Colic has been defined as a newborn crying for more than 3 hours a day, more than 3 days a week, for more than 3 weeks [1].
If you are a new parent with a colicky baby, it can be a very stressful time – not only are you learning the ins and outs of parenthood, but you might also be sleep-deprived from feeding baby all day (and night!). Colic can also cause a strain on your family.
Having to care for a crying baby all day can take away from the experience of bonding with your new child. Poor sleep has been associated with stress. As sleep-deprived parents, stress can lead to outbursts of anger against each other. But there is not another time when parents should be more of a united team than when a baby joins the family. Babies are actually very aware of their environment and can pick up on many cues, including stress, which can make them even more fussy and colicky. Thus, it’s important for new parents with a colicky baby to have an honest discussion about how best to tackle the coming months. (More on that later.) Things do get better!
What are the causes of colic?
For years, colic has stumped doctors, scientists, and most evidently parents!
The actual cause of colic is still not fully understood, but several studies have made estimates as to what causes colic, including:
1. The “Fourth trimester”
If your baby is born full-term that means that they have been inside the womb for the past 9 months. For 9 months they have been rocked back and forth with every movement, and they have been hearing any and all sounds, only muffled. Being born is a jarring experience – the baby feels textures other than amniotic fluid, they hear sounds other than the muffled “womp womp,” and they get to have bowel movements! Baby has to learn how to interact with the world, and this learning curve is very steep at the beginning.
For the first several months after birth, your newborn is learning how to use his or her body. While some babies take no time in learning these skills, some babies take a little bit longer – months, even. This period of learning and figuring life out has been considered by some to be called the “fourth trimester,” since it takes about three months for the mother-baby dyad (or partnership – yes, it’s a partnership!) to learn how to work well together. Sometimes, the scales are tipped more toward one side than the other. This is much like how mothers have different experiences during their different trimesters – they may experience nausea during one trimester and not the others, or they may have stronger emotions during some and not the others.
During this time, it’s important to keep in mind that baby may be used to movement, especially throughout the day. While you were out and about, baby was getting rocked back and forth. If you drove somewhere, baby came along for the ride, literally. The experience could have been calming for baby. Now that baby is born, it may be more of a challenge to have them be involved in those calming movements if they are not being held. Experiencing less movement after birth may be confusing for baby.
In addition, baby was used to hearing sounds muffled – now that they can hear sounds without the many protective barriers that mom provided (for example, amniotic fluid, and mom’s clothing), all of the sounds that they hear are amplified, and potentially startling. Also, not hearing certain sounds can be confusing – babies are very close to mom’s intestines, which make churning sounds all day; also mom’s beating heart was not too far above when baby was in utero, and those same heart beats are now much further away after birth.
2. Gassiness
Newborns, like anyone else, can become very gassy. The gassiness can cause distention of the belly, and discomfort. Your baby can make this known to you (and everyone else!) by crying. Until they pass that uncomfortable gas, their bellies will continue to be uncomfortable.
3. Stooling
When was the last time you had a bowel movement laying down? Probably not since you yourself were a baby (kudos to you if you remember that far back). A baby’s gut is still immature, meaning babies are still learning how to use their bellies to push out poop, and they’re still learning how and when to relax their muscles to let the poop out. In short, infants don’t know how to poop.
How is colic treated?
You have been up late at night, and you are ready for a break. Some of the following tips can help you get the break you need:
1. Keep the movement moving and the sounds sounding
Babies are used to movement and sounds. While at home, one of the best ways we found to bond with our babies and move around was on a rocking chair. My wife often nursed our girls on the rocking chair.
There are also swing sets that can slowly rock baby back and forth.
If you would like to take movement outdoors, many parents (us included) found the Boba wrap to be a very comfortable way of doing so, as the flexible fabric gently wraps around the baby’s and the parent’s contours. Baby will feel comfortable in taking on a similar position as the one in-utero (or, in the womb), and parents can continue to stay active. It’s a win-win.
All of the sounds that babies hear in the womb are heard through amniotic fluid, which means that babies hear sounds as if they were underwater. There was always some sloshing sound that they heard. That is no longer the case once they are born, and they may miss hearing those sounds. There are apps that can play white noise that resembles sounds inside a womb. We still play white noise from one of these apps for our girls when they sleep.
2. Help ease baby’s gassiness – Lactobacillus reuteri
One of the medicines that most parents ask about is Mylicon gas drops. The theory behind how Mylicon works is that is allows gas bubbles to turn into foam, which in turn makes it easier for babies to pass, thus relieving the discomfort. The benefit of Mylicon gas drops is inconclusive, and some studies have not found evidence that it provides any benefit. It ends up being an unnecessary expense for parents. However, there has been recent evidence [2] to show that probiotics have a positive effect in helping relive colic in breast-fed infants. Specifically, the probiotic Lactobacillus reuteri [3]. L. reuteri is a specific type of probiotic (there are many different ones). The only probiotic specifically for infants that has Lactobacillus reuteri that I have found is BioGaia.
