in this post:

if it’s not a diagnosis, what is colic?
what causes colic?
what can be done for babies with colic?

Chances are you’ve heard of “colicky” babies or may even have a child who’s been diagnosed with “colic.” It’s important to understand though, that the term colic is used as a catch-all term for when doctors don’t know why an otherwise healthy newborn is inconsolable for much of the day or night. Colic is a symptom. It is not an acceptable diagnosis. There needs to be more discussion and more investigation to find the root cause if your baby has been diagnosed with colic or you’ve been told to “wait it out.”

If it’s not a diagnosis, what is colic?

Colic is actually difficult to define despite over 50 years of research. It’s estimated that about 1 in 5 babies is affected, boys and girls and breastfed and bottle fed equally so.

Since 1954, doctors used Wessel’s “rule of 3’s” which states that colic peaks between 3 and 12 weeks of age, and can last for 3 hours a day for at least 3 days a week. However, in 2016, specialists came together to produce a broader definition. Colic is now defined as more generic fussing/ crying in a thriving baby or inconsolable bouts of crying that start and stop with no obvious cause. Some specifics in the new definition:

infant is younger than 5 months of age
presenting with recurrent prolonged periods of infant irritability, fussing, or crying reported by parents that occur without obvious cause and cannot be prevented or resolved by caregivers
no failure to thrive- baby is otherwise healthy with no other diagnoses, and is growing and gaining weight

what causes colic?

Colic is so hard to treat because doctors can’t find one root cause even after over 50 years of research. It’s most likely that colic is not to be used as a diagnosis itself, but points to an underlying issue. Some hypothesized possibilities include:

Feeding issues:

Orofacial Myofunctional Disorders
Poor latch (can cause excess air in the belly)
Too-Fast flow (if bottle fed)
Forceful letdown (if breastfed)
Tongue, lip, and/or cheek ties
Allergies to formula brand
Cow’s Milk Protein Allergy (CMPA)
Allergens to egg, soy, gluten, etc.
Trapped gas or constipation

Medical issues:

Gastrointestinal immaturity
Gut PH imbalance
Poor overall gut health and imbalance in gut microbiome
Body tightness or misalignment
Undiagnosed Pain (such as pain from an unknown bladder infection)
Neurological issues
Reflux, silent reflux, GERD

And more...

Temperament style
Sensory processing
Maternal nicotine use
Trauma (traumatic birth, abuse, stressful home environment etc.)
Parental stress or mental illness/ unresponsiveness
Overstimulation or over-tiredness

What can be done for babies with colic?

If you have had a very unhappy baby for a while or even if you’ve gotten the colic diagnosis, you’ve likely tried most soothing techniques already. Just in case you haven’t, I’ll state the obvious things first, and move on to how you can utilize professionals and current science to help you get to the bottom of your baby’s colic.

Soothe and respond to your baby. Leaving your baby to cry will never cure their colic- in fact research states it can make it worse. Research has found that the presence and responsiveness of the parent remain essential to the resolution of any neurological issues that could be underlying in inconsolable crying (i.e., colic) (McKenna, Middlemiss & Tarsha, 2016). Hold your baby as much as you can, offering skin-to-skin and babywearing so they’re upright whenever possible. Babies with colic symptoms will also likely enjoy motion like bouncing, rocking and swinging, and may enjoy the “football” hold or any position where they can be on their tummy. Be sure that your baby isn’t becoming overly stimulated by lots of rushing around, stressful environments, or loud noises, and offer calming routines at regular intervals (wake windows) throughout the day to encourage naps, avoiding overtiredness. This is why using a white noise machine and 100% blackout curtains can help to create a soothing, low-stimulation environment.
Consult with a Lactation Consultant/ IBCLC. In many cases the underlying reasons for colic have to do with poor breastfeeding positioning, too-fast flow/ letdown, or tongue and/or lip ties. Checking in with a quality lactation consultant can save you tons of research and resources, and they can help you find the predominant issue. Much of the time, colic is improved with improved breastfeeding positioning, paced bottle feeding/ avoiding over-feeding if formula fed, and parents remaining calm. An LC/ IBCLC will also be able to help you with determining whether or not your baby’s latch could be contributing to swallowing too much air, which can cause painful trapped gas.

There is no current research that proves significant improvement of symptoms of colic when babies take a placebo vs. a pharmaceutical. Acid blockers such as proton pump inhibitors, which are the recommended treatment for gastro-oesophageal reflux disease, do not provide any relief in colicky infants (Daelemans, et. cal 2018). There is, however, emerging research that shows positive effects of probiotic supplements. This is the only intervention that is well-documented through several quality studies to be both effective and safe with virtually no negative side effects. A 2018 study (Rhoads, et. al) looked at the gut bacteria and inflammation levels in babies with colic and compared them to babies without (both breastfed and formula fed). They found that babies with colic had higher levels of fecal calprotectin which is an inflammatory marker in the gut. They also found that babies with colic had different numbers of some types of bacteria compared with non-colicky babies, known as dybiosis. The authors of the study hypothesize that this is why probiotics are often effective in treating babies with symptoms of colic.

