by Melissa Clark Vickers
November 16, 2011

The ‘C’ word—colic—can be a parent’s worst nightmare. Crying for hours on end for no apparent reason can challenge the patience of even the most dedicated parents.

Parents know that when their babies cry it is a call to action, a sound made for attention when other, more subtle, means of communication have failed.

Sucking sounds, rooting, and squirming are a baby’s way of saying, “Feed me.” Fussing and fretting signal, “I’m lonely. Hold me,” or “Diaper change, please.” Parents soon learn to identify the subtle cues that let them know what their babies need and when they need it. Research shows that babies whose needs are consistently met seldom cry. But what about the 10–20 percent of babies who develop a pattern of crying with no obvious cause?

Does your baby have colic?
The generally accepted definition of colic was first reported by Wessel and colleagues in a 1954 issue of Pediatrics. According to the so-called “rules of threes,” colic is “crying or fussing for more than 3 hours a day, for more than 3 days a week, and for more than 3 weeks, in an infant who is well-fed and otherwise healthy.” Colic typically develops around 2–4 weeks of age, and it usually resolves by 3–4 months.

While “the rule of threes” is a handy guideline, the most important characteristic of colic is “persistent excessive crying.” Colic affects the parent, as well as the child. Frustration and exhaustion can lead to feelings of failure, low self-esteem, powerlessness, depression, and even anger. Ultimately, colic affects the parent-child relationship.

“Normal” infant crying is often predictable, triggered by certain circumstances, and preventable provided pre-cry cues are answered. In contrast, colic is persistent, piercing, and seemingly painful. The crying spells can occur at any time, although many parents report that they usually occur in the evening.

Signs of colic:

• persistent, inconsolable crying
• alternate flushing and paling of the baby’s face
• clenched fists, curled toes, and legs flexed towards the abdomen

Not all persistent crying is colic. Colic does not cause fever; fever is usually a sign of infection. Also, babies with colic do not show signs of pain as soon as they awaken; babies who start to cry as soon as they awaken should be checked for other causes.

What can you do?
If your baby cries for extended periods of time, use a three-step approach: search for triggers; keep soothing; wait it out. The first two require a combination of detective work and trial-and-error, while the third requires patience and understanding.

Search for triggers
Theories about the causes of colic generally point to either an immature digestive system or an immature nervous system. With a bit of effort, you may be able to identify your baby’s triggers and strategies for relieving her discomfort. Common triggers include:

• Gas. The relationship between colic and gas is unclear—is your baby crying because his stomach is full of air or is his stomach full of air because he has taken in extra air while crying? In some ways, knowing which came first isn’t important. If your baby is crying for a prolonged period of time, he’s sure to draw air into his digestive tract. Burp your baby often during feedings, and during colicky spells. Use a combination of gentle pats and upward strokes on his back.

• Poor positioning. Try positioning your baby in a sitting or semi-upright position when breastfeeding, or recline back so your baby is tummy-to-tummy with you. If you are using bottles, practice “paced bottle-feeding” with your baby, and experiment with nipple types and sizes, as a switch may reduce the amount of air your baby draws in with each feeding.

• Food intolerances. Keep a dietary log. There’s no reason to stop breastfeeding if your baby has colic; in fact, switching a colicky baby to artificial infant formula can make the symptoms worse. However, you will want to write down the foods you consume each day, since it is possible that some foods can trigger colic in your baby. Look for patterns. Are your baby’s crying spells worse after you’ve had dairy products? Eliminating dairy from your (or your baby’s, if formula-fed) diet can make a difference, although you may not notice a difference until all of the milk proteins are out of your system. This could take a couple of weeks. Think, too, of other common food-sensitivity culprits, such as caffeine and spicy foods. Avoid any suspect foods for at least one week, to see if there are changes in your baby’s behavior.

• Meal size. Sometimes, colic is caused by over-feeding. Try feeding your baby smaller, more frequent meals. Offer just one breast per feeding. This gives your baby a low-volume, low-sugar, high-fat meal rather than a high-volume, high-sugar, low-fat one. High-sugar meals produce more gas, and increase the risk for colic. Feed from the other breast for the next feeding, and continue to alternate. Shorter feedings may also help to address another theorized cause of colic: immature jaw development.

• Environment. Some medical experts suggest that colic is caused by an immature nervous system in infants who are not yet able to cope with the amount of stimulation in their environment. An overload of sights, sounds, and movement may build up by the end of the day when colic is typically at its peak. Giving your baby scheduled one-on-one quiet time may help to head off the end-of-day meltdown.