All babies cry. Most babies stop crying when their needs are met. However, a sizable minority don’t, often regaling their parents with hours upon hours of demon possessed screams. Welcome to asking yourself “how do I know if my baby has colic?”
What should tired and confused parents do about their inconsolable offspring? Most parents don’t call an exorcist (seriously, don’t call an exorcist; your baby isn’t actually possessed), but many rush to the doctor, the drugstore, or the internet, frantically searching for the source of their baby’s cries.
After choosing an intervention, some parents then claim to have found the root cause of colic, but they probably didn’t. This is because doctors don’t even know what’s going on. But they do know the crying is (likely) normal. And time limited. And maddening in the meantime.
How do I know if my baby has colic? Defining the problem.
Colic has been around forever, exists everywhere, and still befuddles us all. In 1954 Dr. Morris Wessel came up with the accepted definition: A baby who cries for at least 3 hours a day, at least 3 days a week, for at least 3 weeks.
Colic should not be confused with “failure to thrive,” a separate condition that refers to children who don’t gain weight or hit developmental milestones. Colicky babies progress “normally,” but scream their heads off as they do it, especially in the evenings.
This definition is frustrating for the new parent because it describes effect, not cause. It’s also arbitrary. For example, one of my children cried every day for more than 3 hours a day and for way more than 3 weeks. I knew she had colic not because she fit any made-up definition, but because my pediatrician, my part-time babysitter, my mother, and strangers on the street, all exclaimed, “Wow, she is a fussy baby.” The strangers would then ask if she was hungry because if you take a crying infant into public, you will always be asked to feed that infant, even if you have just put your boob or bottle away.
Dr. Chad Hayes believes colic is “a dumpster of a diagnosis into which we toss crying that is felt by parents to be excessive, and that we can’t otherwise explain.” This is a pretty good definition, but I would edit it a bit. It is not crying just “felt by parents to be excessive,” but rather crying that is clearly excessive. Some parents are more sensitive to their baby’s cries, and therefore more likely to categorize their child as colicky even if the crying is within “normal” ranges; but, overall, I suggest we give most parents (okay, me) the benefit of the doubt — their otherwise healthy babies are probably crying more than the norm, even if “the norm” is a highly fluid category.
The 5 Most Common Colic Theories
When my pediatrician suggested my daughter had colic, I assumed it had something to do with the gut. I also secretly wondered if I was causing it (since my attempts to soothe her sometimes made the crying worse). Indeed, tell someone your baby has colic, and you’ll usually get comments on how to reduce gas, to cut out all dairy and soy if breastfeeding or to change formulas if not, to give your baby probiotics, to get them tested for silent reflux, to buy some homeopathy, or, the worst, to just relax so your baby doesn’t pick up on your nervousness.
Why exactly do some babies exit the womb sleepy, serene, and easily soothed, while others spend their first few months permanently pissed off? Are any of these recommendations based on solid evidence? Let’s briefly take a look at some of the common culprits.
A. Gas Pains
Anecdotally, gas is the most prevalent explanation for colic, with many people assuming digestive distress and colic are interchangeable. But this probably isn’t true. Dr. Clay Jones explains:
There is a condition in young infants, really a description of normal development, that probably plays a role in widespread belief in the power of baby gas and the need to intervene… Infant dyschezia is the name for when babies strain, grunt, and cry for at least ten minutes several times a day prior to passing gas or stool. It affects most babies at some point in the first several weeks of life and is the result of an inability to coordinate relaxation of the pelvic floor musculature and intra-abdominal pressure (valsalva). Infant dyschezia is nearly always misinterpreted as pain related to gas or constipation. It is neither.
Crying and straining is merely the baby’s reflexive attempt to valsalva harder against closed anal sphincters. It is not caused by pain or discomfort. When these episodes result in stool, it is normal soft baby poop.
Furthermore, excessive crying likely results in swallowing a lot of air, resulting in more gas, which then makes parents assume the gas is causing the crying, rather than the crying causing the gas. In most cases, connecting gas to colic confuses correlation with causation. Therefore, don’t break out the simethicone.
What about probiotics? Probiotics have been suggested based on the theory that a colicky baby’s “immature immune system struggl[es] with bacterial imbalances in the gastrointestinal tract.” Although some preliminary research is intriguing, the Canadian Pediatric Society notes, “There is insufficient evidence to recommend for or against the use of probiotics or prebiotics in the management of colic.” Not exactly a ringing endorsement.
Many parents also turn to homeopathic tablets that claim to calm babies by helping digestion. For the record, homeopathy can’t and won’t calm your baby, except possibly as a distracting rattle.
B. Dairy or Soy Allergy
Pinpointing dairy or soy as THE cause of colic is difficult because fussiness is amorphous and because the effects of a hypoallergenic diet aren’t seen for some weeks. Nonetheless, most pediatricians will suggest an elimination diet because it’s fairly harmless.
