Colic

Background
Crying babies can be much more than just a cliché, especially when they are colicky as well. What exactly, though, constitutes a colicky infant? Dr. Morris Wessel, a general pediatrician in New Haven, CT, authored a land-mark study about 40 years ago in which he identified excessively fussy children and separated them as a defined group. The criteria he chose to define colicky behavior were actually rather far from scientific. His definition of an infant with colic consisted of a child who cried for more than 3 hours a day, and more than 3 days a week over at least 3 weeks - the rule of 3's. What he found was this group had statistically much longer periods of crying and inconsolability with significant persistence of symptoms. They also proved to be children with whom parents had a more difficult time bonding.

Stress


Parents who have truly colicky children don't need statistics, however, to tell them something is wrong. Their exhaustion and stress are enough to let them know when things are going from bad to worse. Colicky infants have a variety of other symptoms and these may include: reflux, arching of the back, poor sleep schedules, being easily awoken, crankiness, requiring constant holding, walking, or preferring specific positions in which to be held. Parents are just plain tired. To make matters worse, friends and relatives often comment that descriptions of such a child must be made-up or simply exaggerations.

Causes and Patterns
The cause of colic remains an unsolved puzzle. Many reasons are given and many home remedies and commercial products are offered. Few people will get the results that are often promised. Unfortunately, decades of research has yet yielded no scientific insight either into the mysteries of colic. Infants are unable to express their specific complaints, and by the time they can speak, the colic is gone. What has been found is that colicky infants tend to be more often:

• male vs. female
• first-born vs. later born
• white vs. non-white
• upper socioeconomic vs. lower socioeconomic groups

There is no explanation for any of these statistical trends. Some of the more plausible explanations include: · The swallowing of air and a poor response to this sensation · The intolerance of certain food groups that are represented in infant formulae. · An inappropriate response to the naturally occurring gastro-colic reflex, in which the bowels push food forward immediately following food intake. · Painful heartburn from gastroesophageal reflux (GERD) that has gone undetected.

Best Guesses and Solutions
Notwithstanding the lack of true knowledge, people are given immeasurable advice and tips on how to handle colic. Frankly, not a single agent or technique can be considered universally successful. Most are useless or just plain snake-oil products. Since colic is most likely to be not one condition but a set of symptoms seen in babies with a variety of causes, they may respond differently to different treatments. For those children with simple formula intolerance the solution may be equally simple. We change formulae from time to time and occasionally have to use certain special (expensive) versions that minimize the need for an infant to digest their food chemically. These formulae may cause less gas formation. Children with GERD may be treated with either a formula change and/or the use of antacids, most commonly Ranitidine (Zantac), which can have a profound effect on those affected with heartburn. Some others will be best served by medicines which minimize the contractions of smooth muscles. These kids have either overly spastic bowel contractions or are inappropriately intolerant of normal activity. These muscle relaxants are also used for the relaxation of other smooth muscle organs like the bladder.

Infants who do not tolerate the swallowing of excessive amounts of air (aerophagia) are occasionally relieved by the use of surfactants, which help reduce the foam in the stomach by coalescing the gas into one big gas bubble, allowing a child to burp it up. Unfortunately, there are no studies which have found this class of medication (such as Mylicon) to be of any statistical use. In fact a recent comparison found that this product was less useful than an equivalent amount of sugar water - having less effect than a placebo is not a good indicator of usefulness in a medication!

The Puzzle Remains
So, the bottom line is that colic remains an enigma which has no decent solution. However, there are many different approaches to making these children more comfortable. This will take a bit of work and patience on the part of the over-stressed parent. No matter what happens, all children outgrow colic. For some, the opportunity to eat solids makes a great difference. For others, merely being able to sit upright and watch the rest of the family during a meal distracts them enough to make them less upset. A moderate number of infants are helped by formula changes or by certain medications. Finally, there will always be an unresponsive group that remains recalcitrant and will only get better on their own terms at their own speed.

February 2002