What is colic? A guide for the science-minded parent

© 2009 - 2013 Gwen Dewar, Ph.D., all rights reserved

Colicky babies cry excessively and inconsolably. But what is colic, really? And what causes it?

These aren’t easy questions to answer. In part, it’s because researchers are still figuring it out. But it’s also because people disagree about how to define colic.

Still, there is agreement on several points:

• Colic affects all kinds of babies--breastfed and formula-fed; girls and boys; Westerners, Asians, and Africans (Barr 1998; Chen and Chwo 2006; Oshikoya et al 2009)

• In most young babies--including those without colic--crying tends to increase over the first 6 weeks. Thereafter, crying tends to taper off. By 3 to 5 months, most babies cry much less, and colic has gone away (Barr 1998).

• Most babies with colic don’t have any serious medical problems, i.e., their colic isn’t caused by a dangerous or life-threatening condition (Barr 1998).

Nevertheless, colic should be taken seriously.

Why?

1. Caring for a colicky baby can be extremely stressful and frustrating, so much so that parents sometimes make terrible, tragic mistakes. Studies suggest that inconsolable crying is a trigger for baby shaking, an act that can cause head trauma and brain damage (Barr et al 2006).

2. Colic can threaten your mental health and harm your relationship with your baby. Studies suggest that mothers are more likely to become depressed when their babies suffer from colic or cry inconsolably (Maxted et al 2005; Vik et al 2009; Radesky et al 2013). And babies with depressed mothers are more likely to develop insecure attachment relationships (Murray and Cooper 1997; Akman et al 2006), perhaps because their mothers are struggling with feelings of helplessness, anger, and rejection (Pauli-Pott et al 2000).

3. Colicky babies aren’t just crybabies. Colicky babies aren’t crazy, and they aren’t trying to manipulate you. Research suggests that some colicky babies suffer from treatable medical conditions, including cow's milk protein allergy and even migraine (Critch 2011; Romanello et al 2013). Other babies may exhibit distinctive brain chemistry profiles that make it harder for them to calm down.

So it seems to me there’s a lot at stake, and parents shouldn’t let their concerns be trivialized or brushed off.

Parents can take steps to protect themselves and their babies from the worst effects of colic. The first step is learning about the research.

What is colic really about?

In this article, I cover

• the pattern of crying in normal infants

• differing definitions of colic, and

• possible causes of infantile colic

As I note below, it’s important to have your colicky baby examined by a pediatrician. Babies cry for many reasons, and some of them require immediate medical attention.

The University of Michigan Health System recommends that you call your doctor or take your baby to the emergency room if your baby’s cries sound strange, are unusually intense, or continue for 3 hours without interruption.

You should also seek immediate medical advice if your baby has a fever, is vomiting, has diarrhea, or seems to be otherwise ill or in pain.

What is colic? Understanding the normal crying curve

All healthy, young babies cry and fuss--sometimes inconsolably and frequently without any obvious cause. Typically, crying is more common in the late afternoon and evening.

It also seems that most healthy babies cry according to a schedule (of sorts). During the first few weeks after birth, babies increase the amount of time they spend crying. Crying peaks some time during the second month. By the time babies are 3 or 5 months old, they cry considerably less.

That’s normal for babies in Western countries. And ethnographic research suggests it’s normal for hunter-gatherers, too (Barr et al 1991). So what is colic?

The "rule of 3s"

Some physicians follow Wessel’s “rule of threes,” diagnosing a baby with colic if she cries more than 3 hours a day, for more than 3 days a week, for more than 3 weeks in a row (Sijmen et al 2001).

But these cut-offs are rather arbitrary, and they result in a great many babies getting labeled as “colicky.” For example, some studies of Western babies estimate that up to 40% of young babies meet the Wessel criteria (Soltis 2004)!

But to me, a better marker of colic is that the colicky baby’s cries are very hard to stop.

Several Western studies bear this out. Colicky babies don’t cry more frequently than other babies do. But once they get started, they take much more time to quiet down (Barr 1998).

In addition, research suggests that colicky babies are upset by things that don’t bother normal babies very much. Some newborns are much more upset by being undressed, handled, or put down, and these babies are more likely to develop colic (St James-Roberts et al 2003).

What is colic? Criteria that include symptoms of pain

But is colic just about fussing and crying? Not according to some definitions. As noted by Joseph Soltis (2004), a more selective approach to colic stipulates additional symptoms, such as

• Muscle tension and signs of pain (e.g., clenched fists, flexed legs, arched back, a hard, distended abdomen, and grimaces)

• high-pitched crying, or

• signs of gastric distress (flatulence, regurgitation, vomiting, diarrhea)

As you might imagine, babies meeting these additional criteria are more likely to suffer from digestive problems or organic disease. That’s one reason why there is so much conflicting information about the causes of colic. Is colic caused by abdominal pain? Studies may suggest different answers depending on the specific criteria researchers used to identify colicky babies (Soltis 2004).

