The scream that terrifies

Originally published in The Ottawa Citizen October 08, 2005

The word colic is enough to jar parents’ memories of sleepless nights and hours of frustration and angst trying to soothe their newborn. This particular newborn stage has no definitive treatment, hence there are myriad home remedies and suggestions to treat it.

Less than five per cent of all infants with colic have an underlying disease or disorder. A thorough history and physical exam can differentiate between colic and a disease state.

The incidence of colic varies from about five per cent to 25 per cent of infants. If your baby is gaining weight and has a normal physical exam, it is usually not necessary to perform any laboratory or diagnostic imaging tests.

Colic is usually defined by the “rule of three” — crying for more than three hours per day, for more than three days per week, and for more than three weeks in an infant that is well-fed and otherwise healthy. The inconsolable crying is unpredictable, begins without warning and without a specific cause.

Commonly during colic, the infant’s face flushes and the baby pulls his or her legs up toward the abdomen, clenches his or her fists and wails a high-pitched scream.

Normally most infants will cry about 2.2 hours a day. This peaks by six weeks and declines thereafter.

Dr. Tammy Clifford, director of epidemiology and researcher at CHEO’s Research Institute, and other colleagues published an article that supports the current understanding of colic: “It does not last long, nor does it have negative long-term effects on the mother’s mental health.”

Although studies have looked at gastrointestinal function and the home life of these babies, they have not been found to be causative factors. Many hypotheses are currently being investigated for cause, but none have provided conclusive evidence.

When looking at the crying cycle or patterns of infants, it seems that colicky infants are simply at the upper end of the spectrum in that they exhibit a similar but more intense crying pattern. These infants are more difficult to soothe and the crying lasts longer than seen in non-colicky infants.

In both groups, crying wanes by four months of age, implying that this is likely to be a normal neurological development process.

Parents who have concerns about their newborn should be prepared for some questions their physician or community health nurse may ask them:

  • A description of the crying, when they cry and its duration.
  • Do they spit up?
  • Are they drinking or sucking well?
  • Is there any vomiting or diarrhea?
  • Do they have a change in breathing rates, an increased effort to breathe or turn blue when crying?
  • Is the rectal temperature greater than 100.4 degreesF (38 degreesC)?

Keeping a log of the crying frequency, onset and duration is helpful to ascertain if there is a pattern or cycle.

What can you do to help alleviate infant colic? Given that colic spontaneously resolves, it is difficult to substantiate a consistent cause-and-effect relationship.

Breastfed infants should continue breastfeeding. There are some clinical trials suggesting that milk products, eggs, wheat and nuts be temporarily removed from the mother’s diet. Parents who smoke in the house or car should stop.

Studies that changed the formula of formula-fed babies were contradictory. Lactose-free formulas made no difference. Some babies switched to soy-based formula developed a soy protein allergy.

Simethicone (Ovol) is used to absorb stomach and intestinal gas. Several randomized, placebo-controlled, multicentre trial (RCTs) showed that simethicone was no better than a placebo in reducing the effect of colic.

Gripe Water may include any of a variety of herbs and herbal oils, such as cardamom, chamomile, cinnamon, clove, dill, fennel, ginger, lemon balm, licorice, peppermint and yarrow. It may also have added sugar and alcohol. The claim is that it reduces flatulence and indigestion, but these factors have not been conclusively associated with colic. If used, avoid the sugar and alcohol-containing product and ensure that it was produced in Canada or the United States.

There is weak evidence that herbal teas containing mixtures of chamomile, vervain, licorice, fennel, and lemon balm decrease crying in colicky infants. Parents should be cautious because of the lack of standardization of strength and dosage in many of these products and their potential to interfere with normal feeding cycles.

Various interventions aimed at decreasing crying in colicky infants have been equivocal. These include car-ride simulators, crib vibrators, infant carriers, early response to crying, gentle soothing motions, avoidance of overstimulation, pacifiers, prophylactic holding and carrying, infant massage and maintenance of day-night orientation. Chiropractic treatment has shown no benefit over placebo.

Counselling parents about these interventions did not produce any better result than providing support, advice and reassurance.

There is no association of asthma or allergies with colic. At one year of age, babies who had colic were not different from non-colicky babies. Colicky babies grow up normally.

© Dr. Barry Dworkin 2005

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