Infant colic, solutions and latest updates

In the first 15 days of your baby's life, and more especially around six weeks, one of the worst enemies of mums appears. Infant colic. That is why our team of midwives at Happymami has prepared the following post for you, with the latest update on infant colic and solutions.

It is normal for your baby to cry on certain occasions, if they are hungry, sleepy, thirsty or uncomfortable. But the frustration of parents with infant colic lies in the fact that it does not settle when the baby's needs are met, as it does in other situations. And although colic usually disappears from the fourth month onwards, the fact that the baby cries for no apparent reason and cannot be soothed causes great stress for the person caring for them.

What causes infant colic?

I am sorry to tell you that the reasons are not well understood. The latest scientific update speaks of a multifactorial origin, but the exact cause is unknown. It has been linked to the immaturity and/or altered intestinal motility of the baby, the action of intestinal hormones, gastro-oesophageal reflux or excess intestinal gas probably swallowed during the crying itself. All of these are factors that can contribute to the development of infant colic. In some very severe cases of infant colic, it is possible that a cow's milk protein allergy/intolerance is the cause.

Other authors suggest that the possible origin may lie in certain psychological and social factors, such as overstimulation of the baby, an exaggerated or anxious response to their crying, constant changes in the daily routine, as well as the tiredness and inexperience of parents, which is why these colic episodes are more frequent in first-time mums.

Digestive causes are also mentioned, such as difficulty passing gas. But in most babies it resolves spontaneously at three or four months of age. It is true that although it usually disappears on its own, it can be useful to know more about colic in order to better understand what your baby is going through and offer them the best solution.

When does infant colic start?

This excessive crying that we call infant colic usually starts at some point between the third and sixth week after your baby's birth. And it ends when your baby is between three and four months old.

Do all babies get infant colic?

Up to 40% of babies will suffer from infant colic. And they occur with the same frequency in the following groups.

• Boys and girls
• Babies fed with breast milk and with a bottle
• Babies born at term and premature babies
• Whether it is your first or second child or, in the case of other siblings too.

How long does infant colic last?

All babies cry, and they do so more intensely during the first three months of life. There is no standard definition of excessive crying, and it is normal for a baby to cry for up to two hours a day. A baby without colic will cry less often and for less time than a baby with colic, with crying of up to more than three hours in a day.

What are the symptoms of infant colic?

Infant colic is defined as episodes of intense and inconsolable crying that usually appear in the late afternoon or evening, accompanied by drawing up of the legs and reddening of the skin, which do not have to be daily but occur at least 2-3 times a week and for several weeks. Although your baby is fine beforehand, they start to cry energetically, curl up and turn red. They seem to be hungry, but do not settle when fed. When the episode passes, your baby looks healthy, eats and sleeps well and is content.

How is infant colic diagnosed?

Usually no diagnostic test is necessary. Your paediatrician will examine your baby for other causes that could be producing that crying. In addition, there are different diagnostic criteria, the most commonly used being Wessel's. Which defines infant colic as episodes of intense and vigorous crying of at least three hours a day, three days a week for at least 3 weeks in an otherwise healthy and well-fed infant. The baby with infant colic is a healthy baby whose crying is perceived as excessive by their parents. But bear in mind that it is considered normal for a baby of 2-3 weeks to cry for a maximum of three hours a day. It generally appears between the second and fourth week of life and can last between 3 and 4 months, and that is the time when it usually disappears.

Difference between infant colic and crying

Broadly speaking, infant colic is defined as crying for no apparent reason (such as hunger or a dirty nappy, for example) that lasts ≥ 3 hours a day and occurs on ≥ 3 days a week in an otherwise healthy baby under 3 months of age. Because a baby may cry for many reasons, even making them cry excessively, which are often simple problems, such as being hungry, or more serious ones, such as being unwell. To tell the difference, when your baby cries, check whether the cause of your baby's crying is manageable.

Hunger

Try offering your baby the breast or your Happymami bottle to see if hunger is the problem making your baby cry. Because although most babies under three months feed every two to four hours, all babies go through periods of time when they want to feed more often (usually corresponding to growth spurts).

Pain and temperature

Check whether your baby is uncomfortable, for example because of a physical injury. You can touch their skin to determine whether your baby is overheated or too cold. Also check that their clothes or nappy are not too tight or that there is no hair wrapped around a finger of the hand, a toe or the penis (called a hair tourniquet).

Tiredness or overstimulation

Another cause that generates crying in your baby is when they are tired or overstimulated by playing or being handled. Wrap your baby without squeezing them, leave them space to move their legs. If your breastfeeding is already established, you can offer them a dummy or change the scenery, such as going for a walk in the pushchair, this way you will help your baby to fall asleep.

