Everything a new parent needs to know about baby colic! What it is, how to relieve and treat it and what works and what might work!

This blog is written from my professional experience of working with hundreds of new parents as a midwife and health visitor in combination with on-going learning and up to date evidence from the Holistic sleep coaching programme. This includes in-put from lactation consultant Shel Banks  and health educator Maureen Minchin.

The definition of colic was updated in 2017 and is included in the functional gastrointestinal disorders category of the Rome IV diagnostic criteria. Why is this important? Because it acknowledges what many parents have always attested to – that it is a tummy pain! The term “colic” refers to unexplained and acute abdominal pain. The Rome definition states ‘Infant colic can be considered as a behavioral phenomenon in infants aged 1 to 4 months ( sometimes now from birth) and involves long periods of inconsolable crying and hard-to-calm behavior.’ OR Inconsolable, unexplained and incessant crying in healthy infants lasting for more than 3 hours a day.

The crying occurs for no apparent cause and this is one of the main reasons it is distressing and worrisome for parents. For those who like the science the full criteria can be found HERE.

The key point to note is that colic is a symptom and not a cause – i.e. the crying is due to something which is distressing the baby therefore addressing the cause of the distress will relieve the symptoms namely ‘colic’.

What is the cause of your baby’s distress?

Firstly 5% of babies will have an underlying disorder – that’s a small number but enough to warrant a trip to the GP to rule out any medical causes of your baby’s distress.

Secondly address any non-tummy related causes which can be causing your baby some discomfort or anxiety. These include but are not limited to:

  • Uncomfy clothing – ie tight/big label/seams/can’t stretch feet out etc
  • Under stimulated baby– ie wanting to be held and touched
  • Over stimulated baby– more common – for example trying to get baby to repeat a cute new skill for other family members or not noticing baby’s ‘tired cues’
  • Smell – key sense in babies and strong perfumes or room air fresheners can be overwhelming – try gentle relaxing essential oils in a burner or diffuser instead
  • Smoking – smoking during pregnancy increases the likelihood and severity of colic, it is suggested infants may be allergic to exhaled cigarette smoke.
  • Maternal stress – during pregnancy and after birth appears to make babies more likely to suffer from colic. Try some mediation or mindfulness whilst feeding which can also help with baby sleep. See this link Breast feeding relaxation therapy helps babies eat more.
  • Behavioural factors – perhaps baby is just tired – or doesn’t like the way they may be handled

 Colic is tummy related so read on!

Tummy related causes of colic could be;

  • Trapped gas – is very common and caused by swallowing air whilst feeding and/or a reaction in the tummy
  • Hunger – sometimes but more often pain is related to over-feeding
  • Over-feeding – babies suck when in pain and it is very easy to over feed on a bottle – gradually our tummies stretch, and we want more food.
  • Bottle feeding a baby in a lying down position or sub-optimal position and attachment at the breast and/or oversupply. For a good explanation of paced bottle feeding click HERE
  • Cows Milk Protein Allergy (CMPA) –  allergy to the protein in cows milk is becoming more common. CMPA causes tummy distention, cramping, vomiting, skin reactions and diarrhoea ( sometimes constipation also). If there is a family history of allergy or your baby has the above signs please see your GP. See below.
  • Temporary lactose intolerance – this is a due to a lack of the enzyme lactase, which can be due to a tummy virus. Your baby will show tummy symptoms such as continual diarrhoea and difficulty passing gas. It can also be as a result of an inflammed gut when CMPA is present. Again see your GP. Congenital lactose intolerance ( ie from birth) is very rare and serious.
  • Gut bacteria out of balance – this is where the bad bacteria outnumber the good bacteria! The gut microbiome might be altered by birth practices and antibiotic use, read more from Maureen Minchin if you are interested in this fascinating subject!  Altering the bacteria in the gut causes fermentation (ie gas), cramping and bloating.  This can also be caused by incorrect making up of bottle feeds ie with water which is not over 70C. Your baby may not show signs of illness but may be very windy and in discomfort.
  • Please note in young babies straining and going red when passing a stool is common as long as the stool is a normal colour (yellow/brown) and of toothpasty/watery consistency. This is known as infant dyschezia. There is no need for laxatives at this point. A useful pdf guide is HERE.

Please note;

CMPA is getting more common and parents should see their GP if they suspect it or have a history of allergy themselves. Signs are faltering growth, vomiting, rashes, incessant crying, diarrhoea. It takes 6 weeks to clear in mum and baby if present, although improvements will be seen in 2-3 days. Sometimes a lactose intolerance will be present in CMPA due to inflammation of the gut due to allergy.

What about reflux?  40-50% of babies under 3 months will posset some of their feed – non-forceful regurgitation normal physiological process very common as babies spend most of their time on their backs. It is often seen as recurrent hiccups, frequent coughing, irritability or crying and frequent night waking. The techniques below should help with physiological posseting.

Gastro-oesophageal reflux disease (GORD) is more serious however and is covered under NICE guidance. This needs treating as the stomach acid in the oesophagus (food pipe) can lead to longer term damage. Babies with GORD often have difficulty gaining weight with frequent forceful vomiting, possible old black blood in stool or in vomit.

What works and what doesn’t!

There are several products marketed at parents which suggest they can help resolve colic symptoms in a baby. Simeticone and dimeticone (brand names Infacol and Dentinox) are no longer recommenced by NICE due to not enough evidence of effectiveness. It is suggested they work by reducing the surface tension of gas bubbles in the stomach thus making many small bubbles into one bigger bubble. This will only help if the bubble is underneath the sphincter (ie tummy opening) at the time the baby is burped! However both of these products contain sugars (artificial or real) – sugar is well known as a pain relief for babies. Therefore mild pain reliving effects may be seen.

