By Professor Alf. Nicholson
A colic baby will cry more intensely and at a higher pitch than ‘normal’ crying and will sound as if they are in pain. They may also cry for longer – up to an hour at a time – and will resist most of your efforts to soothe them, including feeding.
Their tiny fists may clench, legs may stiffen and they may grimace. They may also throw up milk or be windy.
If it is bad, they may arch their back.
This crying tyrant will typically show up at around two weeks old and sweeten again at about four months. The bouts of colic will usually start and end for no obvious reason. Unfortunately for you, it is often in the evening when you are already worn out.
Is It Colic?
Colic is never a quick diagnosis. The Wessel Rule of Threes is the system traditionally used by doctors: if your baby cries for more than three hours a day for more than three days a week for three weeks, they have colic.
The Inside Track
Surprisingly, though we have been studying colic for years, it is still a bit of an enigma. No one has yet shown a single cause (or a single cure) for it.
About a third of colicky babies will improve on treatment. But it may not be the same treatment and the crying may ease but not stop altogether. Which points the finger at more than one cause. Most studies have now narrowed them down to any (or a mix) of three:
- The windy gut.
- The demanding temperament.
- The feeding theory.
A ‘windy gut’ is often blamed, though it still hasn’t been proved, and very few colicky babies cry because of wind. But tests go on. It’s thought that the tiny digestive system is still working out how to release wind. Babies do create more gas in the colon during their first three months because they are not too good at absorbing lactose. But any evidence that this extra gas causes colic is really very weak. Of course, raucous crying and gulping will really fill them with air and then you have a vicious circle. There is some evidence that how you feed your baby can help.
The idea of the ‘demanding baby’ is gathering support. Your colicky baby’s only thought for the first weeks is sheer survival (after leaving the cosy womb). Then they try to make sense of their new world and they may be more sensitive (or downright demanding) than others. Other factors include sensitivity to noise, fatigue, too little or too much attention. When something distresses your child, their instinct is to keep shouting. It’s their ‘white noise’ to shut it all out and it may take a lot to calm them because they are really very new to the whole business. Of course, if your baby is stressed it will stress you and one feeds off the other.
The ‘feeding theory’ (what they are eating) has some basis too. Maybe you are putting a bottle in their mouth every time they cry? Babies are generally self-regulating and spew out surplus milk, but if they are bothered and sucky they may overfeed. A tiny minority of babies will react to the food itself (either to cow’s milk or to foods their breastfeeding mothers have eaten). You will notice these, however. They will have very severe colic, may be constipated and may have flecks of blood in their bowel motions.
So which is your baby? You may never really know, but what is important is to find some path that makes life easier for you all.
Professor Alf Nicholson FRCPI, FRCPCH is a consultant paediatrician who returned to Ireland in 1996 from Melbourne where he worked in the second largest paediatric hospital in the world. He is Professor of Paediatrics at Temple Street Children’s University Hospital since 2008, Head of the HSE Paediatric Clinical Programme and co-director of the basic specialist programme in paediatrics. He is married with 4 children.