Coping with the nightmare of colic

‘It started when he was ten days old,’ says Jan Maycock of her son James. ‘He’d start at six o’clock at night, howl the house down for 20 minutes and then stop. He’d be quiet for ten minutes and then off he’d launch again. He’d be inconsolable - he just kept going and going. We went through all the things that people suggested to us. We got to that ‘I’ll try anything’ stage - driving around in cars, constantly consoling him, the gripe water, the Infacol, in fact all the medicinal things.’

Jan’s story will be familiar to a lot of parents. James had colic, a condition that may affect as many as one in five babies. There is no single, accepted definition of colic, but most agree that it is characterised by excessive crying (usually defined as more than three hours a day) in otherwise healthy babies. Although it’s common for the condition to start at about two or three weeks old and to stop quite suddenly at about 12-16 weeks, this isn’t always the case. It occurs in both breastfed and formula-fed babies.

Colic tends to start in the early evening, although in some babies it can start at midnight. Other symptoms often accompany the crying: the baby will often go red in the face, draw up her legs, arch her back, clench her fists and pass wind or explosive poos. Typically, the baby cannot be comforted by any of the usual measures such as feeding or cuddling.

The experience of looking after a colicky baby can be extremely distressing for parents, and rates of postnatal depression are higher than usual for mothers of babies with colic. Typically parents will try a variety of remedies, often to no effect. ‘I felt I hadn’t bonded with him in the early days. I remember saying, ‘Look, he doesn’t like me,’ says Jan. She felt helpless. ‘You just think, ‘It’s me, I’m doing it wrong.’

The experience can be compounded by a lack of support from health professionals. Jan was lucky enough to have a supportive health visitor, but her GP told her that colic was ‘just one of those things’ and that James would grow out of it.

What causes colic?

Despite 40 years of research into colic, we cannot be certain as to what causes it or what cures it. Often, colic resolves itself spontaneously, making research difficult to carry out and interpret. Some researchers have theorised that babies are more likely to suffer colic if they have not established good relationships with their parents, but this seems unlikely given that the excessive crying seems to be accompanied by physical pain. While some studies found that mothers of babies with colic bonded less well with them, it is just as probable that this is a result of the colic rather than a cause.

There are several theories and it may be that colic has a number of different causes. Dr Mike Woolridge, a senior lecturer in infant feeding at Leeds University, suggests that colic may sometimes arise because the baby’s gut is immature and therefore oversensitive. It’s possible that this prevents the baby from regulating her crying once it starts. He suggests that the colic stops when the baby is three months old because her gut or nervous system has matured. Sometimes the colic can be made worse by parents mistakenly assuming the baby is hungry and giving it an extra feed. ‘It’s difficult to eradicate three month colic, but you can avoid exacerbating it with other things,’ Mike says.

It could also be that colic is caused by the way the baby is feeding. Sally Inch, an infant feeding specialist for the Oxford Radcliffe Trust, says her experience over the past 15 years is that colic in breastfed babies is often caused by the baby taking in too much of the lower fat foremilk (the milk that the baby gets when she starts feeding), and not enough hindmilk (the milk that the baby gets when she’s been feeding for a while).

Sally explains: ‘Foremilk moves through the gut more rapidly; the stomach empties more quickly. This means the baby’s hungry again sooner, so she has another low-fat feed. Over the course of the day she consumes vastly more milk volume than she would really like and in consequence takes in far more lactose than her gut can cope with, and then you get the fermentation in the gut which causes the pain and the other symptoms associated with colicky breastfed babies.’

There are two reasons why babies end up getting too much foremilk, says Sally. The first is that the baby is taken off the breast before she has finished feeding from it and is then offered the other side. As Mike puts it: ‘It’s the equivalent of getting two soup courses and no main course.’ Whereas if she is allowed to feed until she comes off the breast looking satisfied, she will be able to get all the hindmilk she needs. If she wants more, she can then be offered the second breast.
The second, more common, reason is that the baby doesn’t attach properly to the breast. The baby needs to have a big mouthful of breast, with her tongue forward, away from the base of the nipple, so that she can suckle effectively. If the baby is not properly attached, the breast does not get fully drained, and once again the baby doesn’t take in enough hindmilk. The poor attachment can also lead to sore nipples and uncomfortable breasts.

Sally says that, in her experience, many colic cases have been alleviated once the baby is well attached to the breast and comfortable. A 1994 study lends some support to this, showing that babies who were allowed to finish feeding from one breast had half the incidence of colic of those who were offered the second breast before finishing the first.

