All babies cry, and this can be very draining for a parent or carer. It is often difficult to work out whether your baby is hungry, cold, tired or in need of a nappy change. Sometimes there is nothing you can do to soothe baby, who may continue to cry and scream for a long period of time.

Index to colic article
Does your baby have colic?
Causes of colic
Symptoms of colic
When to see a doctor
Treatment for colic
Osteopathy and colic
How to cope as a parent or carer

Does your baby have colic?

If a healthy baby cries or screams frequently and for extended periods, for no apparent reason, colic may be diagnosed. Symptoms usually fit into the rule of threes: Three hours of crying every day for more than three days a week for at least three weeks in a month. The condition is harmless and the cause unknown but for you as a parent it can be very distressing.

Colic affects about 20% of babies, affecting boys and girls equally. It usually begins at two to four weeks of age and can last for three months, or even longer. If you and your doctor are sure that there is no other medical reason for the baby’s distress, then colic may be diagnosed. Colic is more common in bottle-fed babies, but also affects breast-fed babies.
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Causes of colic

The cause of colic is unknown.  There are many theories:

Digestive system – In the past colic was considered to be associated with the immature digestive system causing cramps but this theory is no longer accepted as the general cause. Painful abdominal gas may well contribute to colic.

Baby’s temperament and immature nervous system – Your baby’s temperament may make him or her highly sensitive to the environment and baby may react to normal stimulation or changes to the environment by crying.  The immature nervous system means that your baby is unable to regulate crying once it starts.

Lactose intolerance – some babies may be sensitive to lactose, a sugar found in breast milk, cow’s milk and most formula milk.

Cow’s Milk – Some babies are sensitive to cow’s milk proteins.  Babies under 12 months should not be given cow’s milk. However most formula milk is based on cow’s milk and breast-feeding mums can also pass on cow’s milk proteins, from their own diet, to their babies.

Gut bacteria – Colicky babies have been shown to have a lack of lactobacillus acidophilus – a bacterium needed in the gut.  Some studies have shown that giving baby a probiotic may improve the condition. 
Smoking and stress of the mother in the third trimester has also been linked with colic.

Birth Process – Natural birth involves extension of the neck backwards as the baby exits the vagina.  This can cause minor strains in the small muscles between the top of the neck and the skull.  At two to four weeks babies start to gain strength in their neck muscles so that they can lift their head if lying on their stomach.  Colic often begins at this age.  So one theory is that using the neck muscles exacerbates any minor tissue strains in the neck area.

Another theory is that the nerve that travels from the brain to the digestive organs is irritated by tension between the head bones persisting from the birth process.  Relieving tension between the bones has been shown to improve symptoms of colic in a high proportion of babies.

Compression of the bones of the head and the spine during natural birth can lead to tensions which continue into infancy.  This tension between the bones can give babies the equivalent of a headache as their head feels under pressure.  A similar strain pattern can occur with a caesarean birth due to the rapid change in pressure as the baby moves from a fluid environment into the open air.  The birth process of natural labour is an important part of coming into the world and the pressure and movement during natural labour stimulates nerves and bodily processes.
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Symptoms of colic

The main symptom, most distressing to parents, is continuous crying for long periods of time.  Crying is usually worse in the evening.  The baby may look uncomfortable or appear to be in pain.  They may lift their head, draw their legs up to their tummy, become red in the face and pass wind.  Difficulty falling and staying asleep is common.

There may be several attacks of vigorous crying in succession. The baby may appear to be calming down when another bout of crying occurs.  Crying may be frantic and high-pitched.

Babies with colic continue to feed and gain weight as normal.  Crying is your baby’s only means of communication and colic is simply an extreme version of this.  It has nothing to do with bad parenting.
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When to see a Doctor

If you suspect your baby is unwell, or if you are worried your baby may have something other than colic, it is important to see your doctor to rule out other possible causes of the distress.  It is important to remember that, as a parent, you know your baby best. Familiarity with your baby’s temperament and behaviour can be invaluable in helping you to recognise a more serious problem.

Before visiting a doctor, other possible causes of crying should be considered. These include:

• hunger
• tiredness
• lack of contact - some babies want to be cuddled all the time
• startling - e.g. due to a jerky movement or sudden noise
• undressing - most babies don't like the feel of air on their skin
• temperature - is the baby too hot or too cold?
• pain - is there an identifiable source of pain, e.g. a nappy rash.

