I believe one of the most distressing (and stressful!) sounds I’ve ever heard is that of a baby crying inconsolably for what appears to be no reason.
Many parents have experienced the confusing phenomenon of a generally happy baby being consumed with apparent discomfort – arching their back, pulling their knees up towards their chest and crying for extended periods.
There are so many contradictory opinions surrounding this poorly understood area of human development. We so often get conflicting advice from family, friends and healthcare professionals too, which just adds to our distress!
I plan to clear up some of the confusion surrounding colic in babies, and give a unique osteopathic perspective on how to best help during times of distress.
Here’s what you’ll learn:
1. Colic – what is it exactly?
2. What are the signs and symptoms to be aware of?
3. Is MY baby’s crying normal?
4. What can be done at home to help?
5. Who should I see to help my baby?
1. What is colic?
Colic is defined as “distress or crying in an infant, which lasts for more than 3 hours a day, for more than 3 days a week, for at least 3 weeks, in an otherwise healthy infant” (Stone, 2007).
Wow – try saying that three times fast!
It originates from the Latin for bowel (colon), and is a very confusing term that can encompass a range of digestive issues in babies, including (Hayden, 2009):
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Reflux
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Gut irritability
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Lactose intolerance
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Allergy
Each of the above presents slightly different signs and symptoms, and requires different management strategies. To confuse things further, it is possible to have different combinations occurring at once. As if babies weren’t confusing enough already!
It is important to note that despite the symptoms appearing very uncomfortable for your baby, it is quite rare that anything pathological is occurring. Most ‘colicky’ babies continue to gain weight appropriately and meet other developmental milestones.
It is for this reason that most parents are advised that your baby will “just grow out of it”. Although this advice is true to an extent, it doesn’t really help right now, when your baby is distressed.
As an osteopath, I find gut irritability to be the most common cause of colic in babies. It appears to be caused by a stress response of the brain and nervous system, which leads to an ‘overactivity’ of the gut.
This can lead to the stomach emptying too rapidly, moving undigested milk through the bowel. This eventually results in fermentation, increased gas production and explosive poos (Hayden, 2009).
Osteopaths have a unique perspective on the cause of abnormal stress responses in babies. As the birthing process is traumatic on many levels, it can lead to undue pressure on a baby’s mouldable skull. This can be amplified with the use of forceps or ventouse (vacuum) extraction.
2. What are the signs and symptoms?
One of the earliest indicators is a very farty (flatulent) baby, that produces explosive poos (Hayden, 2009).
Other signs and symptoms may include:
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Excessive crying and irritability (see definition above).
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Upset stomach, that may be distended (swollen) with loud gurgling sounds.
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Arching of the back and knees drawn up towards the chest.
The baby may also suffer from ‘low level colic’, where they appear restless and uncomfortable, but not necessarily crying (Hayden, 2009).
Here are some interesting facts about colic (Stahlberg, 1984):
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It can affect up to 30% of babies
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Around half of affected babies improve naturally by 3 months, and by 6 months nearly 9 out of 10 babies are better. Some babies continue to have problems after this age however
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Colic symptoms appear to peak around 6 weeks
3. Is MY baby’s crying normal?
Let’s face it – babies are confusing and complex creatures.
It IS normal for a baby to cry, so how much is too much?
Crying is generally a sign that something is not right in the baby’s world. There could be many reasons for this including hunger, tiredness, hot/cold, dirty nappy etc.
As you can see in the chart below, during the first 14-16 weeks, it can be considered ‘normal’ for some babies to cry up to 3 hours per day.
It is also clear that some babies cry more than others, and that the frequency of crying peaks at 6 to 8 weeks, and drops as they approach 16 weeks.
So how do you know when to seek help?
I suggest doing some detective work, and finding out if there are any digestive ‘clues’ occurring.
As gross as it sounds, checking out the colour and consistency of your baby’s poo can give a clue as to what may be upsetting them.
The normal colour of baby poo can vary, from mustard-yellow to greenish (more common with formula-fed babies).
See THIS CHART for a poo-comparison.
Look for any frothing and/or explosive poos, which may suggest lactose intolerance or foremilk/hindmilk imbalance.
