Why is my baby crying? A GP’s guide to colic
Scenario: You’ve brought your newborn home from the hospital and you might even start to feel you’re getting a handle on things, when it hits… the incessant crying. You’ve tried feeding them, changing them, burping them but they simply won’t be settled.
A relative, friend or health visitor says it’s probably “just colic”.
So what exactly is colic?
Around 11% of babies experience true colic in the first four months of life. It’s defined as repeated episodes of inconsolable crying in an otherwise healthy baby. Excessive crying, not that I know anyone who has timed it, is classically defined by the rule of 3:3:1: more than 3 hours a day, for at least 3 days a week, for at least 1 week (1).
It tends to be worse in the evening time when you might notice your baby arching their back or clenching their fists and of course crying a lot.
What causes colic?
The cause of colic is unknown. The most popular theory is that baby’s digestive tract is not fully mature and this causes excess wind and pain (2). While not proven most suggested treatments for colic on the market are based around this theory.
What can I do to help my baby?
As parents you will do anything to soothe your crying baby and it can be tempting to raid the colic relief section of the pharmacy. Unfortunately the most common solutions such as simethicone (sold in the UK as Infacol) and lactase drops (sold as Colief) have no good trial evidence for reducing infant crying. The same can be said for gripe water and herbal remedies (3).
The NICE guidance in the UK does not recommend probiotic drops for infantile colic. However there is some evidence of probiotics working for colic in breastfed infants and so out of all the solutions on the market this one seems reasonable to try (4).
Advice for breastfed babies
If you are breastfeeding you will likely be trying to connect whether something you are eating is affecting your baby but the evidence for impact of dietary change on colic is limited. Most trials looking at this have used a “low allergen diet”, that is a diet excluding dairy, wheat, eggs and nuts, and while they do show some reductions in overall infant crying, it doesn’t work for all babies. For the babies that did have improvement in crying on this diet, the crying improved within a matter of days, so if you are determined to try this you should expect quick results (5).
Advice for bottle-fed babies
If you are bottle feeding you may be wondering about changing to a different brand or type of formula. Unfortunately evidence is limited for the effect of changing formula and the majority of the evidence comes from the formula companies themselves (take from that what you will). Formula marketed for colic is often much more expensive than standard formula. My advice is if you want to try it and you can afford it then by all means give it go but if it’s out of budget then please don’t feel you are putting your baby at a disadvantage; changing formula is unlikely to help and colic will pass whether you change formula or not.
Advice for all parents
Listening to your baby crying is hard. As one paediatrician once described it to me: your baby’s cry can feel like a car alarm that just won’t switch off, it puts you on edge and overwhelms you.
Knowing this, you will need support. If you are struggling reach out as much as possible to your support network. Take breaks from you baby, even if that means setting baby down for 5-10 minutes while you get a cuppa; they will be fine, no really they will be. If you aren’t lucky enough to have “the village” on hand when you need a listening ear and reassurance then reach out to charity Cry-Sis; a charity dedicated to supporting parents of crying and sleepless babies (6).
And finally remember- this too shall pass! Whether you change your diet or not, change formula or not, use probiotics or not, colic will pass and your baby will not always cry like this. Colic for most babies will at the very least improve by 4 months and have disappeared by 6 months.
What if it’s more than colic?
As a parent, if something doesn’t feel right about your baby’s diagnosis of colic then please reach out again to your GP or health visitor. You are with your baby all day everyday and know them best. Reflux and cow’s milk protein allergy can present in similar ways to colic and it can be helpful to ask about and consider these.
References:
https://www.nct.org.uk/baby-toddler/crying/my-baby-wont-stop-crying-coping-colic-symptoms
Biagioli, E., Tarasco, V., Lingua, C., Moja, L. and Savino, F. (2016). Pain-relieving agents for infantile colic. Cochrane Database of Systematic Reviews. [online] doi:https://doi.org/10.1002/14651858.cd009999.pub2.
Sung V, Collett S, de Gooyer T, Hiscock H, Tang M, Wake M. Probiotics to prevent or treat excessive infant crying: systematic review and meta-analysis. JAMA Pediatr. 2013 Dec;167(12):1150-7. doi: 10.1001/jamapediatrics.2013.2572. PMID: 24100440.
Iacovou M, Ralston RA, Muir J, Walker KZ, Truby H. Dietary management of infantile colic: a systematic review. Matern Child Health J. 2012 Aug;16(6):1319-31. doi: 10.1007/s10995-011-0842-5. PMID: 21710185.
