sympathetic nervous system. The five S’s work with a group of reflexes that are vestibular, auditory and tactile, which when combined provide the right balance of stimulation.
The final thing to note is that a child who has had colic is likely to have a different temperament by the time they are six months old than those who haven’t. For starters, in their colicky early months it’s likely been impossible to establish natural sleep habits or get into any 3 hourly routine, so it’s normal that most of these children require some sort of sleep training later on.
However, the other significant difference tends to be that they’re OK with crying; short bursts of crying during sleep training is nothing compared to the stints they used to do. There’s the thought that their stress responses have adapted too, and they may have a higher adaptive level before cortisol kicks in.
It’s also been hypothesised that colicky babies respond differently to those without it; they don’t have the same response to skin on skin and require different soothing strategies. The important thing to remember if you do embark on any sleep training is that the approach has to suit your individual child and respect their temperament.
Emma is the owner and founder of Baby Sleep Consultant, she is a certified infant and child sleep consultant, Happiest Baby on the block educator, has a Bachelor of Science, and Diploma in Education. Emma is a mother to 3 children, and loves writing when she isn't working with tired clients and cheering on her team helping thousands of mums just like you.
Our newborn online sleep program covers all the strategies we know help to reduce colic symptoms.
Stories from actual Mum's who have experienced colic
"My baby has colic/reflux. I think it was more the reflux getting to him than the colic side of things though, but it was hard, so hard. I couldn’t put him down even for a moment.
He had to sleep being held upright or on his tummy on someone. I got hundreds of hours of baby cuddles though and we have bonded so well with my really gentle approach and accepting this is what he’s like and what he needs." ~ Kristen
"We were put in the colic category for so long, and I was so angry that they weren’t helping any more as I knew my little on had something going on (she had reflux also), and it turns out she had an intersussection (telescoping bowel) which then got stuck and she ended up going from just a “colic” baby to a baby vomiting non stop, and pooing red.
I think with this experience of colic, I find that the babies guts are so sensitive, but often mums get lumped into the colic category so that we can call it something but not given any resources to help.
We found a small heat pack warmed to just over cold, placed over her tummy over the blankets helped her. Similar to how we have heat pack on period cramps!
But tissue salts were amazing too." ~ Rachel
" My baby had colic and it was horrible we didn’t know what was wrong with him. We didn’t find anything that worked as far as quiet bath, feeding, walking, driving etc.
In the end the only thing that helped was colic calm the natural remedy. It was a life saver!
We were so desperate for something to help him/us." ~ Gems
" My baby cried a lot in the first 3 months of her life.
One day for over 5 hours straight and I honestly thought I wasn’t going to survive motherhood.
I used to sit on the couch and cry and think I was a failure.
My husband and I tried everything to help her, and even put her on reflux medication as I was sure something was wrong.
Nothing worked and we were constantly housebound as we couldn’t go for outings in the condition she was. Around 13 weeks, she just grew out of it! I wish I knew that crying was normal and that it does eventually end." ~ Abby
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Savino F, Cordisco L, Tarasco V, et al. : Molecular identification of coliform bacteria from colicky breastfed infants. Acta Paediatr. 2009;98(10):1582–8.
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