The trouble with colic is that doctors don’t really know for certain what it is and the leading experts disagree about what causes it. There’s even disagreement about the definition of colic. However the most commonly accepted medical definition is a baby whose needs have all been met and is otherwise healthy, but who cries for more than 3 hours a day, for more than 3 days, a week for more than 3 weeks.
In other words, the generally accepted medical definition of colic really boils down to “a baby who cries a LOT”. It is very important to rule out a medical cause for your baby’s crying (some medical causes are quite serious), so please see your doctor before assuming that your baby has colic.
Typically this excessive crying:
- Begins at around two to four weeks of life;
- Can peak at around six to eight weeks of age;
- Usually resolves by around twelve to sixteen weeks (although it can continue in some cases until a baby is 5 months or older).
Common symptoms of colic include:
- High pitched, piercing crying that lasts for hours at a time;
- The baby is very difficult/impossible to console by cuddling or soothing;
- Grimacing/Frowning – the baby may look like it is in pain;
- Clenched fists;
- Knees drawn up to chest;
- Can (but does not necessarily) occur in the afternoon/evening;
- Reddening of the face;
- The baby may pass (loud) wind and around that time the crying stops.
The biggest challenge with colic is that we don’t know for sure what causes it – which leaves a LOT of room for debate about how to treat it. There are 3 main groups of theories about what causes it.
1. Swallowed Air
Some parents of colicky babies report that their little bundle of joy farts louder than a grown man – ours certainly did! Other parents of affected babies notice that their baby often stops crying after he passes wind. This leads people to wonder if their baby’s discomfort relates to swallowed air that isn’t burped back up, moves through the baby’s intestines and becomes ‘trapped’, causing discomfort.
However, doctors tend to focus on a 1969 study in which radiographic images taken during a crying episode showed a normal gastric outline and on this basis, many suggest that excessive gas or wind may NOT be the cause of colic.
Although most experts would agree that swallowed air is not the underlying cause of colic, it can still make an existing problem worse. In other words, taking the time to burp your colicky baby really well, or using a bottle that helps reduce the amount of air your baby swallows, will assist your bub and can reduce the severity of your baby’s colic. However, it probably won’t “fix” the colic, because the underlying cause is more complex/challenging than that.
2. A Gastrointestinal Cause
Many experts believe that there is a gastrointestinal cause of colic – that something in the colicky baby’s digestive system is not working the way it should be and that is causing the pain and gas.
The tricky part is that there are a whole range of possible gastrointestinal culprits, and different researchers/experts have different views on which one is the real perpetrator. For example, there are theories that it might relate to food moving through the stomach and intestines too fast. Gut hormones such as motilin may be involved in this. It may also involve pain signals from sensitised nerves in the gut. Or it could be related to microflora in the digestive system. There are other theories that colic results from lactose intolerance or a temporary deficiency in the enzyme that breaks down lactose.
3. Environmental Factors
There is another camp of experts that believe that environmental factors are the underlying cause. Some experts point to two key factors:
a) Colic commonly occurs in the evenings; and
b) Colic usually resolves all by itself when the baby is about four months old,
as evidence that colic is caused by overstimulation of the baby’s psyche. They believe that affected newborns are not getting enough sleep and/or are exposed to more excitement, stimulation and interaction than their little brains are ready to handle. They argue that affected young babies have not yet reached a level of development where they can self soothe and limit their own mental stimulation to a level that they can cope with, and as a result their little brain becomes overloaded and they begin to scream (and can’t stop).
A different perspective (but that also falls within the category of environmental factors) is that colic is caused by ‘under-stimulation’. This theory is that affected babies just need advanced settling techniques that mimic the womb environment in order to calm them down.
OK, so we’ve probably ruled out swallowed air as a cause (although diligent burping and/or reducing the amount of air a baby swallows can assist an affected baby who is already struggling with colic).
In the absence of a clear answer, I believe a real possibility is that BOTH remaining schools of thought may be right (to a degree anyway). One plausible explanation for why different babies appear to respond to different solutions is that they had different underlying problems in the first place.
When you think about it, a distressed baby has one main way to express her discomfort, and that’s by crying (a lot)… And then remember that colic is really just a label that is given to babies that are crying excessively when there is no other medical explanation. To me it seems quite possible that any given group of excessively crying babies in any particular study could actually include babies with DIFFERENT underlying causes for their excessive crying.
So I believe that:
- some babies may be crying because of a gastrointestinal issue;
- other babies may be crying because they are overstimulated, lacking enough sleep and/or in need of more advanced settling techniques.
This could explain why the researchers haven’t been able to find a treatment that they can prove works for all babies - because their studies have a group of babies that includes both types of underlying problems. A treatment aimed at solving a gastrointestinal issue won’t help a baby whose problem is really overstimulation (or vice versa), so their results won’t show universal success.
Once you see it from this perspective, it is actually quite liberating and the debate about colic starts to make more sense. You can see why one solution doesn’t work for every baby with colic, because we are no longer trying to box them all into the same pigeon hole. When any particular expert tells you ‘the’ solution for babies with colic, you just interpret it through the filter of ‘a solution for [some] babies with colic’. And when your friend swears by the ultimate cure for colic, but it doesn’t work for your baby, its not that your friend was exaggerating, it may just be that your babies just had different causes for their crying.
That’s the reason why I’ve written a book that covers all the solutions that I’ve come across after reading lots of medical research, our own experiences and talking to everyone from baby whisperers to paediatricians and other parents of colicky babies. It’s the reason why I let you know:
- who thinks each solution works and why (and what research there is to back up that view); and
- who disagrees any why (and any research that supports their view).
That way, you have all the information you need to make informed decisions about what to try to help your baby. Since there is NO universal answer, the best thing I could do to help you was to give you balanced information about all your options.
By the way, if you do come across something that works for you that ISN’T covered in the book, please let me know so that I can update the book and get the word out for other parents of colicky babies.
Take care out there,