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 infants up to 12 months of age. The exact cause of colic is uncertain, and symptoms of colic resolve spontaneously in most infants by 4 to 5 months of age1,2.
The Wessel criteria3 characterises the diagnosis of colic in the following ways:
- Begins around the first 3 weeks in life
- Lasts at least 3 hours a day
- Occurs at least 3 days a week
- Continues for at least 3 weeks
- Seldom lasts longer than 3 months
- Crying episodes are considered to be severe if they last for more than 40 minutes
The symptoms of colic can include
- Intense, persistent and inconsolable crying
- Flushed face
- The desire to draw the knees up to the chest or arch the back
- Clenched fist
- Problems sleeping
Reassurance and support are vital, as symptoms of colic can be a significant cause of distress for parents. Colic should be ideally managed within the primary care team4. Colic is not harmful or dangerous to the infant – they will continue to feed and gain weight normally. However, if colic is suspected, GPs should perform a physical examination to ensure there is no other underlying reason for the excessive crying.
Possible causes of colic
Despite a lot of the research into colic, little is understood about the condition. Diagnosis is made difficult due to the fact that colic may be multi-faceted, and also due to the fact that an infant’s digestive system is still developing.
A number of studies have demonstrated that diet may play a part in infants with colic5-7 and colicky infants have been found to have differences in their gut microflora.8,9 Several hypotheses have been investigated, including disturbed gut motility, excessive gas, food allergies and intolerances and also behavioural issues.
No differences in the prevalence of colic have been found between socioeconomic groups, gender, or breast and bottlefed infants. Due to a similarity in some symptoms, infants may be mistakenly diagnosed with colic or gastro-oesophageal reflux disease, when they are actually suffering from a cow’s milk protein allergy (CMPA) which could, in very severe cases, lead to anaphylactic shock if left untreated.
Between 5-15% of infants show symptoms which suggest a reaction to cow’s milk10 whilst the actual prevalence of CMPA is between 2-7.5%.11 Both bottlefed and breastfed infants can suffer from CMPA, but it is more common in bottlefed infants.
Reducing the symptoms of colic in breastfeeding infants
A reduction in the symptoms of colic has been shown when mothers totally exclude cow’s milk proteins from their own diets7. Breastfeeding mothers may be asked to exclude dairy from their diet for a week to assess whether cow’s milk proteins may be a cause of their child’s symptoms. It has been suggested that colic may be related to a combination of foods12, therefore asking mothers to keep a food diary for a few days may help to identify potential problem foods.
Reducing the symptoms of colic in bottlefed infants
Infants presenting with symptoms of colic may benefit from a reduced lactose formula such as Aptamil Comfort which is clinically proven to reduce symptoms of colic and constipation.13-16 This formula is a slightly thickened feed with small amounts of potato and maize starch. The presence of a small amount of starch may help controlled intake of feed, thereby reducing the amount of air swallowed and resulting in reduced posseting.
It also contains prebiotic oligosaccharides which are clinically proven to soften stools. In a large study with over 600 infants it was shown that Aptamil Comfort was clinically proven to relieve digestive discomfort in 95% of infants13.
(Note: if a parent is switching to Aptamil Comfort, please advise them that the infant’s stools will be greener in colour and looser, similar to that of a breastfed infant16. In addition the formula is thickened, therefore a variable or fast flow teat is recommended.)
Other suggestions include using a hydrolysed formula where the proteins are partially broken down. This means the peptides have been broken down to improve digestibility and reduce allergenicity. For example Aptamil Pepti, an extensively hydrolysed formula for the treatment of cow’s milk protein allergy, can be used for a week as a diagnostic tool in bottlefed infants with colic.
Other suggestions to help parents comfort a colicky infant include
- Check the infant is not hungry or thirsty
- Hold the infant during a crying episode – this can sometimes help
- Prevent the infant from swallowing air by sitting them upright during feeding
- If breastfeeding, advise the mother to avoid drinking too much tea, coffee, and other drinks that contain caffeine.
- Burp the infant after a feed as necessary
- Some evidence suggests that ‘over-stimulating’ an infant by continually picking them up and putting them down may aggravate the crying
- Infants like movement, so pushing them around in their pram or pushchair, or going for a drive, can be comforting
- Background 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
- Garrison M. & Christakis D. Early Childhood, colic childhood development, and poisoning prevention. Pediatrics 2000; 106: 184-190
- Wade & Kilgour. Extracts from clinical evidence: Infantile colic. BMJ 2001; 323(7310:437-40.
- Wessel MA, et al. Pediatrics; 1954; 14(5) : 421-35
- Food Safety Authority of Ireland 2011. Scientific Recommendations for a National Infant Feeding Policy, 2nd Edition.
- Newman J. Breastfeeding problems associated with the early introduction of bottles and pacifiers. J Hum Lact 1990; 6(2): 59-68.
- Jakobsson I et al Effectiveness of casein hydrolysate feedings in infants with colic. Acta Paediatr 2000; 89, 18–21
- Lucassen P et al. Effectiveness of treatments for infantile colic: systematic review. BMJ 2000; 316, 1563–1569
- Lehtonen L et al. Intestinal microflora in colicky and non-colicky infants: bacterial cultures and gas liquid chromatography. J Pediatr Gastroenterol Nutr 1994; 19, 310–314<
- Savino F et al. Intestinal microflora in breastfed colicky and non-colicky infants. Acta Paediatr 2004; 93, 825–829
- Host A. Frequency of Cow’s milk allergy in childhood. Ann Allergy Asthma Immunol 2002; 89 (6 suppl)
- Hill DJ et al. Manifestations of milk allergy in infancy: clinical and immunologic findings. J Pediatr 1986; 109: 270-276Evans RW et al. Maternal diet and infantile colic in breast-fed infants. Lancet 1981; 317 (8234):1340-2.
- Savino F et al. “Minor” feeding problems during the first months of life: effect of a partially hydrolysed milk formula containing fructo- and galacto-oligosaccharides. Acta Paediatrica Supp 2003; 441: 86-90.
- Veitl V et al. J Ernahrungsmed 2000; 2: 14-20.
- Savino F et al. Reduction of crying episodes owing to infantile colic: A randomized controlled study on the efficacy of a new infant formula. European Journal of Clinical Nutrition 2006; 1-7.
- Schmelzle H et al. Randomized double-blind study of the nutritional efficacy and bifidogenicity of a new infant formula containing partially hydrolyzed protein, a high beta-palmitic acid level, and nondigestible oligosaccharides. J Pediatr Gastroenterol Nutr 2003; 36: 343-351.
- Food Safety Authority of Ireland 2012. Best Practice for Infant Feeding in Ireland: A guide for healthcare professionals.