In 2015, a double-blind, placebo-controlled randomized trial was conducted in primary care in Torino. Patients suffering from infantile colic were randomly assigned to receive probiotics daily (oral L reuteri 1 × 108 colony forming unit) or placebo for 1 month. Parents were to keep track of the total minutes their baby spent crying, plus fecal samples were taken to evaluate. After infants with colic were supplemented with L reuteri DSM 17938 for 30 days, crying times were significantly shorter among infants with colic in the probiotic group compared with infants in the placebo group (79 vs. 135 minutes /day). Moreover, the probiotic increased the percentage of Lactobacillus (“friendly” gut bacteria) and decreased fecal calprotectin. This study was done with exclusively or predominantly breastfed infants under 12 weeks old who had already had cow’s milk allergies ruled out as a potential cause for their symptoms.

Breastfeeding mothers of infants with colic might also consider potential allergens in their diets. A randomized controlled trial showed significant reductions in colic symptoms among breastfed infants whose mothers followed a low-allergen diet: infants whose mothers excluded cow's milk, eggs, peanuts, tree nuts, wheat, soy, and fish from their diet cried for 137 minutes less per day, compared with 51 minutes less per day in the control group (Johnson, et. al 2015). In many cases, the mother can reintroduce these allergens slowly back into their diet once their baby is over 6 months.
Cow’s milk protein allergy (CMPA) is especially common in infants, so cutting out cow’s milk dairy might be a good place to start to see if symptoms improve. This allergy can develop in exclusively breastfed babies as the cow’s milk protein is passed relatively unchanged through the breastmilk. It can also present later when cow’s milk is introduced into a baby’s diet through solids. It can cause symptoms ranging from vomiting and regurgitation (can be misdiagnosed as reflux), blood in the stool and/or diarrhea, constipation, eczema, and most seriously wheezing or anaphylaxis (a state of shock where the allergic reaction overwhelms the body and is a medical emergency). The good news about CMPA is that many babies outgrow it by 1 year old, and most children should tolerate cow’s milk products by the age of 3 years and can return to a normal diet. The most effective way to test for this is through an elimination diet. Contrary to myth it does not take weeks for dairy to leave your system, so you could see improvements in your baby’s symptoms in as little as hours or days. Keep in mind that other allergens (eggs and gluten commonly) often need to be checked as well, and especially soy (soy and dairy allergies tend to go hand in hand). Before going on an elimination diet it’s good to consult with your doctor and/or IBCLC.
Consider whether or not your baby is showing signs of reflux, silent reflux, or GERD in addition to the inconsolable crying. This can be a piece of the puzzle, though research shows reflux is unlikely to be the only underlying issue if you have a baby with colic. Studies have failed to show any correlation between pathological gastro-oesophageal reflux and crying in infants less than three months old. In the absence of frequent vomiting, haematemesis and poor weight gain, gastro-oesophageal reflux disease is an unlikely cause of infant crying (Sung, 2018). So, although crying is frequently reported in infants with gastro-oesophageal reflux disease, crying itself is not an indicator of the condition. Moreover, acid-blocking medication contributes to the development of an unbalanced gastro-intestinal microbiome, which is a risk factor for allergy and gastro-intestinal and respiratory tract infections (Daeleman, et. al 2018).
Parents of formula-fed infants might consider switching formula brand. A systematic review of 13 studies found a statistically significant decrease in crying time among infants who switched to partially, extensively, or completely hydrolyzed formulas (such as Nan HA, Similac) (Johnson, et. al 2015).
Having a new baby is hard. We know from recent breakthroughs in neuroscience and psychology that infants attune with their caregivers and co-regulate with them using mirror neurons. Basically meaning that when we’re stressed, baby will be stressed. Colic and maternal depression as well as insecure attachment style are closely linked. Many mothers start to feel inadequate as parents and perhaps feel anger toward their baby. Colic or excessive crying is one of the top causes of shaken baby syndrome because parents become so overwhelmed. Although colic itself is not known to have any long-term effects as children grow up, the disruption of the parent-child relationship is, and attachment can certainly suffer, which can have long-term implications. This is why a huge piece of “treating" colic is finding ways to maintain the bond between parent and baby and to get outside support if needed.

Unfortunately there’s no easy answer here. As you can see, the etiology of colic is still not completely defined but is likely multifactorial. One theory hypothesizes that an important factor is the immaturity of the infant's nervous or digestive system. Other proposed factors include allergy to cow's milk proteins, intestinal hypermotility secondary to an imbalance of the autonomic nervous system, and hormonal changes. (Savino, et. al 2017).

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