Understanding Infant Colic

A guide for the tired and desperate parent

It’s 2 a.m., and once again, you're pacing the room with your baby in your arms. They’ve been crying for what feels like an eternity, and let’s face it, you just want it to stop. You’ve tried everything—feeding, changing nappies, rocking, and even the the soother that sometimes helps. But tonight, nothing seems to calm them. Exhausted, frustrated, and overwhelmed, you start questioning yourself: Am I doing something wrong? Why won’t my baby stop crying? You go online to try and find something that might help, or someone to tell you what to do. You may come across remedies, procedures or therapists that offer quick fixes, and although deep down you know that these are unlikely to work, you are willing to try anything!

If this scenario feels familiar, you're not alone. Many parents face these moments, especially during their baby’s first few months of life. Excessive crying, often referred to as colic, is one of the most distressing challenges parents face. But while it may feel endless, there’s hope: colic is a temporary phase, and with time, it will pass.

What Is Colic?

Colic is a condition that affects babies, usually starting within the first few weeks of life and typically resolving by 3 or 4 months. It is defined as excessive crying that lasts for more than three hours a day, at least three days a week, for three weeks or more. Colic tends to strike in the late afternoon or evening, with bouts of crying that can start suddenly and seem impossible to soothe. Parents often describe their baby’s cries as louder, more intense, and higher-pitched than usual, as though the baby is in pain.

While colic is extremely common, affecting up to 40% of babies (although in my clinical practice, it seem to be higher), its cause remains a bit of a mystery. What we do know is that colic is not harmful, and most importantly, it’s not your fault as a parent. Colicky crying, as exhausting and frustrating as it can be, usually resolves on its own by the time your baby is about 3 to 4 months old. Colic appears to be more common in resource-abundant countries, and in areas that are further away from the equator. The incidence of colic does not appear to differ between boys and girls,  breast- and formula-fed infants, full-term and preterm infants, or first-born and subsequent-born children.

How Is Colic Different from Normal Crying?

All babies cry—it’s their way of communicating hunger, discomfort, tiredness, or the need for attention. But colic is different. Babies with colic often seem inconsolable. Here are some ways colic stands apart from typical crying:

• Duration: Colic involves crying that lasts for longer stretches of time—often more than three hours a day.

• Intensity: The crying tends to be louder and more intense, often described as screaming.

• Timing: Colic episodes often happen during the evening or late afternoon, regardless of what the baby was doing before.

• Body language: Babies with colic may appear to be in pain, with a hard belly, stiff arms, or an arched back.

• Inconsolability: No matter what parents do, it can feel like nothing works to calm their baby during a colic episode.

What Causes Colic?

Despite decades of research, the exact cause of colic remains unknown, but several factors may contribute to it. Some of these factors include issues related to digestion, biology, and psychology.

Gastrointestinal Causes: Colic might stem from an immature digestive system, which can lead to difficulty digesting food or swallowing air. Feeding techniques, such as overfeeding or underfeeding, can also play a role. For instance, imposing a rigid 3- or 4-hourly feeding routine from early on can contribute to digestion difficulties. Babies like to feed small volumes very frequently (regardless of what they feed). Additionally, differences in gut bacteria, such as higher levels of certain strains like E. coli and Klebsiella, have been observed in babies with colic.

Biologic Causes: Several biological factors may contribute to colic. Babies exposed to nicotine or tobacco smoke during pregnancy or early infancy have been found to have a higher risk of developing colic. Colic may also be linked to an infant’s immature motor regulation, meaning their bodies are still learning how to handle certain movements and functions, which can lead to discomfort. Some studies suggest that colic might be related to higher serotonin levels, a chemical that affects mood and regulation.

Psychological Causes: Family stress and anxiety can affect a baby and potentially lead to colic. It’s also believed that colic may be linked to a baby’s temperament, particularly in infants who are more sensitive or easily overstimulated. How parents perceive and respond to their baby’s crying can also play a role, as colic is sometimes influenced by the level of tension or stress within the family.