Food sensitivity

Another issue is that your baby has an allergy or a sensitivity to foods in their mother's diet or to a component of their formula. It is known that foods such as milk, eggs, nuts and wheat present in the mum's diet have a direct effect on the composition of her breast milk. It is possible that this triggers reactions to food in the baby and digestive problems such as abdominal pain, cramps and diarrhoea. Another option is that your baby is allergic to cow's milk protein (present in formula milk) or in the dairy products consumed by the mum (if your baby is breastfed). If this happens, your baby may be unsettled or have blood in their stools. And if we talk about lactose intolerance (a type of sugar normally found in cow's milk). This has little or no effect on the development of colic.

How do I know if my baby is sensitive to foods?

You may suspect that your baby has a food sensitivity if they cry or spit up a large amount of milk in the hour following the feed. Or if they have constipation or diarrhoea. If your baby has a cow's milk allergy, the symptoms they may have are eczema, wheezing, diarrhoea or vomiting. On the other hand, if what your baby has is a cow's milk allergy, they will be unsettled and have blood in their stools.

How to relieve infant colic?

To relieve infant colic in an otherwise healthy baby who has prolonged or excessive crying, it should be treated individually according to the history, the examination and the characteristics of the family. Since some carers and families tolerate the crying better than others. Although at first you might not think so, it is described in health manuals that support for the mum and dad is the fundamental pillar for this stage. And after this support, the first line for addressing the correction of colic consists of two main approaches, feeding problems and the use of techniques to soothe your baby and/or reduce environmental stimuli. Below we will mention different interventions, which you should try out to see which works best in your case. Since the techniques set out below may work for some babies or for a particular baby, sometimes, but none of the interventions works all the time.

First line of anti-colic intervention

The first thing we will do with a baby we suspect has colic is to change the feeding technique and/or try a series of techniques to soothe your baby. We will do this thinking that your baby may swallow air while feeding or be overstimulated.

Feeding technique for the newborn

With regard to the feeding technique, if you are breastfeeding, try to achieve a correct latch; an assessment by your midwife may be necessary to achieve this. If you use a bottle, always try to use an anti-colic bottle like the Happymami ones, which have a double integrated anti-colic system in all their teats, super effective. Place your baby in the most upright position possible, stroke your baby's mouth with the teat of the bottle and when they open their mouth introduce your Happymami bottle, with enough of an angle for the teat to be partially full of milk, and let your baby suck for a few minutes. (Do not hold the bottle horizontally, because if there is little milk, the teat will not fill and when your baby sucks, milk will not fall into their mouth, but air). When your baby pauses, tilt the bottle downwards to empty the teat, this way we will give them their time to feed.

Soothing techniques for the newborn

After feeding the baby, we should now learn about different techniques to soothe a baby. The suggestion of the clinical guidelines is to carry out one or several techniques to soothe the baby and/or reduce sensory stimulation. And continue with the one that works best for you, just as we stop the one that does not work for you. You can use the following techniques to soothe the baby in any order and/or combination. Try each technique for several minutes and, if it does not work, move on to another soothing technique. As we mentioned earlier, a technique may work for you one day and not the next, and that would be perfectly normal.

• Use a dummy (as long as your breastfeeding is established)
• Take your baby for a walk in the car or in the pushchair
• Hold your baby or carry them
• Rock your baby
• Change the scenery or minimise visual stimuli
• Give them a warm bath
• Rub your baby's tummy
• Play audio of heartbeats
• Provide “white noise” (vacuum cleaner, tumble dryer, dishwasher…)
  • With white noise we must be careful because it can produce sound pressure levels above the noise threshold recommended for babies. To minimise the possible adverse effects on hearing or auditory development, white noise generators should be placed as far away from the baby as possible, played at a low volume and used only for short periods of time.

These interventions have not been shown to be effective in randomised trials, but they are inexpensive, unlikely to be harmful, involve the parents and can help reduce the anxiety of the parents or the infant.

Second line of intervention for colic, changing the diet

If the above did not work, we can proceed to a change of diet, especially if a cow's milk protein allergy is suspected. Diet changes vary depending on whether the infant is fed with formula milk or breast milk.

Breastfed babies with colic

It may be interesting for the mum to reduce her consumption of dairy products or follow a hypoallergenic diet (without milk, eggs, nuts, wheat). This is a good option for breastfed babies with colic who have not responded to first-line interventions.

Formula-fed babies with colic

In these cases, there are different preparations to meet possible needs, but if the baby suffers from colic, the recommendation is to use hydrolysed formula to feed babies who are suspected of having an allergy or intolerance to cow's milk formula. Because they present associated clinical features (stools with blood, vomiting, rash, etc.). The improvement usually occurs 48 hours after use.

Other possible lines of intervention

There are also other lines of intervention or possible solutions for colic

Probiotics

This approach proposes using probiotics to reduce the baby's crying. The guidelines do not suggest probiotics (including L. reuteri) for the prevention of colic. Although they appear to be safe and can reduce the time spent crying, there is no clear evidence that they are effective in preventing colic. They are only recommended in cases where the parents want to try it and give their baby breast milk. (But other species or strains should not be used; currently L. reuteri is the only one with studies suggesting that treatment with L. reuteri DSM 17938 is associated with a reduction in crying time.)

