Colic

by Dr Clare MacDonald, General Practitioner

Colic is a diagnosis of exclusion when no other cause can be found for an infant with excessive and frequent crying. Typical onset is in the first weeks of life, with resolution usually around 3-4 months, 6 months in some cases. It commonly occurs in the evening and is often associated with the baby drawing up his/her knees or arching his/her back during feeds. A widely accepted definition known as the ‘rule of 3s’ is that babies have1:

  • Unexplained fussing and crying lasting more than 3 hours a day
  • More than 3 days a week
  • For more than 3 weeks

These criteria do not need to be strictly met though for infants with excessive crying and ‘fussiness’, who are otherwise healthy, to be managed clinically as per colic guidance. It is a common problem with a reported prevalence of 5-20% 2 and breastfed and formula fed babies are equally affected.

The scenario of an excessively crying baby presenting in primary care is a familiar one. The role of the GP in eliciting the parental concern is paramount; the impact of caring for an apparently inconsolable baby on a worried parent should not be underestimated. Parents may view the incessant crying as a reflection of their ability to care for the child.  A thorough history and examination should be performed.

Colic is a self-limiting condition without any specific, proven pathological sequalae (there is conflicting evidence for a link between colic and atopic disease 3), however there are risks of potential distress to parents, risk to the parent-infant relationship and the risk of early cessation of breastfeeding or early introduction of complementary foods. As such, the management is based largely around minimising these risks.


Management

Reassurance is crucial, and a caring and compassionate healthcare professional can help allay parental anxiety4.

If there is a suspicion of cows’ milk protein allergy as a cause for the symptoms, infants should be managed as such.

General measures and advice include:

  • Checking the ambient temperature is appropriate (16-20°C)
  • Carrying the baby may help (see the GPIFN webpage on ‘Baby Carrying‘)
  • Motion may help eg. walking in the pram
  • Encouraging parents to look after their own wellbeing; resting when possible and accepting help from family and friends

Support from the health visitor should be sought5.

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Support and information is available for parents from CRY-SIS – a support group for families with excessively crying, sleepless, and demanding children. Their helpline is available every day from 9 am. to 10 pm. Tel: 08451 228 669. The CRY-SIS website also contains useful information.

In breastfed infants, ensuring good positioning and attachment can help to reduce colic, as can ensuring that the first breast offered is effectively drained before offering the second.  As such, referral to an appropriate infant feeding expert should be considered6.

There is limited evidence for pharmacological intervention and it should only be considered if the parents feel unable to cope despite reassurance and support. The options are3:

Treatment should be discontinued if there is no response within one week.

There is no convincing evidence to support the use of partially hydrolysed (‘comfort’) infant milks in reducing the incidence or severity of colic, wind, gastrointestinal discomfort or regurgitation7. NICE CKS states that the use of low-lactose and lactose free formula is not recommended for colic3.

In terms of complementary therapies, there is inconclusive evidence for spinal manipulation, and limited evidence to recommend massage, acupuncture or chiropractic intervention4.


Further Information 

NICE CKS: Colic- Infantile last revised November 2014

NHS Choices: Colic

CRY-SIS Charity providing self-help and support to families with excessively crying, sleepless and demanding babies. Volunteers with personal experience with crying or sleep problems in their own family provide support via the Helpline available every day from 9 am. to 10 pm. Tel: 08451 228 669.


References

  1. Wessel M, Cobb J, Jackson E, Harris G, Detwiler A. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics. 1954;14(5):421-35.
  2. Lucassen P, Assendelft W, Gubbels J, van Geldrop W. Systematic review of the occurrence of infantile colic in the community.Archives of Disease in Childhood 2001;84(5), 398-403.
  3. NICE CKS: Colic- Infantile last revised November 2014
  4. Drug and Therapeutics Bulletin. Management of infantile colic BMJ 2013; 347 :f4102
  5. Long T, Johnson M. Living and coping with excessive infantile crying. Journal of Advanced Nursing. 2001;34(2):155-162.
  6. The Breastfeeding Network: Assessing the Evidence- Treatments for Colic March 2002
  7. First Steps Nutrition Trust: Specialised infant milks in the UK- 0-6 months
    Information for health professionals March 2017 – see section 3.11

Published April 2017