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There are few things more frustrating for parents than colic, yet it is one of the most common reasons families seek medical care in infancy.  Colic is excessive crying, for no known reason, in an infant.  Le Bonheur pediatrician Christian Bergeron, MD, explains colic, offers advice and discusses the latest in research and treatment options.

Why is my baby constantly crying?

Infants with colic will cry for hours on end and nothing will seem to make them feel better.  The babies will be dry, fed, swaddled, held, rocked, burped and carried but very few of these activities seem to calm them down.  The classic definition of colic was known as the Rule of 3’s: Crying for more than three hours a day, more than three days a week, for longer than three weeks.  More recently, the three-week duration has been dropped from the definition because, as you can imagine, almost no family can wait three weeks with a crying infant.  Parents of colicky babies often cannot help but feel like they are doing something wrong. They may think that they are somehow not being good parents, when in reality they are doing everything possible to help.  For this reason, parents of colicky infants are more likely to show higher levels of guilt, frustration, stress and even depression. 

How do I know if my baby’s fussiness is due to colic?

In trying to differentiate colic from normal fussiness and crying, it is important to understand normal crying in infancy.  While the amount that babies cry varies, it’s usual for babies to cry the most during the first 3 months of life. This is also the time when colic typically begins.  Studies have shown that at six weeks of age, a baby will cry around 100-120 minutes per day.  The good news is that the duration drops to about 70 minutes by 12 weeks old. 

Crying for longer than these times, especially crying that is louder, higher pitched, occurring in waves and associated with arching of the back and extending the arms or legs, points to colic.  An important aspect of colic is that the infants will feed well and grow normally, so if a baby is not doing both of these, it is less likely to be colic.  Typically colic will not start before about 1 month of age, and it is most common between 1-3 months of life.  If an infant is having these symptoms before 1 month of age, he or she needs to be evaluated for other possible causes.    Of course, if other serious symptoms are present such as choking or gagging during feeds, blood in the stool, decreased oral intake, excessive spitting up, difficulty breathing or turning blue of the lips, tongue or hands, please call your doctor immediately.

What causes colic?

The exact cause of colic is unknown, but there are several factors that can contribute to the issue: gastrointestinal motility issues, alterations in the bacteria that live in the GI tract, individual differences in temperament of infants, over/understimulation and even parental variables within the home such as stress, fatigue and anxiety. 

When should I seek medical care for my baby?

If your baby is having symptoms of colic, the first thing you should do is make an appointment to talk with your pediatrician.  You can expect your doctor to ask a lot of questions about you and your baby, perform a full physical examination and measure how well your baby is growing.  If there are any other medical reasons why your baby may be crying, these will be addressed.  If it does prove to be colic, then you and your pediatrician will develop a plan on how to get through the fussy times together.  It is also important to know that there are no long term consequences for infants who do have colic.   

What helps?

First and foremost, know that colic will always get better as your baby grows and gets older.  If in the middle of a crying spell you find yourself at wits’ end, just know that things will get better with time. One study has shown that 60 percent of infants with colic will improve by 3 months of age, and 90 percent will be better by 4 months of age.  Again, we cannot stress enough that the crying will stop.  There are several soothing techniques that can be tried to see if they will help, including:

• Giving baby a pacifier
• Taking baby for a walk/ride in the car
• Swaddling baby
• Using white background noise
• Rubbing baby’s belly
• Putting baby in a swing/bouncy seat
• Giving baby a warm bath

If your baby does suffer from colic, it is absolutely acceptable to just put him or her down on the back in a safe place, such as a crib, and let the baby cry for a short period of time.  Crying will not hurt the baby, and putting the baby down will help parents better cope with the episodes.  Never shake a baby to make them stop crying, and don't be afraid to ask for help.  Family members and friends can be a huge help when dealing with colicky infants. 

Can probiotics/OTC gas make a difference?

Some recent studies looked have looked at giving infants with colic the probiotic, Lactobacillus ruteri, to help alleviate colic.  While a few studies did demonstrate a reduction in colic symptoms, a few other studies did not show any difference at all.  Because of these mixed results, it is hard to absolutely recommend these products as they may or may not work for an individual baby.  That said, there are a few OTC probiotic preparations that have been approved for use in infants with colic, so if other soothing techniques are not working, it may be worth a trial.