Colic in babies

Colic is described as repeated episodes of excessive and inconsolable crying in an infant that otherwise appears to be healthy and thriving. It is thought to affect up to one in five babies, although the condition is not well understood.7

A diagnosis of colic can be made when all of the following are present25:

  • An infant aged <5 months when the symptoms start and stop
  • Recurrent and prolonged periods of crying, fussing or irritability reported by parents (caregivers) that occur without obvious cause and cannot be prevented or resolved by parents (caregivers)
  • No evidence of infant faltering growth, fever or illness

The crying often occurs in the late afternoon or evening. Babies with colic may also draw their knees up, arch their back, clench their fists and become flushed while crying. When assessing colic it is important to exclude other causes of sudden or persistent crying.

Colic usually presents in the first few weeks after birth and resolves by 3–6 months of age with no long-term consequences. The incidence of colic is similar between boys and girls, and breast- and bottle-fed babies.

Causes
A number of causes have been proposed for colic, including:7

  • Stomach cramps
  • Digestive problems
  • Reflux
  • Immaturity of the digestive or nervous system
  • Increased hormone levels
  • Hypersensitivity to the environment

 

Advice for parents

The most useful intervention for colic is to offer support and advice for parents, and reassure them that the symptoms will resolve naturally over time.

However, there are some measures that parents may find useful to help soothe their crying baby; these include:

  • Avoidance of caffeine, spicy foods, garlic, dairy foods and foods that can cause wind (e.g. cabbage, cauliflower, beans, broccoli and onions) by breastfeeding mothers
  • Products specially designed to relieve colic
  • For bottle-fed babies:
    • Ensuring that the teat flow is appropriate for the baby's age and sucking ability
    • Changing to a bottle specifically designed to reduce colic
  • Sitting baby upright during feeds
  • Gently rubbing baby’s back and tummy to wind them
  • Trying different positions to help to relieve wind, e.g. a mother can lay her baby face down on her arm, with her hand under baby’s tummy and baby’s head on her forearm
  • Using white noise – radio static or a vacuum cleaner – or loud shushing to soothe the baby
  • Gentle motion – try a baby swing or a trip in the car or buggy/pram
  • Holding the baby or putting them in a baby sling during crying episodes
  • Baby massage


When should medical treatments for colic be considered?

  • If parents feel unable to cope despite advice and reassurance, medical treatments can be considered for the management of infantile colic8
  • Options include a 1-week trial of colic drops – treatment should only be continued if there is a response, such as a reduced duration of crying
  • If there is no response to one medical treatment, parents could be advised to consider trying another8
  • One of the proposed causes of colic is a short-term reduction in the activity of the enzyme lactase in the intestine which is thought to be due to gut immaturity.9 For this reason, lactase drops added to the milk may be effective in some cases of colic
  • If a baby responds to lactase drops, parents should be reassured that this does not necessarily mean that they are lactose-intolerant indefinitely

 

Further information and support

National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary: Colic – infantile
NICE clinical guideline 37: Postnatal care: routine postnatal care of women and their babies, 2006
The Rome Foundation, Childhood Functional Gastrointestinal Disorders: Neonate and Toddler, 2016

For parents

Cry-sis website and helpline: 08451 228 669
Colic – NHS Choices
Colic – Patient.co.uk

 

Modified infant formula for better digestion

Adaptations can be made to standard first infant formula which may help alleviate the challenges faced by an immature gastrointestinal tract.

Partially hydrolysed whey protein

Partially hydrolysing the proteins in infant formula breaks them up into smaller peptides and may make a formula easier to digest.10

Reduced lactose

In the first few weeks of life, babies are often unable to efficiently digest the lactose in milk, which can cause discomfort due to wind.11 Decreasing the amount of lactose in formula has been found to improve symptoms of crying and wind in some babies.11

SN-2 palmitate-enriched fat blend

An SN-2 palmitate-enriched fat blend structurally resembles that found in breast milk and is well-absorbed by infants.12 Infant formulas using this fat blend reduce soap formation in stools and help make stools softer.13 They may also be associated with significantly reduced crying compared to formula with a different fat blend.14

SMA® Comfort Easy to Digest Infant Milk has been modified in three ways: it contains partially hydrolysed 100% whey protein; it has a reduced lactose content; and contains a fat blend enriched with SN-2 palmitate. It is designed for babies experiencing tummy troubles.

References
  1. Department of Health. Infant feeding recommendation. May 2003 Available here.
  2. Best Practice for Infant Feeding in Ireland. Food Safety Authority of Ireland, 2012.
  3. Iacono G et al. Dig Liver Dis 2005; 37: 432–438.
  4. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary (CKS): Constipation in children. September 2010. Available here.
  5. National Institute for Health and Care Excellence (NICE). Clinical Guideline. Constipation in children and young people: Diagnosis and management of idiopathic childhood constipation in primary and secondary care (CG99). May 2010.
  6. Tabbers MM et al. JPGN 2014; 58: 258–274.
  7. NHS Choices. Colic. 2014. Available here.
  8. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary (CKS): Colic - infantile. November 2014. Available here.
  9. Vandenplas Y et al. Nutrition 2013; 29: 184–194.
  10. Billeaud C et al. Eur J Clin Nutr 1990; 44: 577–583.
  11. Infante D et al. World J Gastroenterol 2011; 17: 2104–2108.
  12. Carnielli VP et al. J Pediatr Gastroenterol Nutr 1996; 23: 553–560.
  13. Yao M et al. JPGN 2014; 59: 440–448.
  14. Limanovitz I et al. The effects of infant formula beta-palmitate structural position on bone speed of sound, anthropometrics and infantile colic: a double blind, randomized control trial. ESPGHAN 2011.
  15. Hyman PE et al. Gastroenterology 2006; 130: 1519–1526.
  16. Ramirez-Mayans J. J Int Pediatr 2003; 18: 78–83.
  17. Vandenplas Y et al. J Pediatr Gastroenterol Nutr 2009; 49: 498–547.
  18. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary: GORD in children. March 2015. Available here.
  19. Moukarzel A et al. J Clin Gastroenterol 2007; 41: 823–829.
  20. Xinias I et al. Curr Ther Res Clin Exp 2003; 64: 270–278.
  21. Heyman MB, Committee on Nutrition. Pediatrics 2006; 118: 1279–1286.
  22. Saneian H et al. Iran J Pediatr 2012; 22: 82–86.
  23. Huang Y, Xu JH. Chin J Contemp Pediatr 2009; 11: 532–536.
  24. Moya M et al. Acta Paediatr 1999; 88: 1211–1215.
  25. Benninga M and Nurko, S et al. Gastroenterology 2016;150:1443-1455.

*Ingredients of all formulas were confirmed by telephoning company carelines dedicated to answering queries about their products (March 2015)

IMPORTANT NOTICE: Breast milk is best for babies and breastfeeding should continue for as long as possible. Good maternal nutrition is important for the preparation and maintenance of breastfeeding. Introducing partial bottle-feeding may have a negative effect on breastfeeding and reversing a decision not to breastfeed is difficult. Caregivers should always seek the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist on the need for and proper method of use of infant milks and on all matters of infant feeding. Social and financial implications should be considered when selecting a method of infant feeding. Infant milk should always be prepared and used as directed. Inappropriate foods or feeding methods, or improper use of infant formula, may present a health hazard.