Family doctor

What is colic?

Colic is frequently used in the sense of being a diagnosis but strictly speaking it is a one word clinical description of a crying, fussing, irritable infant without any obvious cause for this behaviour.

This is a common condition and is estimated to occur in 10 - 15% of newborns.

A medical assessment and examination should always be done to check for other conditions which may cause similar symptoms.

Key features:

• Typically occurs late afternoon and early evening.
• Very difficult to placate once symptoms develop. Feeding usually does not relieve distress.
• Infants often have legs drawn up and back arching during crying episodes.
• Generally abates spontaneously by around three months of age.
• Equally likely between breast and bottle fed infants.
• Generally otherwise healthy and gain weight at an appropriate weight.
• Long term outlook - excellent.

Diagnosis:

1. The importance of a family history of allergy needs to be noted. It is estimated that 10% of infants who are labelled as having 'colic' are in fact intolerant of dairy milk protein either in terms of a reasonable dairy intake the mother is having if breastfeeding or in being on a cows milk protein formula.

2. Possible urinary tract infection. This is not an infrequent condition in infants and may present with a clinical picture mimicking that of colic. It is therefore reasonable for a urine check to be done on all infants who are suspected of having colic. Similarly if there is anything else on the physical examination or history that suggests an underlying medical history, then this does need to be explored.

What is the treatment?

1. If there is a suggestion of intolerance of cows milk protein in either a breast or a formula feeding infant, then steps to reduce or eliminate this from the diet are worth considering. For a breastfeeding mother, this would mean eliminating dairy products from her own diet. For a formula fed infant, the approach would be to try either a goats milk or soya milk formula to see if this provides relief.

2. Other dietary changes do not commonly produce a substantial improvement although a heavy caffeine load in a mother's diet can sometimes produce this pattern of irritability and it is therefore worth considering reducing or eliminating coffee or tea from the diet to see what changes occur.

3. If a urine test shows a urinary tract infection or if there is evidence of another medical problem, clearly this will need to be treated in any event and often will substantially improve the irritability.

4. Various physical approaches have been tried with reasonable success rates in children who are displaying colicky behaviour. Motion of one kind or another often seems to provide some sort of relief. There are different ways of doing this. For example:

a) Taking the infant for a car ride. Most infants seem to settle with the motion of car movements.

b) Kangaroo care with carrying the infant in a front pack. This also seems to provide relief or at least some degree of soothing for irritable infants.

Surviving colic

Helping parents cope with this frightening situation is one of the key points in surviving this condition. The infant will certainly survive it but parents may need assistance.

Key points for parents:

• Try to avoid sleep fatigue by catching up on sleep where possible.
• Accept what offers of help are available to look after the infant for a while.
• Talk to other parents of infants who have been or are similarly affected.
• Both parents should try to spend some time together outside home without their infant for 2-3 hours at a time.