Baby massage

Baby massage can be a great ally to relieve your baby's colic. Before starting the massage we should have 4 things prepared.

1. We prepare a warm room: 20-22°C.
2. Soft music and dim light
3. Prepare vegetable oil (sesame, almonds) and check beforehand on a small area of the baby's skin that it does not cause any allergic reaction (reddened area).
4. The person giving the anti-colic massage should have clean hands, without rings, watch or bracelets, and relax, releasing tensions, worries and haste, in a good mood and feeling comfortable.

Now yes, let's start the massage. Your baby should be calm, awake with bright eyes that express attention and eagerness to play. Make sure they are breathing normally. You can stroke them and say nice things while you undress them for the massage. Put the oil between your hands, rubbing them, and say to the baby: “how about a little massage on your tummy?”.

Positions during the massage

• For babies from 0 to 3 months. The mum should sit on the floor on a rug or mat. With the legs bent, one sole of the foot facing the other, so that the legs form a cradle. Place your baby's head in the gap left when you bring your feet together. The baby's feet should be in front of your abdomen with the legs slightly raised.
• For babies from 3 months onwards. Place your baby on their back with the legs slightly raised. On the table, changing mat, sitting on the bed or on a comfortable surface.

You should bear in mind that when giving the specific colic massage we stop there and at that moment we do not add the massage to any other part of the body. Your baby should rest. If we want to do the full body massage, we will look for another moment. Also, do not give this massage during a crisis of colic, nor when your baby has just eaten.

Performing the massage

Massage your baby's abdomen (below the ribs down to the pubis) with gentle pressure, following these steps.

1. Hands resting. We place our hands on the baby's belly. Try to relax completely even if the baby moves or cries
2. Waterwheel. We make paddling movements on the baby's belly, one hand after the other, as if you were making a hollow in the sand. The hands should mould to the little one's belly. Repeat 6 times.
3. Knees up and down. Bend the baby's legs and then press gently towards the belly, hold this position for about five seconds, 1 time (we should not bring the knees together before crawling).
4. Relaxation touch. We run our hands along their legs down to the ankle to release tension and help them relax.
5. Sun-moon. We imagine a clock on the baby's abdomen. Mum with her left hand starts on the right side of the baby's abdomen (7 o'clock) drawing a full circle clockwise, without lifting the hand. When your left hand passes over twelve o'clock, the right hand comes in over eleven o'clock until 17 o'clock, like a half moon. You should repeat it 6 times.
6. Again we repeat step number 3. Knees up and down.
7. Relaxation touch. Run your hands once from the bottom to the feet, reducing the pressure, to help them release tension and relax.

The recommendation is to repeat the whole cycle (steps 1 to 7) 3 times. 2 times/day for 2 weeks (we can assess whether to continue if necessary). Several days may pass before your baby responds favourably; sometimes, the baby already starts to expel the gas on the first attempt. Remember, every baby is different.

Conclusion: update on infant colic and solutions

Infant colic is famous because if your baby suffers from it, it is hard going. But in the latest recommendations, they place great emphasis on informing that what is happening to your baby is a benign process, with no after-effects, and that it disappears spontaneously between the third and fourth month. Remember that if you use a bottle, not all of them are designed to prevent colic, and a baby who uses a bottle is at greater risk of suffering from this infant colic. That is why all teats from Happymami have an integrated double anti-colic system. With no need for added elements that make cleaning them afterwards more difficult. In addition, they are functional in any position in which the bottle is placed. Take heart: this is just a phase, and it may take a little more patience, but the latest evidence tells us it will pass. And if you need help, count on us, we will always continue to offer you the latest update on infant colic and solutions.

Bibliography

The Happymami Project is based on scientific evidence, we are aware that science evolves every day, so if you have more up-to-date scientific evidence than ours, we will be delighted to receive it. We work every day to offer the best and most up-to-date to our mums.

1. Iacovou M, Ralston RA, Muir J, et al. Dietary management of infantile colic: a systematic review. Matern Child Health J 2012; 16:1319.
2. Hall B, Chesters J, Robinson A. Infantile colic: a systematic review of medical and conventional therapies. J Paediatr Child Health 2012; 48:128.
3. Sung V, Hubiera S, de Gooyer T, et al. Probiotics to prevent or treat excessive infant crying: systematic review and meta-analysis. JAMA Pediatr 2013; 167:1150.
4. Balapatabendi M, Harris D, Shenoy SD. Drug interaction of levothyroxine with infant colic drops. Arch Dis Child 2011; 96:888.
5. Aviner S, Berkovitch M, Dalkian H, et al. Use of a homeopathic preparation for “infantile colic” and an apparent life-threatening event. Pediatrics 2010; 125:e318.

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