Colic

Colic and colicky apply to crying behaviors in otherwise healthy infants who, despite their caregivers’ attempts at soothing, cry inconsolably. Colic has been defined as inconsolable or excessive infant crying for which no physical cause can be found and which lasts a minimum of 3 hours of total crying per day, at least 3 days a week, for at least 3 weeks throughout the infant’s first 3 months of life [Wessel’s Rule of Three (1954)]. The incidence of infant colic, thus defined, is estimated to affect approximately 20% of infants. Colic is an anomaly, not a disease that can be cured. Infant crying is a universal phenomenon. It begins shortly after birth and increases thereafter with the peak amount of crying occurring at about 4 to 6 weeks of age. Crying then decreases in amount until about 3 months of age. It has been reported that all infants during this time cry an average of 2¾ hours per day, with colicky infants crying considerably longer.

Colic has been thought to be a problem originating in the gastrointestinal (GI) tract of infants, resulting in flatulence or “gas,” cramping, or intestinal pain. Little, if any, scientific evidence supports this connection. In addition to similarities in GI function, research comparing colicky infants with normally crying infants has shown no differences in sex distribution, birth order or parity, birth weight or weight gain, feeding practices (breast, bottle, or mixed feeding), infant allergies or eczema, or family history of allergy. There also has been little evidence of related factors such as maternal age or education or maternal illness during pregnancy. Some evidence supports an association of colic with maternal emotional state or family tension. However, these studies were done retrospectively  after  parents’ experiences  with  their  colicky infants, making it difficult to determine the direction of causality. It is possible that the increased anxiety and/or family tension was the result not the cause of the colic. Some evidence exists that colic may run in families.

Research on infant crying has shown similarities between normal crying and colic. First, both colicky and normally crying infants appear healthy with no physical cause for their crying. Second, both normal crying and colic show the same diurnal pattern, that is, most crying occurs during the evening. While crying bouts can occur at any time during the day, they seem to be most common during the later hours of the day.

Third, both normal crying and colic show the same developmental course over weeks.

Colic most often has its onset during the 2nd or 3rd week of life, with the severity of symptoms and the proportion of infants reported as colicky increasing until the 2nd month of life and decreasing thereafter. Inconsolable crying usually ends at 9 to 16 weeks of age. In populations of normal criers, a similar developmental course of increase and subsequent decline in amount of crying has also been reported. Hence, normal crying and colic differ from each other quantitatively but not qualitatively.

There is no cure for colic. However, colic will usually resolve on its own by about 3 to 5 months of age. In the meantime, colic can be managed by soothing techniques that have proven helpful. These include swaddling, non-nutritive sucking (pacifiers), auditory stimulation, and rocking. All four classes of soothers can be provided simultaneously to the infant who is carried by and in close contact with his or her caregiver. Experimental research has shown that combinations of these soothers are more effective in calming crying infants than a single soothing technique used alone. Infant massage has been shown to be no more effective than other soothing techniques such as carrying, but when used in combination with supplemental carrying, for example, has proven helpful.

Caregivers need to remind themselves that they are not the cause of their infant’s colic. First, changing feeding methods has not helped to reduce the colic. Since colic is not indigestion, stopping breast-feeding does not necessarily reduce the colic nor does changing formulas or offering solid foods. A number of herbal or nonprescription remedies exist that are unlikely to reduce the colic and which may even be harmful to the infant.

Because of the challenges presented by a colicky infant, caregivers need respite time in order to attend to their own sleep and social needs. They also need reassurance that this difficult and frustrating time coping with their infant’s colic will improve with the passage of time when they will enjoy their happier infant.

References:

1. Ansel, A. (1999). Infant colic. Retrieved from http://www.chmed.com/mod.php?mod=userpage&page_id=101&menu=1522
2. British United Provident Association (BUPA). (2003, October). Colic. Retrieved from http://hcd2.bco.uk/fact_sheets/html/infant_colic.html
3. Elliott, R., Fisher, K., & Ames, E. W. (1988). The effects of rocking on the state and respiration of normal and excessive cryers.  Canadian  Journal  of  Psychology,  42(2),163–172.
4. Elliott, M. , Pedersen, E. L., & Mogan, J. (1997). Early infant crying: Child and family follow-up at three years. Canadian Journal of Nursing Research, 29(2), 47–67.
5. Elliott, M. R., Reilly, S. M., Drummond, J., & Letourneau, N. (2002). The  effect  of  different  soothing  interventions on infant crying and on parent-infant interaction. Infant Mental Health Journal, 23(3), 310–328.
6. Weissbluth, (1984). Crybabies. Coping with colic: What to do when baby won’t stop crying! New York: Berkley Books.
7. Wessel, A., Cobb, J. C., Jackson, E. B., Harris, G. S., & Detwiler, A. C.  (1954).  Paroxysmal  fussing  in  infancy, sometimes called “colic.” Pediatrics, 14, 421–434.