If the crying is associated with feeding, then look at the timing of onset, as this can give a lot of information as to the cause:
i) If your baby cries immediately on feeding, or within the first 20 minutes, then REFLUX may be the cause of discomfort.
ii) If the crying begins 30-90 minutes after feeding, then GUT IRRITABILITY may be suspected. Look for a distended abdomen, loud gurgling stomach noises and explosive nappies.
iii) If longer than two hours after feeding your baby becomes distressed, then they may be LACTOSE INTOLERANT. Again, explosive, frothy poos may be present.
If this crying is accompanied by other signs such as lack of weight gain, projectile vomiting or blood in the stool then it is important to have them medically assessed immediately. These signs are rare however.
4. What can I do at home to help?
I have found that general advice changes over the years, from spacing feeds out, to feeding on demand and whether to wind or not to wind?
I think the best advice is to try all methods, and pick and choose what helps your baby best.
i) Feed spacing
Traditionally it has been suggested to space feeds no fewer than three hours apart. The thinking here is that the baby is potentially still digesting the last feed, so more could create increased upset.
Dr Pamela Douglas, a GP from the ‘Possums Clinic’ in Brisbane, suggests that the crying could be due to hunger, especially towards the end of the day, and encourages shorter-spaced feeds to help (Douglas, 2014).
ii) Winding
Another contentious issue is whether to wind (burp) or not.
Some reasons NOT to burp are that it’s not really necessary (babies will bring wind up when they are ready, irrespective of position), and that it can interfere with the natural sleepiness that occurs after feeding (Douglas, 2014).
I think trialling both, or possibly a combination (such as don’t burp overnight) is wise to see what works best for you and your baby.
iii) Baby massage
This is best performed when your baby is calm. If they are upset, it’s best to wait for a more opportune moment.
I recommend performing a gentle massage over the whole body using a baby-friendly oil after their bath or shower. This can be a nice transition to bedtime.
At other times of the day you can perform a gentle massage of your baby’s abdomen / tummy in a clockwise direction. This is the path that the bowel takes and can encourage movement and decrease tension in the area.
iv) Medication
Some medications can bring relief, depending on the cause. It is essential to see a healthcare practitioner with a special interest in the treatment of babies before considering these options.
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Lacteeze – contains the enzyme lactase, to break down lactose in milk. Useful if lactose intolerance is suspected. It can be found HERE.
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Infacol – this helps to slow the motion of the gut. It is suggested to alleviate some colic symptoms, but the evidence isn’t clear if it is more effective than placebo.
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Gripe water – is a combination of sodium bicarbonate and herbs (such as fennel, ginger, chamomile, cardamom, liquorice, cinnamon, clove, dill, lemon balm, or peppermint, depending on the formula). It seems to help some babies, but again the evidence is lacking.
5. Who should I see to help my baby?
If you are breastfeeding, then your first port of call should be a qualified lactation consultant.
It is vital to ensure that you haven’t missed anything in the feeding department that may be exacerbating the issue(s).
At Bardon Osteopathy Brisbane, we only use gentle techniques such as cranial osteopathy for babies and children.
To read more about cranial osteopathy and its role in the treatment of babies, please click HERE.
Disclaimer: This is for educational purposes only
This is for your education only. It is in no way intended to replicate or replace expert assessment and guidance from a healthcare professional qualified to diagnose and treat colic.
And I’d go one step further…
Don’t just go to any health professional… go to one who has a special interest in the assessment and treatment of babies with colic … or even better, someone who is passionate about providing the best care possible during a time of immense difficulty and confusion.
I’m sure you understand that I disclaim any and all responsibility for anything that you do as a result of reading this post. I don’t know your family’s medical history or physical state … and by reading this post you agree with this and accept 100% responsibility for your actions.
I welcome your comments or questions in the comment section below … but please realise that I can’t provide professional advice in this context.
References
Stone, C. (2007). Visceral and Obstetric Osteopathy. London: Churchill Livingstone Elsevier.
Hayden, C. (2009). Understanding Infant Colic: An Osteopathic Perspective. England: Viners Wood Associates.
Stahlberg, MR. (1984). Infantile Colic: Occurrence and Risk Factors. Eur J Paed; 143(2): 108-111.
Douglas, P. (2014). The Discontented Little Baby Book: All You Need To Know About Feeds, Sleep and Crying. Brisbane: University Of Queensland Press.
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