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COLIC CONSTERNATION

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some Proud Parents Holding Baby in the bedroom

Scientists have discovered mirror neurons. These are nerves that activate in response to the actions and emotions of other people. Mirror neurons play an integral part in the attachment of human beings. The parent infant dyad is one of shared emotions. When babies smile parents feel emotions of elation. When babies cry parents feel emotions of distress, anxiety, stress, despair, grief, hopelessness, inadequacy, etc. Infants likewise likely detect and respond to the emotions of parents.  

Colic is periods of persistent crying in otherwise healthy infants. About one in five infants experience significant crying lasting several hours a day and more days than not. This crying can be extremely stressful for parents especially if the cause of crying is unknown.

Although colic has been present throughout the ages of human existence the cause is still unclear. The timing of onset and resolution of colic is so predictable that in part colic must be neurodevelopmental – a function of the normal nervous system development of the infant. One property of our nervous systems is to self-regulate and self-calm in response to adverse stimulation. Crying frequency and duration gradually increases until 2 months of age and then improves by four months of age. It seems that babies developmentally have less ability to integrate stimulation and self soothe as they approach two months old and then naturally improve this capacity with normal development by around four months of age. One interesting study found that infants that develop colic have less variety in the types of bacteria that colonize the intestines than non-colicky infants. It’s possible that the cause of colic is multifactorial: a combination of neurologic sensitivity to stimulation with some provoking factors. Regardless the actual cause one can be assured that true colic is not harmful in and of itself to the infant.   Parent’s response to colic can be deleterious as I’ll explain. Colic imitators must be detected and understood to avoid missing important diagnoses.

A sad tale. During my residency at Primary Children’s Hospital I knew of a situation in which young parents struggled to cope with a colicky baby. The father tried to quiet the baby to aid an exhausted mother and began to bounce, spin, and randomly shake the infant. The baby responded to this intense stimulation with decreased crying but the shaking caused a brain bleed that left the infant severely damaged for life and the father facing criminal charges. The marriage failed and the mom cares for a neurologically devastated child to this day. The emotional reaction a crying baby creates in a parent can be overwhelming. Having a plan and skills to cope are essential.

Ways to live with a colicky baby:

1) Know when it’s colic and when it might be something else.  If you’re not sure, see one of our Pediatricians at Canyon View Pediatrics. Colic generally gradually worsens over several weeks and the crying usually clusters around a predictable time of day, especially the evening, with scattered episodes of crying at other times. Colic is crying without other symptoms. If any of these symptoms occur your infant should be seen immediately: fever of 100.4 F rectal or greater, labored breathing, marked decrease activity or lethargy (see newborn sepsis blog), feeding problems, vomiting (see newborn intestine blog). If crying is uncharacteristic for the infant, diagnoses other than colic should be considered. For example, if the baby has a horrible crying episode for the first time, or if this is the worst crying the baby has ever had which is different than past fussiness.   Colic is not generally all day long without a break or worse predictably after feeding. If colic symptoms don’t follow the classic presentation of predictable fussiness in a limited time of day,  that  gradually worsens over weeks, in an otherwise asymptomatic infant who is mostly content the rest of the day,  then have one of our Pediatricians evaluate your baby.

2) Keep perspective that this will get better around four months of age, but it can be an exhausting battle in the meantime.

3) Believe that colic crying will never hurt your infant. All people have a threshold of stimulation they can tolerate before they begin to decompensate (deterioration of a previously working structure or system). If you or your partner is reaching your limit put the baby down alone in the crib to cry while you take a break.

4) Respect your significant other’s threshold of tolerance and don’t pressure your partner to keep the baby calm. Recognize and support the strong emotional response the crying can create.  Maintain a team approach to deal with the crying rather than allow the baby to create a wedge of blame and inadequacy in the partnership.

5) Never ever shake or spin your baby to comfort her. Sudden jarring or spinning movements of your infant’s brain can cause bleeding and damage.

6) Never sleep with your baby to treat colic. Co-sleeping definitely increases the risk of Sudden Infant Death Syndrome and is not an appropriate way to cope. (see Newborn SIDS blog)

7) Decrease unnecessary stimulation with which the baby has to cope. Overhead bright lights can be very irritating and babies can’t divert their gaze. Keep lights dim that the baby might look at frequently. Avoid excess jostling, kissing, noise, lights, etc. Love your baby, but do it softly

8) Use some methods to try to comfort your infant and decrease overall crying but keep a realistic perspective that they may or may not work. When it comes to colic there is no guarantee resolution except for passage of time.  It is always good to be attentive to your baby’s signals and try to comfort your infant at the earliest signs of need.

