Newborn colic

Overview

Newborn colic is described as repeated episodes of excessive and inconsolable crying in an infant that otherwise appears to be healthy and thriving. It is thought to affect up to one in five babies.^1,2
Colic can cause distress for baby and parents, although it can be a normal stage whilst baby’s digestive system is maturing. This article will enable you to discuss the condition in depth and, if appropriate, offer solutions to ease the symptoms.

Common signs of colic in babies

Signs of colic usually appear in the first few weeks after birth and resolve by 4 months of age with no long-term consequences. The incidence of colic is similar between boys and girls, and breast- and bottle-fed babies. A diagnosis of newborn colic can be made when all of the following are present³:

• An infant aged <5 months when the symptoms start and stop
• Recurrent and prolonged periods of crying, fussing or irritability reported by parents (caregivers) that occur without obvious cause and cannot be prevented or resolved by parents or caregivers
• No evidence of infant faltering growth, fever or illness

Crying often occurs in the late afternoon or evening. Babies with colic may also draw their knees up, arch their back, clench their fists and become flushed while crying. When assessing colic, it is important to exclude other causes of sudden or persistent crying.

Several causes for colic have been proposed^1,4

• Immaturity of the digestive system
• Trapped wind
• Transient low lactase activity
• Intestinal microflora imbalance

Colic remedies and reassurance

A useful intervention for newborn colic is to reassure parents that the symptoms will resolve naturally over time.

In the meantime, there are many colic remedies for parents and caregivers to try:

• If breastfeeding, avoid tea, coffee and other caffeinated drinks. Spicy food and alcohol may also aggravate colic
• If bottle feeding, ensure the teat flow is appropriate for the baby's age and sucking ability – and perhaps change to a bottle specifically designed to reduce colic
• Try sitting baby upright during feeds and/or create a gentle down-slope in the cot to discourage reflux while sleeping
• Gently rubbing baby’s back or try different positions to relieve wind, e.g. lay baby down with their tummy facing down along your forearm
• White noise mobile phone apps – e.g. rain, waves or a tumble dryer – may soothe baby and provide colic relief for newborns

Colic treatment – when to consider medical advice

If parents begin to struggle despite colic treatment advice and reassurance, medical advice can be considered for the management of infantile colic:⁵

• One-week trial of colic drops – treatment should only be continued if there is a response, such as a reduced duration of crying. If there is no response to one medical treatment, parents may be advised to consider trying another¹
• One of the proposed causes of newborn colic is a short-term reduction in the activity of the enzyme lactase in the intestine which is thought to be due to gut immaturity.⁴ For this reason, lactase drops added to the milk or a short-term switch to a lactose-free formula may be effective in some cases of colic. If a baby responds to these methods, parents should be reassured that this does not necessarily mean that they are lactose intolerant indefinitely. Further information on lactose intolerance can be found here.

Further newborn colic support

There are many external resources to support parents and to expand your professional understanding. Active links are provided below to simplify your search for information.

Extra colic support: HCPs

National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary: Colic – infantile https://cks.nice.org.uk/colic-infantile#!topicsummary

NICE clinical guideline 37: Postnatal care: routine postnatal care of women and their babies, 2006  https://www.nice.org.uk//guidance//cg37//evidence//full-guideline-485782237

The Rome Foundation, Childhood Functional Gastrointestinal Disorders: Neonate and Toddler, 2016 https://theromefoundation.org/wp-content/uploads/childhood-functional-gastrointestinal-disorders-neonate-toddler.pdf

Extra colic support: Parents

Cry-sis website https://www.cry-sis.org.uk/ and helpline: 08451 228 669

Colic – NHS https://www.nhs.uk/conditions/colic/

Colic – Patient.co.uk https://patient.info/health/baby-colic-leafletM

Colic – Health Service Executive (HSE) https://www.hse.ie/eng/health/az/c/colic/