Colic pain : a survival guide

Crying is a good signal that a child is in need of something but a poor signal of what he/she needs. When infantile colic starts in a baby , it presents with continuous , prolonged , unstoppable cry which is source of distress for already exhausted parents. Parents are helpless and blame themselves. Babies can’t explain and keep crying. Doctors don’t find anything wrong with baby and hence can’t treat and this is how infantile colic disturbs all of them.

The classic definition of infantile colic was first given in 1954 by Wessel, who described colic as a condition occurring in an otherwise healthy, well fed infant with crying or fussing for more than 3 hrs a day ,for more than 3 days a week , and for more than 3 week. These criterias give general vague idea about colic. Every baby has different onset, duration, presentation of colic. It may start as early as 1week of age and lasts for 3-4 months of age.

Recent updated criteria for colic is Rome IV criteria given in 2016 which is diagnostic criteria.
“ An infant who is less than 5 months of age, when symptoms start and stop abruptly ; recurrent and prolonged periods of crying , fussing or irritability reported by caregivers that occur without obvious cause and can not be prevented or resolved ; no evidence of the infant of failure to thrive , fever or illness”. Here fussiness refers to intermittent distressed vocalisation which is not quite crying but not awake and contented either.

There is something called as PURPLE to remember colic


.Peak of crying,Unexpected ,Resists soothing, Pain, Long lasting,Evening.

FEATURES:

  • Classic presentation: Overanxious parent with inconsolable infant.
  • Colicky cry is different from other cries as you can tell baby is in pain.
  • Crying starts and stops abruptly.
  • Generally colic starts from 2-3 weeks of weeks and peaks at 6-8 weeks ; resolves at its own at 3-4 months.
  • There is biased opinion on ‘if breast fed babies have less chance of having colic than formula fed.’
  • There are no signs of illness like fever,rash seizures loss of weight, failure to thrive ,dehydration
  • Some babies associated with Gastrointestinal esophagial reflux disease (GERD )may have signs like throwing up, being more gassy , crying while passing gas. Babies may stretch arms and legs. May feel better on burping.

The source of colic is not defined yet. Some of the causes are thought to be associated are:

Gut related: Lactose intolerance, immaturity of bowel , altered gut flora of microbes , discomfort due to gassy belly.

Non Gut related: Poor feeding technique,altered behaviour, maternal anxiety , maternal diet, inadequate burping.

Management:

  • Rule out other causes of excessive crying.
  • There are no specific medical guidelines for management as such to achieve colic calm.
  • Few things like behavioural changes, Diet,Medication may help but should be done under proper guidance as every baby is different.

Behavioural Modifications:

  1. The caregiver should understand that it’s not his/her fault. The care he is giving is not inadequate and should be confident
  2. Understand the difference between normal and colicky cry
  3. Learn 5 soothing techniques: Swaddling,Side stomach, Shhh sound, Swinging the baby, Suckling ( on breast/ pacifier)
  4. Other techniques: minimise handling, various exercises to remove gas from belly, tummy time in prone position,burping frequently during feed ( after 30ml of formula or while switching the breast) , holding upright for 20mins at least after each feed, car ride( somehow helps a lot).

Diet and Medication:

Diet:

  1. Probiotics —> improve gut flora —> better digestion —> less gas —> less colic.
    L. Reuteri, Lactobacillus, Bifidobiton are some of them. They are added in formula also these days. U can get probiotics separately also in pharmacy.

2. Hydrolysed infant formula :

This is given to babies with Cow Milk Allergy ( CMA) . CMA is manifested rarely. Though breast milk is gold standard for first six months , few babies are formula fed due to inadequate breast milk supply.So hydrolysed infant formula is recommended in infant with CMA. Partially hydrolysed formula is easy to digest as it is already broken down to some extent.

3. Fermented formula with oligosaccharides:

Many formula feed have Human Milk Oligosaccharides ( HMO’s) which help in building immunity, preserve gut flora and help digestion and so cause less gas.

Medication ( including grandma suggestions) :

  1. Dicyclomine and Cimetropium are believed to relieve gut spasm and hence relieve the pain. They are smooth muscle relaxants which help to relieve the spasms of gut that has immature enteric nervous system. These medicines may have side effects on circulation and respiratory system so should be taken only when it is advised by a qualified paediatrician. These colic drops are available under various names like colic-aid,
  2. Babies having GERD may benefit with antacids advised by paediatric doctor.
  3. Prebiotics added in milk can help with better digestion and hence less gas.
  4. Gripe water is an old remedy believed to help in digestion and relieving abdominal pain. No proven scientific evidence though.
  5. Dill oil, Fennel oil are some grandma’s remedies.
    There are no health related consequences of infantile colic in adulthood.
    TAKE HOME MESSAGE:
    Infantile Colic is a multifactorial condition to which various solutions seem to be available but still the definite way to end the hustle is to let the baby grow up beyond 3-4 months ; that is to let it resolve on its own.
    Patience is the key. Keep looking for momentary solutions. Days will pass and one day there will be no inconsolable cry.As a parent your mental health will be tested but this will pass. As a mother I have tried almost all the things mentioned in this blog. In spite of being doctor I couldn’t help being restless and anxious sometimes. I have visited paediatrician for many times just to listen there is nothing wrong with my baby girl .So Just remember there is nothing wrong with baby and you are also not doing anything wrong. Be confident and keep in mind it is just a phase and it will end soon.