Before going to the doctor, parents should try to take note of when the baby cries, eats and sleeps, as well as the pattern of bowel movements. This will help the doctor determine the cause of the crying. The doctor will examine the baby and ask about the symptoms to help exclude other disorders that may be causing the crying.
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Treatment for colic

If your baby is bottle-fed then trying a different formula milk may help.  Breast-feeding should be continued.

Certain foods may make colic worse, so if the breast-feeding mother eliminates these foods colic may improve:

Eliminate these foods for one week to see if symptoms improve.  Gradually re-introduce each food to identify which foods may be causing the problem.
Sometimes babies are not able to digest lactose (milk sugar) so breastfeeding mothers could try eliminating cow’s milk and all dairy products from their own diet.  This is especially important if there is a history of lactose intolerance in the family.  Usually this intolerance improves as the baby gets older.  Bottle-fed babies should try a lactose-free formula for one week to see if the colic improves. If your baby has a lot of wind, make sure you burp him or her frequently.  Bottle-fed babies may need to be fed in a more upright position or with a bottle designed to reduce the amount of air the baby swallows during feeds.  A bottle teat with a large hole or several holes will reduce the amount of air your baby swallows.

Over-stimulating babies by continually picking them up and putting them down may aggravate their crying.  Gently comforting your baby in a dark, quiet room may help.  If your baby is not hungry, tired, needing a clean nappy, or too hot or cold then it may help to leave him or her in their cot for a short while.

Other methods for soothing your baby include:

• Carrying baby in a front sling or back pack – your body heat and movement may help.
• Placing baby near continuous noise or vibrations from household appliances e.g. dishwasher, vacuum cleaner or washer-dryer.  A CD can be bought which simulates these ‘white-noises’. (See my links page for baby CDs).
• Music or singing may help to calm baby down. 
• Taking baby for a walk or car ride.
• Giving baby a dummy to suck on – particularly after feeds and in the evenings.
• A gentle rub on the stomach – massage in a circle on the stomach from baby’s left to right sides to help pass wind. 
• Massaging the back may help to relieve discomfort
• Giving baby a bath.

The Cuddle Cure for colic is five Ss: - this was developed by an American paediatrician – Harvey Karp and details can be found in his book: Baby Bliss (published by Penguin Books Ltd.)

1. Swaddling – use a large, square blanket placed in a diamond shape with the top point folded toward the middle.  Place the baby on the blanket so the neck is along the fold.  Hold baby’s arms by their sides, wrap the left flap around the baby and tuck it under the body, keeping it tight.  Bring the bottom point up and tuck it under the baby’s left shoulder.  Bring the right edge of the blanket down across the baby’s chest and hold it in place with your left hand.  Then wrap the rest of the right flap tightly around the baby and tuck the corner in to keep it secure
2. Side or Stomach lying – Hold the swaddled baby on their side or stomach.  This is not a position to sleep in but for comforting only
3. Swinging – gently swing or jiggle the baby, do not shake
4. Shhhh sound in the baby’s ear – say shhhhh in the baby’s ear, this may need to be loud.  White-noise machines can also help e.g. vacuum cleaner, washing machine
5. Sucking – give the baby a breast, bottle, clean finger or dummy to suck on

Medicines

Colic drops or gripe water can be used to relieve abdominal symptoms.  Infacol helps relieve trapped wind.
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Osteopathy and colic

Osteopaths use gentle hands-on techniques to assess your baby for tightness in their muscles and in the movement of their spine and head (cranial) bones.  Relieving strains in muscles and joints makes your baby much more relaxed.  Most babies enjoy treatment and can be seen visibly relaxing.  Very gentle massage and stretching techniques are used to improve muscle tension and movement.  Babies usually respond very quickly to treatment and most only need 3 – 4 sessions for a full recovery.  The effectiveness of osteopathy for the treatment of colic is based on relieving strains from birth, so that the nerves to the digestive system are not irritated and your baby is not suffering any discomfort from tension between cranial bones or muscle strains.
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How to cope as a parent or carer

Having a colicky baby can be very stressful, frustrating and challenging for any parent, particularly if it is the first child. Babies may pick up on anxiety around them, and this may make colic worse.  For first time parents it can be a disappointment to discover that your baby is not always the bundle of joy you were expecting.

It's important for the parents or carer to have time to themselves. Parents who feel overwhelmed should take a break. Ask a partner or friend to take over for a while, even for an hour or two.  Make sure you give each other times to rest or for some peace and quiet away from your baby.

You can find help from support groups often led by Health Visitors in your local area.  Ask your Health Visitor for details.
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