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Ask Dr. Sears: Does Stage 4 Colic Exist?

Q. My daughter-in-law said her pediatrician told her the baby has "stage 4" colic. Is there really such a condition?


A. Over the past five years, pediatricians have been rethinking the diagnosis of "colic." New insights into why babies have sudden, explosive bursts of crying as if they're in severe pain has revealed that "colic" usually has a medical cause. To my knowledge, there is no official "staging" of colic. I suspect that it was a term used by the pediatrician to simply emphasize to the mother that baby has severe colic. Anytime I hear the term "severe colic," (or in your case "stage 4 colic,") that description is a tip-off that the baby likely has an underlying medical cause for the colic, and one that is readily treatable. Here's a plan for detecting the cause:

[BOLD {Don't settle for the simple diagnosis of "colic."}] Colic is really a description of outbursts of crying, not a diagnosis. Once upon a time pediatricians would pass off these outbursts as colic, without getting more specific. Nowadays, pediatricians tend to look more closely for an actual diagnosis (usually some abdominal cause). In fact, I no longer use the term "colic" in my medical practice  -- I prefer to use the term "the hurting baby," which motivates both the parents and the doctor to keep searching for reasons why baby is in pain. Some ways you could advise your daughter-in-law to approach the problem:

Look for clues of an underlying medical cause:

  • Nightwaking in severe pain
  • Timing of pain is usually right after a feeding
  • Excessive spitting up
  • Wet burps
  • Sour breath following a feeding
  • The "colic" does not resolve  -- which it usually does by four to six months

Consider gastroesophageal reflux. The most common medical cause of severe colic is gastroesophageal reflux (GER). It's caused by a weak valve between the esophagus and the stomach allowing stomach contents to regurgitate up into the esophagus, causing what adults would call "heartburn." If your grandchild has any of the above symptoms, suspect GER. Two simple rules of mine for resolving reflux: 1) feed baby twice as often and half as much; and 2) keep baby upright and quiet for at least a half hour after feeding. If these don't work, the doctor may recommend over-the-counter or prescription antacid medication.

Milk allergies. The next common medical cause of colic is a milk allergy, either to the formula or to a food in mom's milk if breastfeeding. If your daughter-in-law is breastfeeding, the two most commonly offending foods are dairy and wheat. Try suggesting that she eliminate both of these foods from her diet for a week to see if it makes a difference, and then gradually add one of them back in to identify which one may be the culprit. If it turns out to be a dairy allergy, she may want to try eating yogurt for her daily calcium fix instead of that glass of milk, as it tends to be less allergenic due to the culturing process. Also, some babies (breastfed and formula-fed) can get "colicky" just by drinking too much milk too fast  -- it enters the intestines faster than it can be digested. The excess then ferments and causes gas and bloating, similar to lactose intolerance. Simply slowing down feedings and giving them in smaller amounts more frequently will help alleviate the problem. Or, perhaps try a hypoallergenic formula recommended by your pediatrician.

Reassure her that "colic" does indeed have a cause and both she and her doctor should keep searching  -- the solution will be found eventually.

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