Written by Dr. N. Theron, Pediatrician.
When speaking to Moms (new and old), conversations always seem to be about sleep, poos… and crying. Our next-door neighbour just turned 90, and she tells me about her first baby that had severe colic every time we visit. What is colic? What is normal crying in a baby? Is it dangerous in the long term? Dearest Mom with a colicky, cranky, crying baby… I want you to know the distress you and your family are experiencing is real, we hear you and believe you. You are not alone. Read on to understand more about colic and excessive crying. I will try to use the latest research to help you understand your baby, and then we can look at remedies and treatments in the second part of this article.
“The thing about kids is that they express emotion. They don’t hold back. If they want to cry, they cry, and if they are in a good mood, they’re in a good mood.”Eddie Murphy
Let us look at what is normal… please remember that all babies cry! It is their only way to communicate in this great big world! Just like us they also have different temperaments and personalities, and some will communicate louder and more persistently than others. They will also have more difficult days, overstimulated days, growth spurts and mental leaps (the “Wonder weeks” app and information helped me sooo much on the niggly days). In 2017 a large meta-analysis was done (they looked at and included more than 5000 previous studies) to try and find “normal” crying times in babies in the Western world. It was found that at 6 weeks of life the average crying time was 130min per day, with about 20-25% of babies crying more than 3hrs a day. At 10-12weeks of age it dropped to an average of 70mins of crying per day, with only 0.6% of babies crying more than 3hrs a day. It is thus important as a new parent to adjust your expectations, do not compare yourself to the mom on Instagram whose baby is sleeping through from 2 weeks!
Why is more than 3 hours important? We used to diagnose colic when a baby cried for more than 3 hours a day, more than 3 days a week for more than 3 weeks. (This time-limit was quite frustrating, because what if your baby cried for 2.45 hours??) This definition was made in 1954 and was used until a group of specialists wrote and published a new definition in 2016. So what is colic? In short: more-than-normal crying in a healthy baby. There are some important specifics in the new definition:
- an infant who is younger than 5 months of age
- presenting with recurrent prolonged periods of infant irritability, fussing, or crying reported by parents that occur without obvious cause and cannot be prevented or resolved by caregivers
- without evidence of infant failure to thrive, fever, or ill health. (So baby is growing well and is otherwise healthy)
About 1 in 5 babies (20%) will be affected to some degree by excessive crying / colic. It is equally frequent in breastfed or bottle-fed infants, boys or girls. The colic seems to start around 3 weeks of age, peaks at 6 weeks and then improves by 10 – 12 weeks with complete resolution around 4 – 5 months of age. Colicky babies can seem to have pain/stomach cramps because they also scrunch up their faces, pull their legs up or throw their heads backward when crying. Research show that they do not cry more frequently, but once they start crying, they take longer to settle. They are difficult to soothe and respond to stimuli (e.g. loud noises, getting dresses/undressed, bath time) with crying that will not upset non-colicky babies. There is usually also a certain time of the day when the crying is worse.
If you recognise your baby in any of these symptoms / definitions, it is important to visit a healthcare provider before you self-diagnose colic. They need to rule out any other diseases causing the crying, but these usually have some other symptoms or clues. The most common problems found:
- Pain or fever due to infections (for example a bladder infection)
- Cow’s milk protein allergy
- Gastro-oesophageal reflux disease
((Yes, babies also cry when they are hungry, and there were some questions about supplementing breastmilk with formula to ensure that baby is not hungry. Please remember that breastmilk is digested easier and baby might be hungry again sooner, especially during a growth spurt. It is important to then let baby feed more frequently to up your supply rather than supplementing with formula. Formula might even cause more cramps/discomfort in an exclusively breastfed baby. If baby is really not getting enough milk we will see it with slow/no weight gain.))
If you were lucky enough to not have a colicky baby, you might wonder why all the fuss? If the baby is actually healthy, why worry? Some studies show that there might be a higher risk for babies with colic to develop other functional intestinal diseases such as irritable bowel syndrome, or even a higher risk for migraines later in life. However, the biggest risk is in the parent-infant relationship. It is difficult to bond with a screaming baby, the moms have a higher risk for post-natal depression and these babies are at risk for abuse. Colic causes stress and decreases the quality of life in the whole family. So I want to emphasise that although we cannot always find a medical explanation for your baby’s crying, please seek help!
“I will certainly hear their cry.”Exodus 22:23
Even after more than 50years of research, we are still not entirely sure what causes colic! Swallowing air, abdominal discomfort and cramping are all seen as causes for crying, but the reason why some babies experience these to a worse degree is still being investigated. There are many theories, and colic has a whole spectrum of causes. Here are some of the causes that we have some evidence for:
- Unbalanced gut-microbiome. This is all the good bacteria living in your intestines and it has been shown that the balance is disturbed in infants with colic. This makes them more sensitive to pain in their intestines (visceral hypersensitivity).
- Immature intestinal barrier. It has been found that the gut of colicky babies allow bigger proteins to pass through to the blood. This could also allow toxins through, causing chronic inflammation in the intestines. (Some studies show that babies with colic has double the amount of calprotectin (marker for intestinal inflammation) in their stools).
- Some babies might have temporary lactose intolerance due to insufficient lactase (the enzyme that is responsible for breaking down the lactose-sugar in milk) leading to more abdominal cramps.
- Behavioural factors such as overstimulation also plays a big role. We experience stress in our intestines (remember that bout of diahroea just before your big exam??) and some babies are more sensitive to the sounds, smells and sights of the big world around them.
- Parental stress or parenting with minimal responsiveness (not holding baby, not responding soon enough to cues). Babies in the first 3 months cannot manipulate you, they just want to feel safe.
I hope I have not left you with more questions than answers! In the second part of this article we will look at the possibilities for coping with a baby with colic. Until then know that this too shall pass, you are not alone, and there is hope!
- Daelemans S, Peeters L, Hauser B, Vandenplas Y; “Recent advances in understanding and managing infantile colic”; Version 1. F1000Res. 2018; 7:F1000 Faculty Rev-1426
- Wolke D, Bilgin A, Samara M; “Systematic Review and Meta-Analysis: Fussing and Crying Durations and Prevalenc of Colic in Infants; J Pediatr. 2017