a) Do routine care first at the first signs of crying to satisfy your infant’s needs: feed, burp, change diaper, gently hold, etc.

b) Use soothing stimulation to try to comfort your infant. Many babies do well with rotations of different soothing stimulation every ten to twenty minutes. Try a variety of things and see what works best: gentle holding, rocking, vibrating chair, car ride, vacuum cleaner noise, white noise app on your smartphone, kangaroo pouch baby sling, gentle stimulation on an exercise ball with careful head support, stroller ride, mechanical swing on low gentle setting, gentle rubs while tummy down on your knees with gentle motion, calming music.

c) If all else fails put your baby in the crib to cry for a while.  It’s like exercise for some babies. After an intense period of crying he may calm better. Some babies seem to need a break from any stimulation or just need a nap. Explore whether your baby prefers swaddling or not. Never lay your infant down unattended on her tummy even if it seems to comfort her (see the Newborn SIDS blog) For safe swaddling information look at the AAP site https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Swaddling-Is-it-Safe.aspx

 

9) Don’t chase methods that are not likely to work. Classic colic symptoms of predictable nighttime crying rarely respond to formula change or diet change in breastfeeding moms. If you’re breastfeeding and your diet is balanced and moderate it’s not likely to cause colic symptoms. If you are ingesting lots of caffeine, eating lots of one type of food, smoking, using substances, or taking medication then talk to one of our Pediatricians.

10) Use Lactobacillus Reuteri probiotic. This is a good bacteria (probiotic)  that has been shown  repeatedly in studies  to decrease colic symptoms. No one knows why it works but the theory is that something with intestinal bacteria is important to decrease annoying stimulation the baby has to tolerate. This probiotic can be found in Biogaia. Give 6 drops daily. It may take two weeks to see effect. It may or may not completely resolve colic symptoms but may make it more tolerable.

11) Consider herbal preparations that have been studied for colic. Unfortunately no herbal preparations have undergone repeated scrutiny in studies to categorically prove benefit at a specific dose. The ingredients with the most studies are Fennel and Chamomile. Although there is no reason to believe they cause harm or side effects, they are not regulated by the FDA for effective dose and dosing limit for safety. Unlike studies of lactobacillus reuteri which use a single commercially available ingredient at a specific dose to determine efficacy, studies on Fennel and Chamomile were done with wide dosing ranges or in combination of preparations not commercially available. In other words, these ingredients have been show to work but we don’t know what dose or what combination of doses works best. Easily obtained commercial products, gripe water for example, don’t contain dosing instructions that correspond with doses used in studies. In my experience these gripe water preparations occasionally work for patients but usually not. If they work, there is a response in the first one to two days of use.

My Recommendations:

a) Consider Quiet Tummy Gripe Water or Mommy’s Bliss Nighttime Gripe Water both available at Good Earth or on Amazon.

b) Use these preparations according to recommended doses on the box and if any side effects occur stop them immediately.  A one or two day trial is sufficient and if you don’t see benefit then stop.

12) Sugar makes everything feel better. M&M’s work for me. Sugar has been shown to have an analgesic effect for babies undergoing procedures. About 2/3 of colicky babies given small amounts of sugar water calmed and sometimes for extended periods of time. Is it a good idea?  Studies are small with no long term follow up for metabolic effects such as weight gain or abnormalities in glucose regulation. It is unsettling to me to give small infants frequent doses of refined sugars. M&M’s take their toll after a while. Personally, I would use sugar in limited amounts, if you have tried everything else and for some reason you’re desperate, with you or your partner riding on your last nerve. Visit with one of our Pediatricians If you feel your baby needs sugar very much.  Sweat-ease 24% sugar in water can be found on Amazon.  Use 1 ml.  If it is going to work, it will work almost immediately.

I hope this helps prevent colic from dampening an otherwise joyous experience with your newborn baby. Please let one of the Pediatricians at Canyon View Pediatrics help if you are concerned crying may represent something other than colic or if you are struggling with managing prolonged fussiness.

John Bennett, MD FAAP

Resources:

Intestinal Microbiota of Infants With Colic: Development and Specific Signatures,  PEDIATRICS Volume 131, Number 2, February 2013

The Efficacy and Safety of the Probiotic Bacterium Lactobacillus reuteri DSM 17938 for Infantile Colic: A Meta-Analysis of Randomized Controlled Trials.  Man Xu,# Jiao Wang,# Ning Wang, Fei Sun, Lin Wang, and Xiao-Hong Liu*.  PLoS One. 2015 Oct 28;10(10):e0141445. doi: 10.1371/journal.pone.0141445. eCollection 2015.

Nutritional Supplements and Other Complementary Medicines for Infantile Colic: A Systematic Review  Pediatrics 2011;127:720–733


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