So what are the causes colic?

There are many theories, and I suspect that there isn’t any single answer. In the rest of this article, I outline two major types of explanation:

1. Care-giving explanations (i.e., colic is caused by the way parents interact with—or fail to interact with—their babies)

2. Physiological or disease-based explanations (i.e., colic is caused by a medical condition or reflects an infant’s problems with emotional regulation)

Care-giving explanations of colic

Some researchers have suggested that colic is caused by child-rearing practices that minimize responsiveness and physical contact between parents and babies. According to this idea, colic might be prevented if caregivers adopted a highly responsive, tactile approach to baby care--

• holding or carrying the baby at least 80% of the time, and

• giving the baby a breast or otherwise soothing him within seconds of hearing him cry.

That’s what happens to babies in hunter-gatherer societies—societies where daily life most closely resembles life in the Pleistocene and where colic is virtually unknown.

But while this approach has benefits, it’s not necessarily a cure for colic.

Studies of Western parents suggest that “Pleistocene” baby care may promote secure attachments (e.g., Anisfeld et al 1990). It also seems to reduce crying in normal babies (Hunziger and Barr 1986). But it doesn’t seem to reduce the rate of crying in colicky babies (Barr et al 1991b). So if you are a good “Pleistocene Parent” and still have a colicky baby, you’re not alone.

Another care-giving theory of colic concerns stress. According to this idea, babies become colicky because their parents are tense or “stressed out.” This isn’t implausible. But it’s also evident that colic causes stress in parents. Which comes first, the parental stress or the colic? Like the “Pleistocene” theory, the parental stress theory lacks strong evidence in its favor.

The bottom line? While I don’t doubt that care-giving has crucial effects on babies, it’s wrong to assume that babies have colic because their parents aren’t being responsive, affectionate, or patient enough.

For more information, see my articles on infant crying and parenting stress and the anthropology of infant crying.

Physiological explanations of colic

When we ask “what is colic,” many pediatricians emphasize that colic is usually not indicative of disease (e.g., Barr 1998).

But—as noted above—that depends on what definition of colic you use. In studies that include symptoms of pain or gastric distress as criteria for colic, a high proportion of colic cases are caused by disease. Moreover, research suggests that colicky babies may have different physiological reactions to stimulation.

For the full story, see my article about the physiological causes of colic.

Here are the highlights:

Screen your baby for illness

If your baby shows signs of colic, it makes sense to consult your pediatrician about the possibility of disease. Excessive crying may be a sign that your baby suffers from a disease, like cow’s milk protein intolerance, isolated fructose intolerance, infantile migraine, or acid reflux (Barr 1998).

It’s also possible that your baby is experiencing abdominal pain caused by elevated levels of motilin (a hormone that stimulates intestinal contractions), intestinal inflammation, and/or an unfavorable balance of gut microflora (Savino et al 2007; Rhoads et al 2009; Savino et al 2009). Research suggests that colicky babies may benefit from treatment with specific types of probiotic (Savino et al 2006).

The colicky brain: Are colicky babies just different?

There is intriguing evidence that babies with colic may react differently to both disruptive and soothing stimuli. For instance, colicky babies may be more upset by handling and less comforted by sweet flavors. For more information, see this article about colic and the brain.


What is colic? The bottom line...

Babies diagnosed with colic may have a variety of underlying problems. These might include medical conditions (like cow’s milk protein intolerance, gut inflammation, or gas). Or they might include differences in brain chemistry--differences that affect the ways that colicky babies respond to being moved, handled, and soothed.

But whatever the cause of your baby’s colic, coping with colic is very stressful. It can make you anxious, depressed, resentful, and angry. And excessive, inconsolable crying is a trigger for baby-shaking, which can damage a baby’s brain.

So if your baby has colic, it’s important to avoid blaming yourself or the baby. Get social support, ask for medical advice, and take time out if you find yourself losing patience. It’s better to let the baby cry in a cot or crib than risk a momentary loss of control.

More information

For more information relevant to baby colic, see these articles:

• " Infant crying, fussing, and colic: An anthropological perspective on the role of parenting" outlines the ways that parenting choices can influence infant crying.

• "Physiological causes of colic" discusses medical conditions that can cause excessive, inconsolable crying. "Colicky babies...just different?" considers the possibility that differences in brain chemistry may contribute to colic.

• “Infant sleep aids” examines the evidence for various techniques designed to soothe young infants. These techniques include swaddling and white noise.

• “Everyday stress in babies” addresses the kinds of stimulation that soothe (or distresses) normal, non-colicky infants.

• “Newborn sleep patterns” reports the science of baby sleep. “Infant sleep problems” includes a troubleshooting guide to coping with babies who have trouble falling or staying asleep.

• “Postpartum stress” is an evidence-based review of the normal feelings that new parents experience when caring for young babies.



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References: What is colic?

For the studies cited in this article, see "What is colic? A bibliography of scientific studies about the causes of colic"


Content last modified 5/13