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Baby colic is one of the common causes of sudden bouts of crying by babies for no apparent reasons. This usually occurs in babies younger than 3 months. It usually starts around 2nd week of life.

Baby colic rarely persists after 3 months of age. Though this can occur at any time of the day, it is more common in the evening. It is also called as infantile colic, evening colic or 3 months’ colic. There are support groups which educate mothers about baby colic.

Colic describes a frequent symptom complex of sudden and intermittent attacks of abdominal pain, presumably of intestinal origin and of severe crying. These symptom complexes occur at the same time everyday for at least 3 days a week. Each episode of colic lasts for about 3 hours. Infantile colic is common in firstborn children and among male infants.

Symptoms of baby colic

An attack of baby colic starts suddenly. The baby starts crying. The baby cries at the top of his/her voice. The cry is more or less continuous and may last for several hours. The baby may appear to be settling when suddenly another bout of crying occurs. This may go on and off and the attack may terminate only when the baby is completely exhausted.

The face may be flushed and the region around the mouth could be pale. The abdomen is distended and may feel hard. The legs are drawn up on the abdomen. During the attack the hands may remain clenched and the feet are often cold. The baby may pass gas or feces. This may provide temporary relief from colicky pain.

Causes of baby colic

The exact cause of baby colic is not known. Various factors are thought to be responsible for this condition. Some of them are:

  1. Swallowing of air - During feeding and crying excess of air is swallowed. The swallowed air is passed in to the intestine which is thought to be causing the pain.
  2. Overfeeding - This can cause discomfort and distention of the abdomen
  3. High carbohydrate – The baby’s digestive system is immature. Certain foods especially those with high carbohydrate content may be responsible for excessive fermentation causing symptoms. But unfortunately a change in diet only occasionally prevents further colic attacks.
  4. Gastroesophageal reflux - This reflux may occur in normal infants for the first few months of age. It has been found that in certain babies the incessant crying could be due to gastroesophageal reflux.
  5. The baby may have intolerance to some of the food items in the mother’s diet. This may cause an attack of colic especially if the baby is breastfed.
  6. Since attacks of colic is mainly seen during the evening, a change in the household routine may possibly cause them
  7. Baby’s temperament may be responsible. In an older child worry, fear, anger and excitement can cause vomiting. These can cause colic in infants.

In an infant crying incessantly the following conditions should be ruled out:

  • Intestinal obstruction
  • Peritoneal infection
  • Intussusception
  • Strangulated hernia
  • Hair in infant’s eye
  • Infection of the ear
  • Pyelonephritis ( infection of the upper urinary tract)

Treatment of baby colic

The pediatrician who treats the baby should be supportive and sympathetic while treating the infant which is very essential for successfully resolving the problem. There is no specific treatment that cures colic. The following are some of the options that can be considered while treating an infant with evening colic.

  • Adequate feeding – The baby should be fed on demand. Feeding the baby every 2-3 hours would be appropriate.
  • Changing the position of the baby – By holding the baby upright or making the baby lie with the tummy on the mother’s lap or heating pad or hot water bottle would he helpful.
  • Using an infant swing may provide relief.
  • Rocking the baby gently may be done. The baby should never be shaken violently as it may damage the brain.
  • Playing soft music has been found to calm down a crying baby.
  • Using a suppository or an enema to aid the expulsion of flatus or feces may provide relief sometimes
  • Change in feeding techniques is also advised to prevent baby colic. This includes
  1. Feeding in a stable emotional environment
  2. Burping after each ounce of feeding
  3. Keeping the baby in the propped up position after feeding
  4. Avoiding underfeeding
  5. Avoiding overfeeding
  6. Eliminating foods that are possibly allergenic from the infant’s and the nursing mother’s diet. The food items that are to be avoided by the mother include dairy products, caffeine, soy products, citrus fruits, egg, fish, peanuts, wheat, garlic onion and cabbage. If the baby is fed with cow’s milk, it should be stopped.
  • If the above measures fail, the baby may be sedated especially if the colic attack is a prolonged one.
  • In extreme cases of infantile colic, the infant may have to be hospitalized with a change in feeding routine and providing rest for the mother.
  • Though no medication can be used specifically to treat baby colic, sometimes Simethicone can be given to provide relief. This would be helpful if the pain is due to excess gas. Probiotic supplements can restore the good bacteria in the gut and provide some relief especially if the pain is due of gas.

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In a case of baby colic - when to consult a doctor?

Most of the times the baby colic can be resolved with the simple measures mentioned above. But sometimes it would be frustratingly difficult for the mother or the caregiver to pacify the baby and getting help from the Pediatrician would be appropriate. The role of Pediatrician in treating baby colic includes:

  • To rule out more serious conditions ( mentioned above) which could be responsible for the sudden bouts of crying by the baby
  • To hospitalize the baby for sometime which not only helps in treating the baby but also provides rest to the stressed and exhausted mother
  • For prescription of medications like Simethicone which will provide relief if the colic is due to trapped gas
  • Occasionally to sedate the baby when nothing abnormal is found on clinical examination.