Lactase enzyme (brand name Colief) is also not advised by NICE. Primarily because if a baby has a congenital lactose deficiency then medical advice will be needed. The suggested way of use of the product is also fiddly for both breast and formula fed babies – but it contains sweeteners so a pain relieving effect may be seen. However in a baby/toddler who has had a diarrhoea and vomiting virus there may be a temporay lactose intolerance due to damage to the gut wall – a lactose free formula or lactase enzyme preparation may be suitable for use in these circumstances.

It is important to note that I am not recommending giving a baby any kind of sugar preparation for pain relieving effects. Both breast and formula milk contain enough sugars and carbohydrates – preventing the cause of pain is the most effective way of helping a colicky baby. Gripe water contains dil oil, water and sodium bicarbonate (sodium hydrogen carbonate). BUT sodium bicarbonate added to stomach acid will produce hydrogen gas thus baby produces a nice big burp therefore it looks like its worked!

So what about the many infant milks for ‘special medical purposes’ which can be found on the supermarket shelves? There are many marketed milks and a lot of them are thickened, meaning they have to be made up at a lower temperature. This will increase the risk of bacteria overload as the powder has not been sterilised. Bad bacteria may accumulate in baby’s gut and produce extra gas and discomfort. In combination with a bottle making machine, which uses cold water to fill the bottles, this may be enough to produce a very windy and uncomfortable baby.

NICE also does not recommend manipulative strategies such as cranial osteopathy for colic due to lack of evidence of effectiveness for tummy pain. However in a baby with a tight jaw, neck or some kind of head or shoulder pain they may not be able to work their jaws as effectively. This means they not be able to form a ‘bolus’ of milk to swallow properly. This can lead to more air than necessary being swallowed with the feed. As there is no evidence of harm of these strategies  these treatments are worth investigating.

OK so what does work?

Firstly fix any of the above situations if they apply to your baby. Seek advice from your GP and breastfeeding group/or health visitor regarding feeding. Discuss under or oversupply with a knowledge breastfeeding adviser or peer supporter and attend your local well baby clinic.

Keep your baby upright after a feed, making sure they are winded properly before laying them down, therefore preventing the gas going into the intestine. When winding your baby try having them upright, leaning forward and slightly to their left – this give bubbles the best chance of escaping upwards! Lots of tummy time, massage and warm baths also help!

If formula (or bottle feeding with expressed milk) try the following;

  • Smaller, more frequent feeds.
  • Reduce pressure on baby’s abdomen – tight waist bands and nappies etc
  • Frequent burping and paced bottle feeding.
  • Avoid shaking formula to mix it – use a sterile spoon instead to avoid micro bubbles and froth.
  • Ensure formula feeds are made up correctly with water over 70 C and not left to stand for too long.
  • Feed babies at their early feeding cues – not when distressed on or a strict schedule
  • Try a vented bottle to reduce air intake
  • Don’t coax baby to finish the bottle – if this is hard to do try placing a sock over the bottle and follow your baby’s cues
  • Pay attention to sterilizing bottles and dummies – a build-up of pathogenic bacteria will lead to fermentation, cramping and discomfort.

If breast feeding try the following;

  • Avoid allergens in maternal diet if breastfeeding – see note below.
  • Burping after a few minutes if a mother has a fast let-down.
  • Improve position and attachment.
  • Keep babies upright after feeds and wind as above

The NICE clinical knowledge summary on infant colic and www.nhs.uk  give the same advice when it comes to helping your baby with colic. However both state changing maternal diet when breastfeeding is not indicated due to lack of evidence. It is not in my role to go against this advice. However I suggest that if you or your partner (baby’s father) have family histories of food allergy then identifying any foods which either of you avoid/dislike due to causing you digestive discomfort is a good idea. As mild as the discomfort may be to either parent, due to epigenetics these foods may be causing your baby more discomfort. Avoiding these foods you have identified may provide relief from the colic.

What is definitely needed?

A colicky baby is very hard to deal with so extra help and support can make all the difference to parents. If there is no physical help available from family or friends then parents can access supportive online groups or find a local supportive group. Considering which other aspects of daily life are causing stress and finding a solution to those is also a possibility. This could be a cleaner, extra childcare for older children, reduced working hours for a partner, or hiring some extra baby help for example.

If the above are not financially viable then parents can contact their health visitor or children’s centre to ask what local support is available.

Self-help measures a parent could try are;

  • Identify a supportive online group
  • Explore mindfulness – headspace has a lot of positive reviews
  • Exercise with your baby – there are many local classes designed for parents and babies
  • Look at your diet – alcohol and caffeine increase anxiety and dehydration worsens anxiety. Complex carbohydrates and protein will stabilise and boost mood.
  • Activites which boost oxytocin such as touch and massage or a calming smell
  • Spend time outdoors in bright light to boost melatonin.
  • A positive mindset and mental dialogue – this colicky phase WILL pass.
  • Foods (or supplements) rich in DHA, EPA and Omega-3. These have been shown to reduce inflammation which is a key influence of anxiety and stress.
  • Essential oils can also help – lavender, clary sage, frankincense, and vetiver are a few which may help.
  • A decent nights sleep is not possible or practical with a new and/or colicky baby and will affect milk supply if breastfeeding. However evidence has shown that a 4-5 hour stretch is protective of parental mental health and may be achievable with some help. This does not have to be overnight if help is only available in the day. After 2-3 days of a 4-5 hour stretch of sleep (plus additional hours here and there in the 24 hour period) parents can consider the above suggestions. Sleep first!

This blog has been written by Rachel Greaves of Goodnight Solutions – and information from Lyndsey Hookway’s Holistic Sleep Programme is acknowledged.

Please visit my website for additional support or to contact me.