Colic

In Ireland many infants experience colic in their first year of life, yet the exact causes are still unknown. Colic is a widespread condition affecting up to 20% of infants.¹ The exact cause of colic is uncertain, latest evidence suggests that it is multifactorial and could involve one or several digestive or behavioural problems.^2,3 Symptoms of colic usually resolve in most infants by 4 to 5 months of age.

Rome IV criteria for the diagnosis of colic:⁴

For clinical purposes, must include all of the following:

• An infant who is <5 months of age when the symptoms start and stop
• Recurrent and prolonged periods of infant crying, fussing, or irritability reported by caregivers that occur without obvious cause and cannot be prevented or resolved by caregivers
• No evidence of infant failure to thrive, fever, or illness

For clinical research purposes, a diagnosis of infant colic must meet the preceding diagnostic criteria and also include both of the following:

• Caregiver reports infant has cried or fussed for 3 or more hours per day during 3 or more days in 7 days in a telephone or face-to-face screening interview with a researcher or clinician
• Total 24-hour crying plus fussing in the selected group of infants is confirmed to be 3 hours or more when measured by at least one prospectively kept, 24-hour behaviour diary

Practical tips for managing colic^5-7

• Parental support: parents of a baby suffering from colic need support. They will most likely be anxious and so need reassurance that colic is a common infant feeding problem and most infants will outgrow the problem by 4 to 5 months of age.
• Prevent the infant from swallowing excess air by sitting them upright during a feed. If breastfeeding this may involve the mother trying a different breastfeeding position.
• Wind the infant during and after a feed as necessary.
• Infants like movement, so pushing them around in their pram or pushchair, or going for a drive, can be comforting.
• Background noise or ‘White noise’ such as the sound of a washing machine or vacuum cleaner may be soothing for an infant.
• Gentle stomach, or back rubs, or a warm bath, may also help to relieve colic.
• If the infant is being breastfed, consider talking to mum about her diet. Some small changes may help to alleviate colicky symptoms. Advise the mother to avoid drinking too much tea, coffee, and other drinks and foods that contain caffeine and see if symptoms improve. Breastfeeding mums should be encouraged to continue breastfeeding.
• Formula-fed infants presenting with symptoms of colic may benefit from a formula specially formulated for the dietary management of colic.
• Medical treatments (simeticone or lactase drops) should only be tried if parents feel unable to cope despite advice and reassurance.
• NICE recognises that studies of interventions for infantile colic behind simeticone and lactase drops tend to lack methodological quality, making it difficult to evaluate the effectiveness of any treatment.