Colic

Does my baby have colic?

A baby with colic is a baby that is crying more than expected. Colic does not meet the usual criteria for a disease. There are no obvious causes, no tests to identify it, and no effective treatments. When a baby cries frequently, is generally unhappy, and can’t be settled by holding, the baby may be underfed or sick. It is important to identify the cause of distress and address it with an appropriate solution. Any baby who cries frequently should be checked by a health-care provider. There is little evidence to support acid-suppressing medication or over-the-counter treatments such as Gripe water or prebiotics and probiotics and furthermore, these may carry risks.

A) Defining colic

Colic does not meet any of the usual criteria for a disease. Diseases are disorders in the structure or function of the body that produce certain signs. Diseases generally have causes, can be identified by tests, and can respond to treatment.  

With colic, the only sign is crying. There are even classification systems for colic that consider the number of hours and days a baby cries (Zeevenhooven 2017). 

With colic, the structure and function of the baby, aside from the crying, seems normal. The baby grows well. No causes, tests, or effective treatments have been identified for colic (Harb 2016; Johnson 2015).

B) The history of colic

The word colic comes from the ancient Latin word for the large bowel (colon), colicus. Thomas Phaer’s The Boke of Chyldren, published in 1544, describes colic as “noyse and romblying in the guttes.” It is still thought to be a form of gut disorder.  

Over the years, babies received a range of useless to terrifying and occasionally lethal preparations to “treat” colic, that is to say, keep them quiet.

In the second century AD, the Greek doctor Galen recommended opium to calm fussy babies. It was used until the early 20th century. Thousands of babies died because of opium poisoning (Obladen 2016).

Other historic colic treatments have included sedating medications such as alcohol, phenobarbital, and benzodiazepines such as diazepam. These pose a risk to the baby’s developing brain (Hardoin 1991; Maitre 2013) and can suppress breathing. They were given as drops, added to drinks, or given with pacifiers.

Drugs to slow the baby’s bowels have also been used, including atropine, dicycloverine (also called dicyclomine), cimetropium, belladonna, hyoscyamine, and methylscopolamine. These are no longer recommended because of various side-effects (Illingworth 1955; Myers 1997; Williams 1984). At least two babies two babies are thought to have died because of dicyclomine  (Garriott 1984).

Some of the medications were combined with herbs and sweeteners (Pickford 1991).

Today, medication for colic continues to be marketed. Home remedies for colic include honey, sugar, lactase drops, teas, and herbal preparations and can pose a risk to the baby (Benjamins 2013). Chiropractors offer spinal manipulation for colic but it does not appear to be effective (Olafsdottir et al. 2001).

C) How health-care providers view colic

Health-care providers continue to diagnose colic. The percent of babies claimed to be affected by colic varies widely. One study (Hide 1982) reported about 16% of babies as having colic. Another study (Bellaiche 2018) of 2,000 otherwise healthy infant formula-fed French babies whose parents reported one or several mild digestive disorders reported that 64% of these babies were diagnosed with colic and 22% of the babies received prescription medication.

Unhappy babies are often now treated with acid-suppressing medication. These can have side-effects and do not generally stop babies from crying (Gieruszczak-Białek 2015).

E) Our opinion

Our clinic believes that colic is not a diagnosis or a disease. We have seen roughly 14,000 babies and have never diagnosed one with colic.

We believe that dismissing babies as simply colicky isn’t fair to them or their families, nor is it medically sound. We encouraged families to work with their health-care providers to identify the cause of the crying and address it with an appropriate solution. This results in a happier baby and happier parents.

Most babies are healthy. They are happy when fed and held, and they cry for short periods when something is bothering them.

In the rare case when a baby cries frequently, is generally unhappy, and can’t be settled by holding, it is likely the baby is underfed or sick. Any baby who cries frequently needs to be checked by a health-care provider to determine the reason for the distress. Parents should be wary of dismissing their baby’s cries as “just colic.”

References

Bellaiche M, Oozeer R, Gerardi-Temporel G, et al. Multiple functional gastrointestinal disorders are frequent in formula-fed infants and decrease their quality of life. Acta Paediatr. 2018 Mar 31
 
Benjamins LJ, Gourishankar A, Yataco-Marquez V, et al. Honey pacifier use among an indigent pediatric population. Pediatrics. 2013 Jun;131(6):e1838-41
 
Garriott JC, Rodriquez R, Norton LE. Two cases of death involving dicyclomine in infants. Measurement of therapeutic and toxic concentrations in blood. J Toxicol Clin Toxicol. 1984;22(5):455-62
 
Gieruszczak-Białek D, Konarska Z, Skórka A, et al. No effect of proton pump inhibitors on crying and irritability in infants: systematic review of randomized controlled trials. J Pediatr. 2015 Mar;166(3):767-70.e3
 
Harb T, Matsuyama M, David M, et al. Infant Colic-What works: A Systematic Review of Interventions for Breast-fed Infants. J Pediatr Gastroenterol Nutr. 2016 May;62(5):668-86
 
Hardoin RA, Henslee JA, Christenson CP, et al. Colic medication and apparent life-threatening events. Clin Pediatr (Phila). 1991 May;30(5):281-5
 
Hide DW, Guyer BM. Prevalence of infant colic. Arch Dis Child. 1982 Jul;57(7):559-60

Illingworth RS. Three month's colic; treatment by methylscopolamine nitrate (skopyl). Acta Paediatr. 1955 May;44(3):203-8
 
Jain K, Gunasekaran D, Venkatesh C, et al. Gripe Water Administration in Infants 1-6 months of Age-A Cross-sectional Study. Journal of Clinical and Diagnostic Research. JCDR 2015;9(11):SC06-SC08
 
Johnson JD, Cocker K, Chang E. Infantile Colic: Recognition and Treatment. Fam Physician. 2015 Oct 1;92(7):577-82.
 
Kreitschmann M, Epping LC, Hohoff A, et al. Sucking behaviour using feeding teats with and without an anticolic system: a randomized controlled clinical trial. BMC Pediatr. 2018 Mar 16;18(1):115
 
Maitre NL, Smolinsky C, Slaughter JC, et al. Adverse neurodevelopmental outcomes after exposure to phenobarbital and levetiracetam for the treatment of neonatal seizures. Journal of perinatology : official journal of the California Perinatal Association. 2013;33(11):841-846
 
Myers JH, Moro-Sutherland D, Shook JE. Anticholinergic poisoning in colicky infants treated with hyoscyamine sulfate. Am J Emerg Med. 1997 Sep;15(5):532-5
 
Obladen M. Lethal Lullabies: A History of Opium Use in Infants. J Hum Lact. 2016 Feb;32(1):75-85

Olafsdottir E, Forshei S, Fluge G, et al. Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child. 2001 Feb;84(2):138-41

Pickford EJ, Hanson RM, O'Halloran MT, et al. Infants and atropine: a dangerous mixture. J Paediatr Child Health. 1991 Feb;27(1):55-6
 
Williams J, Watkins-Jones R. Dicyclomine: worrying symptoms associated with its use in some small babies. Br Med J (Clin Res Ed). 1984 Mar 24;288(6421):901
 
Zeevenhooven J, Koppen IJN, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatric Gastroenterology, Hepatology & Nutrition. 2017;20(1):1-13