However, some moms take this ambivalent advice and become obsessive. If their baby still cries after a few weeks of their cheese-less diet, they assume they weren’t diligent enough in removing foods, rather than concluding an allergy probably wasn’t the root cause.
A dairy and soy allergy definitely causes excessive fussiness (aka colic) in some infants, but I suspect the number of moms permanently removing soy and dairy from their diet does not line up with the actual prevalence of these allergies (about 2–3% of children under 3). This is why I think of allergy as the “celiac” of colic. Some babies definitely have it, and it can be managed with dietary changes. But it probably only explains a small minority of fussy babies.
As with probiotics, the Canadian Pediatric Society is ambivalent about the helpfulness of a hypoallergenic diet.
Some studies have demonstrated a reduction in colic when breastfeeding mothers consumed a hypoallergenic diet, although there is conflicting evidence. Maternal consumption of a hypoallergenic diet may reduce colic in a small number of infants.
This ambivalence summarizes the general tenor of advice I got from my pediatricians: Cut out dairy and soy for 2 weeks, see if it makes a difference, if not, oh well.
C. Infant Reflux
As with a dairy or soy allergy, infant reflux is real. It is very similar to adult gastric reflux, caused by stomach acid moving into the esophagus. In it’s most severe form, it is called GERD (gastroesophageal reflux disease). However, many doctors debate the actual prevalence. Reflux medications for babies saw a 7 fold increase in prescriptions in the early aughts. This could either be viewed as good news or bad news. Good news if you think this means more children are given relief, or bad news if you think the diagnosis may not be lining up with reality. I’m not qualified to answer that question. But the question itself is interesting.
For example, a few years ago Dr. Eric Hassall wrote a much publicized commentary in the Journal of Pediatrics in which he criticizes doctors for jumping on the GERD bandwagon:
The largest randomized, controlled study to date in infants showed that for symptoms purported to be those of GERD, a PPI was no better than placebo. A smaller placebo-controlled, cross-over study with a different PPI showed similar findings. With increasingly less time to evaluate patients, rather than take on the more time-consuming history, discussion, and approaches, including behavioral and dietary, that are required around the evaluation of unexplained crying, and not without parental pressure to “do something,” doctors have taken to a quicker approach: prescribing.
In his letter, Hassall expresses concern about the logic of prescribing acid blocking drugs, but also about the side effects:
It is all about risk compared with benefit. Young children, especially infants, are highly vulnerable populations. In a child with likely or proven GERD, the benefits of being on an acid-suppressing medication in appropriate dose obviously outweigh the risks, and, in most cases, also far outweigh the risks of antireflux surgery, because of its morbidity and high failure rates.
For infants with benign, ultimately self-resolving symptoms such as physiologic reflux, “unexplained crying,” or both or transient sensitivity to dietary components, the opposite is true. Because of the high prevalence of spitting up, unexplained crying, or both in otherwise healthy infants, these symptoms and signs are just “life,” not a disease, and, as such, do not warrant drug therapy. There is plenty of time for that in later years.
Similarly, in a Medical Daily article, Dr. William Carey of the Children’s Hospital of Philadelphia encourages parents not to over-react to excessive spitting since many babies spit-up and many babies cry, but this doesn’t mean spitting up causes the crying. And Laura Sherer says, “Be darn sure that there is an abnormality before treating it as such.”
Therefore, GERD may or may not be the cause of individual cases of excessive crying, but it most certainly isn’t THE cause of most colic.
D. Temperament or Inability to Self-Soothe
Many sources suggest colic could result from different temperaments among babies, combined with an inability to self-soothe when confronted with stimuli. According to this theory, colic gradually goes away as a baby’s nervous system improves. Dr. Harvey Karp is one of the biggest proponents of this definition.
If colic is caused by an inability to self-soothe, time is quite literally the only solution. This explanation is comforting because it requires no onerous diets or medication, but it is also infuriating because it offers few solutions or easy experiments. But, since infant crying follows a temporal pattern for both non-colicky and colicky babies, this explanation is possible, perhaps even probable, for many infants.
E. Momma Caused It
Some pediatricians think “parental nervousness or perceptions” cause colic. Often, this belief is based on office visits in which a baby doesn’t seem that fussy, especially compared to the behavior the mother describes (let’s be honest, the mother, rather than the father, is blamed).
As a parent, I would like to remind pediatricians of the infant version of “white coat syndrome.” It’s like the adult version, only reversed. Instead of becoming agitated by a doctor, many colicky babies are distracted and cry less. Therefore, those suggesting mothers are causing the colic should lay out some slam dunk evidence. Otherwise, this belief stigmatizes an already frazzled parent.
Nevertheless, some studies suggest family background and maternal stress can contribute to colic. However, the evidence isn’t strong because it is based on self-reports of both stress and crying. Colic is stressful, so this becomes a chicken and egg dilemma. Does colic cause a stressed out mom or does a stressed out mom cause colic?
