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Ask Dr. Sears: Causes of Colic

Q. What exactly causes colic? When my son was born, the doctor told me that he had colic before we brought him home from the hospital. I've heard all kinds of explanations  -- even an old wives' tale that it's from taking your infant out into the world too early! Can you tell me the real facts behind this condition?


A. The term "colic" comes from the Greek word kolikos, meaning "suffering in the colon." As you have already discovered, there is more fiction than fact surrounding this mysterious condition. A pediatric gastroenterologist friend once told me that, in his opinion, "colic" was a five-letter word meaning "nobody knows why a baby cries." I tend to agree! First, keep in mind that colic is a description of a crying baby, not a diagnosis. Generally, a baby is deemed colicky if he shows sudden and unexplained outbursts of crying in accordance with the "rule of threes"  -- crying at least three hours a day, for three days a week, beginning within the first three weeks of life, and seldom lasting longer than three months. In my 35 years of pediatric practice, I have found it helpful to use the term "hurting baby" rather than to label a baby colicky. My term motivates the parents and the health care provider to investigate why baby hurts and find ways to comfort him. Consider these causes of colic:

Gastroesophageal reflux (GER). In my experience, this is the most common cause of colic. Because the valve-like band of muscle joining the esophagus to the stomach is immature, stomach contents and acids can regurgitate back up into the esophagus, irritating its sensitive lining and causing what adults would call heartburn. Clues that your baby may suffer from GER are: frequent spitting up soon after feeding, more pain when lying flat, restless and painful night-waking, back arching, and expressing comfort when being held in an upright position. Here are two simple reflux remedies: 1) Feed your baby half as much and twice as often, and 2) keep baby upright and quiet for at least half an hour after feeding. GER usually subsides between 6 and 9 months of age. If the GER seems to be getting more severe, discuss further treatment options with your baby's doctor.

Formula or milk allergy. Another medical cause of colicky, abdominal pain is an allergy to infant formula or to dairy products in a breastfeeding mother's diet. If breastfeeding, eliminate dairy products from your diet for a week to see if it makes a difference. Other possible "fuss foods" are wheat and vegetables such as broccoli and cauliflower, which can produce gas. Also, to keep baby from swallowing too much air during nursing, be sure his lips form a good seal and are placed far back on your areola, not just on your nipple. If you are bottle-feeding, consult your doctor about using a hypoallergenic formula. Oftentimes, food allergies and reflux can occur together. Generally, breastfed babies experience less reflux because breast milk is digested faster from the stomach. Hypoallergenic formulas may help a bottle-feeding baby with reflux, since they are also digested quickly.

Life outside the womb. A third possible cause of colic in some babies is hyperexcitability and difficulty adjusting to life outside the womb. For these babies, the sensation of the womb needs to last a bit longer.

Comforting techniques. Remember this tried-and-true triad: sounds that soothe, motions that mellow, and sights that delight. Wear your baby in a soft infant carrier as often as possible. Sing him soothing lullabies. Dance with him. By trial and error, you'll learn what soothes him. There are two colic holds that worked well for me and that all dads and babies can enjoy together. One is the football hold. Drape baby tummy-down along your forearm. Place baby's head in the crook of your elbow with his legs straddling your hand. Grasp the diaper area as you press your wrist against his tensed abdomen. Another hold is the neck nestle. Snuggle your baby's head into the crook of your neck and drape your jawbones against the top of his head. Croon a low-pitched tune (our babies' favorite was "Old Man River"). This is where dad can shine: The male voice is deeper and vibrates more and thus acts as a natural baby calmer. Finally, there is one more fuss-buster, a favorite of mine, called magic mirror. During a crying jag, place your baby's feet against a mirror and let him witness his fit. This distraction will usually stop the fussing. But note that "magic mirror" won't work on newborns, since they can't see very clearly.

Be sure to keep a colic diary, noting what triggers the crying and what comforting measures work best. The information in your diary will not only help you find comforting techniques, but also provide clues to your doctor as to why your baby is crying and what to do about it. Above all, turn a deaf ear to anyone who advises you to "let your baby cry it out." Assume colic has a cause; keep trying to discover why baby hurts and experimenting with ways to comfort him. Crying increases intro-abdominal pressure and aggravates abdominal pain, especially that caused by reflux, so the more you can soothe baby's cries, the better.

Babies usually outgrow even the medical causes of colic at around 6 to 9 months, and oftentimes much earlier. So don't despair, there is a light at the end of the tunnel!

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