Written by Dr. Nické Theron, Pediatrician.

The Management of Colic

Now that you understand as much as we know about colic (see the previous post), let us look at what you can actually do about it once your baby starts screaming at the top of his/her lungs and does not want to settle:

Firstly, take a deep breath! Your baby will not calm down if you are not calm. Do what you need to do to look after yourself. Gather your village and ask for help, make an appointment at the pediatrician to get the reassurance that there are no other causes for the crying. Make a playlist of your favourite “pick-me-up” or “I-can-do-this” songs on your phone and pop in your earphones. Stock up on healthy snacks. Leave baby with someone you trust and go on a quick coffee-date with your husband. It is important that the two of you can stay strong.

“Be strong and take heart, all you who hope in the Lord.”

Psalm 31:24

Ok, now we can look at what to do with baby. Remember that all babies cry and crying in itself is not going to cause any long-term harm. That said, if you feel that the crying is causing any damage to your own mental health or to the bonding-relationships in your family, you need to get help.

Any interventions you try should be proven to do more good than harm. Some of the syrups that might “work miraculously” are not well researched or have some ingredients that are not listed on the packaging or are listed but could have serious side effects for your baby. I will discuss the interventions I am aware of together with the research/facts about them:

Practical tips:

• The 5 “S” manoeuvres: Swaddling (makes them feel contained and safe), Shushing (white noise), Stomach position (in your arms or in baby’s cot while you can watch him), Swinging (put baby in the Kangaroo Mother care position with a wrap/sling/carrier. Babywearing really helps), Sucking (sucking calms them, they are not always hungry when they suck on their dummy/hand). There is not a lot of research done on these interventions, but they stimulate the vestibular, auditory and tactile senses, causing baby to feel like they are back in the safety of the womb. They are also FREE and will not cause any negative side effects.

• If you think your baby might be very sensitive to overstimulation, it will not help to pass him from hand-to-hand to try and calm him once he is crying. This just brings more smells and touches and sights which further upsets him. Try to calm baby down by taking him to a dark, quiet room, offer a feed, then hold him close or put him in his cot and just put your hand on him. Talk softly to reassure him you are there or play some white noise. He will eventually calm down. If you need to take a break and leave the room for a few minutes that is ok!
• I want to advise you not to go to a chiropractor. Even though they promise great results and many moms claim their babies are better, there is no evidence that a session at the chiropractor really has any benefits. In babies they either use such soft manipulations (safer for baby) that it cannot make any realignments or difference, or they are handled so intensely that there are risks of injuring the baby’s spinal cord. Please be careful.

Dietary changes

• There is no research to back the myth that what you eat causes cramps in baby. So be sensible before cutting out everything from your diet if you are breastfeeding. Avoid food that makes you gassy such as beans/onions/cabbage, limit caffeine intake. Other than that, I would only advise you to avoid something if you realise baby is more gassy/cries more every time you eat something specific.
• If you are breastfeeding and your doctor suspects that there might be a food allergy in baby, you can try an elimination diet (cut out the possible allergens) for two weeks. If there is no change in baby’s behaviour/symptoms, please do not continue to eliminate the foods.
• If you are formula feeding, you can try to change to a partially hydrolysed protein formula (eg Nan HA, Similac) which is easier for baby’s intestines to digest, leading to less cramps and inflammation in the intestines. Studies show that there is a mild improvement in colic with this intervention.
• Some babies have a temporary lactase deficiency (the enzyme that has to break down lactose in the milk). This leads to more cramps and even diarrhoea. You can give oral lactase (Colief) for 2-week trial and see if it makes any difference in baby’s symptoms. There are some studies that prove that the oral lactase decreased the crying time in colicky babies.

Supplements / Medications:

• Simethicone (Telament drops): there is no evidence that it is beneficial in colic. However, it is not absorbed by the intestines and as such should not do any harm to baby.
• Studies that were done on preparations containing fennel, show that it can improve the symptoms of colic in breastfeeding babies.
• Be careful of homeopathic agents as their use is not regulated by normal pharmaceutical rules, and it can thus contain harmful ingredients that are not listed, or the quality of the ingredients can be doubtful. Just because it is natural does not always mean it is safe!
• Colic calm: listed by the FDA in America because it is manufactured using safe practises. Ingredients looks safe, but it is expensive. No research available.
• Gripe Water: many different formulations so check the ingredients! Mostly contains Sodium bicarbonate (baking soda) that can change the pH in baby’s intestines to alkaline (the acid in the stomach is important as a factor in the immune system). Can also contain alcohol!
• Bennet’s colic mixture: Contains Diphenhydramine (an old type of antihistamine causing drowsiness, but also dry mouth, fast heartbeat, constipation). Also contains “tincture Belladonna” which can also cause a dry mouth, large pupils, fast heartbeat. I would not use this medication for my baby.
• “Behoedmiddel”: contains magnesium carbonate, chalk, sugar and alcohol. I would not risk using this medication in my baby.
• Pain relieving agents such as paracetamol has not been consistently studied/proven to help. It is also easy to overdose your baby if you give it every time baby cries. Rather keep analgesia for the times baby has another cause for pain.
• PPIs (Proton Pump Inhibitors) such as Nexiam sometimes given as treatment for reflux is not effective in improving the symptoms of colic.
• Medigel/Spasmogel contains Dicyclamine which relieves muscle spasms, but studies have not proven any improvement in colic symptoms, and it could have side effects such as dry mouth, blurry vision, dizziness, nausea, constipation and a fast heartbeat.

Probiotics:

This is the only intervention that is well-documented, effective and safe. There are a few well designed studies that proved that the crying time halved in 50% of the babies. It was also proven that using probiotics can reduce the calciprotectin in the feces (protein produced by the intestines when there is inflammation.)

Probiotics has even been proven to work prophylactically, where research showed decreased episodes of infantile colic if compared to placebo. The probiotics are thus given from birth to 3 months. The recommended dose is 100 million units once a day. (This equates to 5 drops of Reuterina daily.)

The research was done on breastfeeding babies, and the strain that was the most effective is the Lactobacillus Reuteri DSM17938. Reuterina contains this strain. Many of the cheaper probiotic brands contain multiple strains, which is great with antibiotics use / after an episode of diarrhoea, but is not proven to improve colic.

In summary, I would suggest that you try the practical tips and start giving baby Reuterina 5 drops per day. See your doctor/pediatrician to make sure there is no medical reason for the crying, and if these measures make no difference after 2 – 3 weeks, you can try some of the other medication in moderation.

“To all mothers in every circumstance, including those who struggle, I say, ‘Be peaceful. Believe in God and yourself. You are doing better than you think you are.’”

Jeffrey R. Holland

I hope this post has equipped you with the necessary knowledge to make safe choices to help your baby and yourself cope with this difficult time of crying and little sleep. Try to focus on the fact that this too shall pass, and enjoy your baby…they grow up way too quickly!

Resources:

1. Photo by Kelly Sikkema on Unsplash
2. 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
3. Wolke D, Bilgin A, Samara M; “Systematic Review and Meta-Analysis: Fussing and Crying Durations and Prevalenc of Colic in Infants; J Pediatr. 2017
4. Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;
5. https://www.parentingscience.com/what-is-colic.html
6. Benninga MA, Faure C, Hyman PE, et al. : Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150(6):1443–1455
7. http://www.coliccalm.co.za/101/colic-calm-101.htm