3. Set baby up for success to poop
On top of not knowing how to poop, babies have to learn how to poop while laying down! Wouldn’t it be much easier if they were propped up, possibly on your chest? Not only is this tummy time beneficial for building baby’s neck and back muscles, it also helps them empty their bowels and bladders easier.
Other causes of colic
1. Hair tourniquet
A hair tourniquet is simply a hair wrapped tightly around a part of the body. A common place that hair can wrap around on babies is on their fingers and toes. Sometimes it’s difficult to see those parts of their bodies, as their hands can be inside gloves, and their toes could be inside a sleep sack, or onesie. If your baby is crying inconsolably, do a thorough check of their body to look for any hair tourniquets. Some parents have used depilatory creams or sprays to remove hair that can’t be removed by blunt tweezers. Depilatory creams or sprays should not be placed near the face or near the genitalia – if there is a hair tourniquet that cannot be safely removed at home, see a doctor immediately.
2. Formula intolerance
As mentioned above, babies have immature stomachs. If baby is formula fed, the formula that they are drinking could be irritating to their sensitive bellies. The formula that they are drinking may need to be changed to a hydrolyzed formula [4], and the first formula change recommendation that I make to parents with a fussy and gassy baby is to Similac Alimentum Hypoallergenic.
Some babies can also have a milk protein intolerance and develop bloody stools, which may require a change in formula. While some of these babies may seem to be completely normal, they should be seen by a doctor to make sure there is not another reason for the bloody stools.
3. Mother’s diet
If baby is breast fed, they are in a sense eating what mom eats. Certain foods can make their way into breast milk and they can be irritating to baby, such as spicy foods, foods with strong smells, and foods with strong flavors. Much like how certain foods can cause discomfort adults, certain foods in mom’s diet could be contributing to gassiness, distention, and discomfort in baby. Cutting out certain foods from your diet could help relieve colic in baby. This discussion should be had with your doctor.
Other considerations
1. Three months is a magic number
If your child is struggling with colic, there is hope. Both of our daughters had colic, and while the above remedies did help, our biggest ally was the tincture of time. After about three months, our girls began sleeping longer through the night and they were less fussy. It’s almost like they “got it.” They had been out in this world now for several months, and they were getting used to it. Not only were their little bellies a little more mature, they were also used to not being rocked as much now that they had been out of the womb. Most parents also report noticing a significant improvement in fussiness, sleep, and overall quality of life by about three months of age.
2. Set expectations as parents for each other
As mentioned above, parents who are caring for a colicky child are under a lot of stress. This stress can permeate through every aspect of life, including the relationship between the parents. It is important to have a discussion with one another as to how the next several months will look like for the family. If maternity or paternity leave is an option at work, this would be an option that I would recommend taking advantage of, as time spent at home is time spent dividing the work that comes with having a new baby. Partners can be very helpful especially after moms are recovering from the delivery. Doing simple things like taking out the trash, doing the laundry, or making meals can go a long way. Also giving mom a break by taking the baby on a stroller ride, or even feeding baby can have a strongly positive effect on the entire family.
3. Don’t forget you’re still a couple
If a family member is willing to spend time with baby and caring for baby (for example, grandparents spending a weekend over), this can be a great reprieve for both parents. Things to do during this (much needed) free time can be sleeping, seeing friends, or just spending time with each other. Don’t forget, just because you have a new baby does not mean that you are not still a couple. Spending time together as a couple can relieve some of the stress that may have been building up recently.
4. Reaching out for help is a sign of strength, not weakness
Depression is a major concern in the “peri-partum” stage (time “around” the birth), usually several months before and after birth. One of the contributors to depression, both maternal and paternal, is having a colicky baby [4]. When there seems to be no way out of the day-in and day-out of the seemingly endless crying, parents can feel trapped and hopeless. One of the contributing factors in infant non-accidental trauma is colic [5]. Reaching out to others – friends and family, a church or a temple – for help should never be taken as a sign of weakness. Instead, it should be seen as a sign of strength – strength to know that someone else may need to step in and take on some of the weight that a new baby brings; strength to know that others can help you give the best care possible to your new baby.
For your reference:
1. Wessel MA, Cobb JC, Jackson EB, et. al. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics. 1954; 14(5):421-435
2. Probiotics in food: health and nutritional properties and guidelines for evaluation. FAO Food and Nutrition Paper 85. Rome: Food and Agriculture Organization of the United Nations and World Health Organization; 2006.
3. Sung V, Hiscock H, Tang ML, et al. Treating infant colic with the probiotic Lactobacillus reuteri. BMJ. 2014;348:g2107
4. Sung, Valerie. “Infantile colic.” Aust Prescr, vol. 41, no. 4, Aug. 2018, pp. 105-10.
5. Berkowitz CD. Physical Abuse of Children. N. Engl. J. Med. 2017 Apr 27;376(17):1659-1666