Many mothers assume that their baby’s colic is caused by a food allergy (when the immune system reacts to a particular food) or food intolerance (when the body has difficulty metabolising certain foods). Allergies are unusual, says Mike: ‘Cases of a genuine allergy are exceptionally rare - we haven’t counted more than half a dozen in 1500 babies.’

Food intolerance is more common. Louise Jupp had a baby with severe colicky symptoms that lasted until he was two, when he was still breastfeeding. He would sleep for only six hours a day, broken into 20-30 minute stretches. Eventually it occurred to her that he might have cow’s milk intolerance, and as soon as she took dairy products out of his (and her) diet, the symptoms disappeared. He is now, says Louise, ‘a different child.’

Mike says that some breastfed babies have low tolerance of caffeine (found in coffee, tea, cola drinks and chocolate) and foods such as cabbage or broccoli. A good guide, he says, seems to be the foods that mothers develop an aversion to when they are pregnant: ‘Anything which the mother ‘went off’ during pregnancy, when she was capable of reacting intuitively to her fetus, may be a trigger for things to avoid postnatally, such as red wine, cheese, or coffee.’

However, we should be cautious when trying to find out which foods may be triggering a bad reaction, he adds: ‘Simply avoiding groups of products does not work; trying to establish links then avoiding foods which may have caused problems is a better approach. However, we are extremely good at making spoof, superstitious connections with things in our diet - so beware.’ Cutting out coffee is one thing, but it’s a good idea to consult a sympathetic health professional if you are considering more drastic changes in your diet.

What about formula-fed babies?

One possibility is that the baby may be swallowing air from the bottle. Try feeding her in a different position, or reducing the amount of air she swallows by changing to a teat with a faster flow, bottles with a vent or bottles with a collapsible bag inside. If this doesn’t make a difference, it’s possible, though not probable, that she is reacting badly to cows’ milk protein. In this case, switching the baby to a hydrolysate formula may help a small number of babies, although this is not recommended if the baby is otherwise healthy and gaining weight.

Coping strategies

Parents have come up with numerous strategies for dealing with colic, such as: sharing care, so you take turns with the baby, carrying her, or using a sling. Mike suggests that applying pressure to the baby’s tummy, either by carrying her over the shoulder, face down on your lap, or in the ‘aeroplane’ position on your arm. Some parents have found that white noise, such as a vacuum cleaner, soothes the baby. NCT research networker Ruth Hewston found that the only thing that seemed to help her daughter was to drive around in the car for hours. Over-the-counter remedies, such as Infacol, gripe water and Colief are also commonly used, and some parents think they are helpful. However, there is no good quality research showing any benefits from these remedies.

Other mothers have had success with complementary therapies. Jan Maycock discovered, to her surprise, that baby James’s colic stopped when she tried the homoeopathic remedy camomile.

Another mum, Kelly Cornish, had a baby who screamed in agony for an hour every night. ‘He would go bright red in the head, his body would be flailing about, and he was utterly miserable,’ says Kelly. His colic was alleviated when she took him to a cranial osteopath.

There is no guarantee that any treatments will work, however. While one small study has shown cranial osteopathy to be effective in the treatment of colic, the parents who participated were aware of whether their baby was being treated or not, which may have influenced the outcome.

Many parents never find a solution that works. It can help to realise that it is not your fault and that, eventually, you will get out the other side. In the meantime, there are coping strategies that can help. Accept offers of support from friends and relatives, as time away from your baby can give you the chance to get things into perspective, even if it only for an hour or so. Try to use the time to do something you enjoy or to give yourself a treat. Talking to a sympathetic health visitor or phoning a support line such as Cry-sis can also help. Ruth advises joining a group of mothers with the same problem: ‘That certainly worked for me - it helps to know it isn’t anything you’ve done.’

What the research says

• Colic affects between 5 and 20 percent of babies.
• No-one knows for sure what the cause is - there may be several.
• If you are breastfeeding, make sure that the baby is well attached and ‘finishes’ the first side first.
• Some foods, such as cow’s milk, may trigger colic in some breastfed babies. However this is a very hit-and-miss process and not the first thing to try, as it’s easy to restrict your diet too much.
• Checking positioning and teat size may help bottle-fed babies.
• Support from groups such as Cry-sis can help you to feel less isolated.

Sources of Support

The NCT National Experience register puts people who have had similar experiences in touch with each for support and information. Contact Sandra Walsh on 07968 069 683 or walsh_sandra@hotmail.com

Cry-sis offer support for families with excessively crying, sleepless and demanding babies on 08451 228 669 (7 days a week, 9am - 10pm) see www.cry-sis.org.uk or email info@cry-sis.org.uk.

NCT breastfeeding counsellors offer information and support on all aspects of feeding and weaning your baby. Call 0870 444 8708 (8am to 10pm every day).