What is colic?
Colic is a topic surrounded by myths and legends with numerous wonder cures. The entity has crept into medical usage over the past 50 years.
There is no real consensus as to what actually constitutes the problem labelled "colic". It is a term given to identify a common situation that occurs in about 1 in 10 babies between the age of a few weeks to 3 months and is seldom encountered thereafter (often called "3 month colic").
It occurs in all socio-economic levels.
Studies have shown that all babies have periods of crying and fretting during the course of the day and that these episodes reach a crescendo in the evening. This pattern is noted throughout the world, but in some cultures colic does not appear to be an issue at all. This has led to the theory that colic is simply an excessive manifestation of what is essentially normal behaviour.
The presentation suggests pain originating from the intestines, although no pathologic process has ever been confirmed on examination.
What causes colic?
The cause of colic is unknown.
It occurs both in breast and bottle fed babies. Hunger, overfeeding, swallowed air, the ingredients and the reconstitution of formulae have all been implicated. However, changing formulae, feeding schedules or feeding practices have only a very limited effect in preventing further colic.
Some authors consider that it is the mother’s and family’s reaction to the baby’s crying and the manner in which it is handled that contributes significantly to colic.
Who gets colic?
Any baby from birth to about three months can get colic and there are no known risk factors.
What are the symptoms and signs of colic?
Often an irritable or fractious and continually crying baby is incorrectly labelled as "colicky".
The characteristics of colic are: occurs in paroxysmal episodes; a quantitative change in the pitch and intensity of the usual cry; increased muscle tone and movement such as pulling the legs against the abdomen and the baby is almost, if not totally, inconsolable. Often there is apparent relief when the baby passes wind or stool.
Vomiting is not a feature and normal stools are passed.
These episodes can occur during any activity in which the baby may be involved. There may be a build-up to the colic period or it may suddenly occur. One of the frequent comments made is how "angelic" the baby is during the visit to the doctor. This in itself should be reassuring.
These episodes may last an hour or two and can cause great stress to the mother.
Can colic be prevented?
Because the exact nature of colic is unknown and there are no definite precipitating causes, it is impossible to say which babies will get colic and therefore to institute any preventative measures.
How is colic treated?
A fractious and crying baby can usually be consoled simple by a dummy, being pushing around in the pram or being carried around and being the centre of attraction. A baby with colic may be inconsolable and only stops when both the mother/parents and the baby are totally exhausted.
A mother may get very despondent and despairing because nothing that she does seems to help. Feelings of guilt and inadequacy soon arise. A vicious cycle is initiated and it is this that some feel exacerbates the problem of colic. A screaming, inconsolable baby and a despairing mother can have a devastating effect on the family. In extreme cases these babies have become victims of non-accidental injury.
It is very important therefore that the correct diagnosis be made so that the mother/parents can be reassured and counselled.
Although many remedies and regimens claim success, nothing has been shown to consistently or significantly alter the course of nor prevent colic.
What is the outcome of colic?
Colic is a self-limiting condition that rarely persists beyond the age of three months. There do not appear to be any objective long-term consequences associated with colic.
When to see your doctor
An intestinal blockage or twisted bowel may mimic colic. If there is a change in the pattern of the colic episode, vomiting (particularly bile), pyrexia, abnormal stool or any difficulty with breathing then a health professional should be consulted immediately.
Written by Dr John D. Burgess, FCPaed (CMSA), Senior Specialist, Red Cross Children's Hospital.