As a pediatrician, I have diagnosed and managed lots of colicky babies. Families often have lots of questions:
- What is colic?
- What is the cause?
- What can I do so that my baby will stop crying?
I recently attended a medical conference with a wonderful evidence-based lecture on complementary and alternative medicine management of colic by Kathi Kemper, MD MPH. I have recommended a lot of these therapies for years and it was quite rewarding to learn that research supports these strategies. As I often tell my families, as a pediatrician, I have signed up for the job of giving traditional western medications to children, but it really bums me out. I really believe that children should grow and thrive with minimal medications. If there are safe and evidence-based interventions to manage common childhood conditions, my preference and natural inclination is to do that first. Dr. Kemper outlined a wonderful plan for the management of a newborn with colic that I want to share with my Palisades Pediatrics community and others.
What is colic?
Colic is very common. Ten percent of newborns will have colic. Colic presents between 3 weeks and 3months of age. It is intense crying for 3 or more hours a day for 3 or more days of the week. The crying episodes are particularly intense in the evenings.
What is the cause?
Simply put, we do not know the cause of colic. There are various theories about the etiology including temperament or gastrointestinal microbiome imbalance.
What can I do so that my baby will stop crying?
Every newborn is unique and will respond to different interventions. The behavioral interventions that Dr. Kemper suggests are based on the Karp approach and included: swaddling, slow, rhythmic swinging or rocking side to side, shooshing, stroller walk, side or tummy position (while awake), sucking on a pacifier, and sound (white noise). Parents should respond quickly to crying. I always tell parents that they can not spoil a child less than 12m, so they should feel comfortable holding their baby. According to Dr. Kemper, babies who are carried more, cry less. This is supported by research published in Pediatrics in 1991 by Barr.
The nutritional interventions for colic pertain to both formula and breastfed babies. Nursing infants may benefit from frequent feedings and if mom avoids irritating foods, such as soy, corn, wheat, eggs, chocolate, green leafy veggies, onions, beans and cow’s milk. Formula-fed infants may benefit from hydrolysate formulas like Nutramigen or Alimentum. There is no benefit for nursing or formula fed infants to adding solids, fiber or juice to their diet.
All colicky babies should receive probiotics. OTC products such as BioGaia and Gerber Soothe contain L.reuterii, which has literature to support it’s use in colicky newborns. OTC CulturelleKids has also been researched and found helpful in colicky babies. Some babies will respond to herbs, similar to what is found in Gripe Water. There is literature to support some benefit to chamomile, fennel, vervain, licorice, lemon balm. There are no medications that have been found helpful with colic. Some pediatricians, may suggest simethicone, lactase sedatives, alcohol, and dicyclomine for colic, but there are not randomized control trials that support the safe and effective use of these medications.
The research is inconclusive regarding the role of massage, chiropractic manipulation and acupuncture. Massage may have some benefit for colicky newborns, but the data is mixed for chiropractic and acupuncture interventions. Better studies are needed but it is challenging to design randomized blind clinical trials for these interventions.
Finally, the newborn should not be around any second-hand smoke, including cigarette, cigar, pipe and electronic cigarettes.
Most families work hard to prevent their child from crying, so a newborn with colic can be a very stressful and challenging experience for parents. It is important to remember:
- You have not done anything to cause colic
- A colicky baby is not in pain
- Colic is time limited , this too will pass