Understanding these potential causes can help parents feel less at fault, as colic is not due to anything they’ve done wrong. Instead, it’s often a combination of factors that are out of their control.

Important Signs to Watch For

While colic is usually harmless, it's important to make sure your baby’s excessive crying isn’t caused by something more serious. Conditions like withdrawal from certain medications (neonatal abstinence syndrome), not getting enough to eat, ear infections, oral thrush, heart problems, reflux, or issues like pyloric stenosis or intussusception can sometimes be the cause. Infections like sepsis or meningitis could also lead to excessive crying. Some warning signs that need immediate medical attention include persistent rapid breathing, unusual paleness, extreme tiredness, unexplained bruising or rashes, floppy muscles, a bulging soft spot on the head, poor weight gain, vomiting with green or bloody fluids, or stools with blood or mucus. If you notice any of these signs, contact your doctor right away.

How Can I Soothe My Baby’s Colic?

There’s no single "cure" for colic. More importantly, there is no “quick fix” for this condition and you should run a mile away from anyone offering you a quick solution.

As parents, it’s tempting to grab onto any “quick fix” for sleepless nights, crying spells, or feeding struggles. But the truth is, there are rarely quick solutions for infant issues. Babies are complex and their needs change constantly. What works for one might not work for another, and any advice that promises instant results is often too good to be true.

However, there are many strategies that may help reduce your baby’s discomfort. Every baby is different, so you may need to experiment to find what works best for your child. Here are some common soothing techniques:

• Modify feeding techniques: If your baby's colic is related to feeding issues, making some changes might help. For bottle-fed babies, try feeding them in a more upright (vertical) position and burp them often to reduce the amount of air they swallow. Using a bottle with a collapsible bag or a curved design can also help reduce air swallowing. Offering smaller volumes, more often during the day can also help in alleviating gas buildup and later discomfort during the evening. For breastfeeding, adjusting how you feed may also be beneficial, but it’s important to personalize these changes based on your and your baby’s needs. If you're unsure, consulting a lactation specialist can provide helpful guidance.

• Offer a soother: Sucking can be soothing for many babies, though parents of breastfed infants should be mindful of the WHO’s guidelines on pacifier use.

• Hold your baby: Carrying your baby in a front carrier or sling may help them feel secure and calm. Remember, you can NEVER spoil your baby by being responsive to their needs.

• Change the environment: Sometimes a trip in the stroller, a car trip, or a change of scenery can help.

• Swaddle your baby: Wrapping your baby snugly in a blanket (while ensuring their hips can move) can provide comfort. Make sure what you are monitoring your baby at all times while swaddled.

• White noise: The sound of a vacuum cleaner, fan, or white noise machine can help soothe a fussy baby.

• Warm baths or belly massages: Gentle warmth or massages can provide some relief.

• Take breaks: If you feel overwhelmed, it's okay to place your baby safely in their cot and take a few minutes to calm down.

Evidence-Based and Non-Evidence-Based Treatments

While colic typically resolves on its own, various treatments have been explored. Here’s what the research shows:

1. Evidence-Based Treatments

Probiotics (Lactobacillus reuteri): Studies suggest that Lactobacillus reuteri may reduce crying time, particularly in breastfed infants. The evidence is stronger for this strain compared to other probiotics, and it may be worth trying if other strategies have failed. Probiotics other than Lactobacillus reuteri are currently not recommended.

Hypoallergenic Formula: For formula-fed babies with suspected milk protein intolerance (not a full blown allergy), switching to a comfort or a partially hydrolysed formula for one week may help reduce symptoms - I only recommend doing this after consulting a healthcare provider who is comfortable in dealing with feeding difficulties in newborn infants. If no improvement occurs, the original formula can be resumed.

Breastfeeding Modifications: For breastfed infants, ensuring adequate latch, milk transfer and milk supply (and ruling out a tongue tie) are important steps in ruling out other causes of fussiness and frustration, especially if weight gain is suboptimal. Restricting the diet of the mother for general fussiness and colic in infants is not advised.