Probably not the latter. We also have evidence that crying follows a pattern, which would take away credence from the “momma caused it” hypothesis. Additionally, first time mothers aren’t more likely to have a colicky baby (presumably first time mothers would be more nervous). Therefore, momma probably didn’t cause it.
How to Treat Colic
Now that you don’t know what causes colic, how should you proceed if your baby won’t stop crying? According to the American Academy of Family Physicians,
Colic is a diagnosis of exclusion that is made after performing a careful history and physical examination to rule out less common organic causes. Treatment is limited. Feeding changes usually are not advised. Medications available in the United States have not been proved effective in the treatment of colic, and most behavior interventions have not been proved to be more effective than placebo…. Above all, parents need reassurance that their baby is healthy and that colic is self-limited with no long-term adverse effects.
In other words, assuming no underlying etiology has been found, you should wait it out. While you wait, you can focus on soothing techniques, including rocking, swaddling, white noise, different feeding patterns, distraction, etc…
However, all this talk about the baby can overlook the scariest part of colic — the effect on parents. Therefore, perhaps the most important piece of advice is “get help,” both physically and emotionally. Don’t be afraid to put your baby down if you are stressed, to walk out of the room to take a breather, to get out of the house for a walk even if your child is crying, or to call someone to come over.
Ultimately, the most important question isn’t “how do I know if my baby has colic?” but rather “how do I get help for myself as I care for my fussy baby?” This is because colic probably doesn’t have one cause. Let yourself be okay with uncertainty. Parent the best you can. Take care of your baby’s needs, but don’t forget about your own. Colic may not be what you think it is, but it is real. It is hard. And it will end.
Fellow colic survivors, how did you know your baby had colic? Also: let me know how you went through it.
Chad Hayes, “Just Call It ‘Colic’: The Diagnosis That Isn’t,” ChadHayesMD.com http://www.chadhayesmd.com/just-call-it-colic-the-diagnosis-that-isnt–2/
Clay Jones, “The Windi: Revolutionary Relief for Colic or a Pain in the Butt,” ScienceBasedMedicine.org, 19 June 2015. https://www.sciencebasedmedicine.org/the-windi-revolutionary-relief-for-colic-or-a-pain-in-the-butt/
“Colic and Gas,” The Children’s Hospital of Philadelphia http://www.chop.edu/conditions-diseases/colic-and-gas#.VjAHQYSztvx
Dr. Harvey Karp, “Colic Q&A,” HappiestBaby.com http://happiestbaby.com/colic-qa/
Eric Hassall, “Over-Prescription of Acid-Suppressing Medications in Infants: How It Came About, Why It’s Wrong, and What to Do About It,” The Journal of Pediatrics, 24 October 2011. http://www.jpeds.com/article/S0022–3476(11)00897–3/fulltext
Gwen Dewar, “Which Comes First – The Unhappy Baby or the Unhappy Parent?” ParentingScience.com http://www.parentingscience.com/infant-crying-and-parenting-stress.html
I.S. James-Roberts and T. Halil, “Infant Crying Patterns in the First Year: Normal Community and Clinical Findings,” Journal of Child Psychology and Psychiatry, 1991 Sep;32(6):951–68. http://www.ncbi.nlm.nih.gov/pubmed/1744198
JN Critch, “Infantile Colic: Is There a Role for Dietary Interventions?” Canadian Paediatric Society, 1 January 2011, Reaffirmed 1 February 2014. http://www.cps.ca/documents/position/infantile-colic-dietary-interventions
Katrina Wozniacki, “Probiotics May Reduce Crying from Colic,” WebMD, 16 August 2010. w.webmd.com/parenting/baby/news/20100816/probiotics-may-reduce-crying-from-colic
M. Alvarez and I.S. James-Roberts, “Infant Fussing and Crying Patterns in the First Year in an Urban Community in Denmark,” Acta Paediatrica, 85: 463–466. http://www.ncbi.nlm.nih.gov/pubmed/8740306
Matthew Mienta, “Gastroesophageal Reflux Disease (GERD) Over-Diagnosed in Newborns, As Anxious Parents Rush to Medicate,” Medical Daily, 1 April 2013. http://www.medicaldaily.com/gastroesophageal-reflux-disease-gerd-over-diagnosed-newborns-anxious-parents-rush-medicate–244847
Mikaela Conley, “Too Many Babies Receive Acid Reflux Meds, Says Pediatrician, “ ABCNews, 11 November 2011. http://abcnews.go.com/Health/babies-receive-acid-reflux-meds-doc/story?id=14926271
“Milk and Dairy Allergy,” American College of Allergy, Asthma, and Immunology http://acaai.org/allergies/types/food-allergies/types-food-allergy/milk-dairy-allergy
“Normal Newborn Fussing,” Sutter Health Palo Alto Medical Foundation, http://www.pamf.org/children/newborns/common/fussing.html
Scott Gavura, “Understanding and Treating Colic,” ScienceBasedMedicine.org, 29 September 2011. https://www.sciencebasedmedicine.org/understanding-and-treating-colic/