Gentle Infant Massage: Infant massage can be a soothing and bonding experience that may help calm a fussy baby, including those with colic. By gently massaging your baby’s tummy, back, arms, or legs, you can help ease muscle tension, improve digestion, and reduce gas, which are common culprits behind colic-related discomfort. The rhythmic motions of massage may also help your baby relax and even drift off to sleep. Beyond physical benefits, infant massage can strengthen the emotional connection between you and your baby. It offers a calming way for both of you to relax and connect, helping to reduce stress and anxiety for both parent and child. While massage isn't a guaranteed "cure" for colic, it’s a simple and gentle tool that can be part of your soothing routine, and many parents find it helpful in calming their little ones.

2. Treatments with Limited Evidence

• Simethicone Drops: These are used to relieve gas, but there’s little evidence that they effectively treat colic.

• Herbal Remedies and Gripe Water: While some parents use herbal teas or gripe water, there is limited scientific support for their effectiveness. Some gripe water products have been found to contain potentially harmful substances. In fact, back in the day, gripe water was a bit like a baby’s first cocktail—yes, it actually had alcohol in it! Imagine that: babies sipping on gripe water that could’ve doubled as a nightcap. Along with alcohol, the original recipe had a dash of sodium bicarbonate and some dill oil for extra flavour. But thankfully, modern science stepped in and said, “Wait a minute, maybe alcohol isn’t the best remedy for fussy babies.”

• Lactase Drops: These may help if your baby has lactose intolerance, but this is rarely the cause of colic in infants.

3. Treatments with No Proven Benefit or Potential Risks

• Activated charcoal is sometimes marketed as a natural remedy for colic, but it is not safe for newborns or young infants. While it can absorb toxins in cases of poisoning (under medical supervision), it also binds to essential nutrients, medications, and beneficial gut bacteria, potentially interfering with a baby’s ability to absorb what they need from breastmilk or formula. Additionally, charcoal-containing products like Colic Calm can cause black-stained stools, which may mask signs of serious digestive issues, such as gastrointestinal bleeding. There is no scientific evidence that activated charcoal helps colic, and safer, research-backed alternatives exist. If your baby is struggling with colic, speak to a healthcare professional before trying any remedies.

• Acupuncture and Chiropractic Adjustments: There is no evidence to support the use of these therapies for colic, and they may carry risks.

• Sucrose or Glucose Solutions: Though these may soothe babies during short painful procedures, they do not help with colic.

• Manipulative Therapies and Plastic Tubes: Chiropractic and other manipulative therapies, as well as plastic tube insertions for trapped wind, are not recommended for colic.

When Should I Seek Help?

If your baby is crying excessively and you're unsure if it's colic or something else, or if you feel overwhelmed, don’t hesitate to contact your healthcare provider. Call your doctor immediately if:

• Your baby cries non-stop for more than two hours.

• Your baby has a fever, refuses to eat, or shows signs of illness.

• You are afraid you might hurt your baby.

• Your baby has vomiting, diarrhoea, or a sudden change in behaviour.

How Can I Cope with the Stress of Colic?

Caring for a colicky baby can be physically and emotionally draining. Here are some tips to help you cope:

• Take turns: Share the load with your partner or a trusted caregiver. If you can, take turns comforting the baby so each of you can get a break.

• Take a break: It’s okay to step away for a few minutes if you need to. Place your baby in a safe place, like their cot, and give yourself time to breathe.

• Reach out: Call a friend, family member, or your doctor if you need support. Remember, colic is temporary, and you don’t have to go through it alone.

The Light at the End of the Tunnel

The good news about colic is that it’s temporary. For most babies, colic resolves by the time they are 3 to 4 months old. It’s a tough phase, but you will get through it. In the meantime, lean on your support network, trust your instincts, and remember that you are doing your best, even on the hardest days. If you ever feel like you need more help, don’t hesitate to contact your healthcare provider. They can offer guidance and reassurance, helping you navigate this challenging period with confidence and care.

For more, tune in to the Baby Tribe Podcast to learn more about the causes of infant fussiness: https://headstuffpodcasts.com/show/the-baby-tribe/