What is colic?

Causes and Symptoms

The term “colic,” when unmodified, generally refers to infantile colic. Infantile
colic is a group of behaviours displayed by young infants that includes crying,
facial grimacing, drawing-up of the legs over the abdomen, and clenching of the
fists, which are not caused by a medical problem and typically resolve by four
months of age. Infantile colic was once believed to be caused by abdominal spasm,
gastrointestinal obstruction, or twisting of an abdominal organ, but there is no
known underlying medical cause for colicky behaviors in infants. The term biliary
colic refers to cramplike pain caused by a stone obstructing the bile ducts, and
renal colic can refer to a stone obstructing the urinary tract.

The crying of colicky infants tends to be more prominent in the evening, although
they cry more than other infants at other times of day. The “rule of threes” of
infantile colic holds that infants with colic cry for more than three hours per
day for more than three days per week for more than three weeks. The associated
gestures suggest to some that the infant is experiencing abdominal pain and is
responsible for the use of the term “colic” to describe the condition. Colic
describes crying and fussy behaviors in an otherwise health infant without
condition that may elicit prolonged crying; for example, colicky crying persists
in the absence of organic disease, hunger, or neglect.

Several causes of infantile colic have been postulated, but conclusive evidence is
lacking for any of them. This combination of behaviors has been interpreted as
abdominal pain, leading to the idea that cramping somewhere in the intestine is
the cause. Neurobehavioral explanations have been offered. The most common is that
colic represents a state of agitation that may not require a noxious stimulus for
agitation and crying to continue. Rarely is colic the result of organic disease,
and the prevailing opinion is that it is a variant of normal infant behavior.
Almost all babies display colicky symptoms to varying degrees. It appears to be
unrelated to caregiving style or intensity. Other proposed mechanisms include
difficult temperament, sleep disturbance, diarrhea, child abuse, and
irritable
bowel syndrome (IBS). Intestinal
gas, either from air swallowed during feeding or crying or
from fermentation of incompletely absorbed carbohydrates in the colon, has also
been investigated. Parents of colicky infants frequently describe flatulence as an
associated symptom.

Treatment and Therapy

The medical treatment of the infant with colic begins with a thorough medical history and a careful physical examination. While the likelihood of finding a cause of the infant’s symptoms are slight, the thoroughness of this approach provides an effective basis for reassurance and demonstrates that the parents’ complaint is taken seriously.

Infantile colic virtually always resolves spontaneously, leaving the infant
healthy and thriving. The essentials of therapy are demystification, reassurance,
and support for the haggard and anxious parents. Demystification is the
explanation of the source of the infant’s distress, which alleviates the anxiety
attendant on diagnostic hypotheses that occur to or are suggested to the parents.
It is important for pediatricians to deal with the anxiety aroused by the infant’s
symptoms with reassurance, pointing out that the baby will be fine.

Quick, superficial attempts to solve the problem with formula changes or
medications, particularly when not accompanied by patient demystification and
reassurance, reinforce the parents’ suspicion that there is something wrong with
the child, ultimately increasing parental perception of the child’s vulnerability.
Dietary changes are generally not recommended as a treatment for colic, as many
controlled studies have indicated that most cases of colic are not related to
diet.

More frequent, smaller feedings may help, as may increased carrying (called
“walking the floor”) and rocking. One theory holds that mimicking the environment
in the womb is reassuring, which can be achieved through closeness to a warm
person with a detectable heartbeat (sometimes called “kangaroo care”), swaddling
(wrapping the baby in a blanket to restrict movement of the extremities and
prevent the baby from becoming overstimulated), and rhythmic stimulation provided
by background music, white noise, and car or stroller rides. One commonly used
method involves placing the baby in an infant bouncer, thus exposing the infant to
constant vibration. Care must be taken to stay with the baby or to secure the
infant seat to prevent injury resulting from a fall. Caretakers should experiment
to see which methods best soothe their crying infant. Many colicky infants have
excessive gas, and gas pains have long been suspected as being responsible for
colic, although the gas may be due to excessive air intake from prolonged crying.
Since virtually all the gas in the intestine is swallowed air, minimizing air
swallowing and maximizing burping after feedings are important measures in
reducing colic. Identifying and then avoiding the dietary triggers of colic and
learning how to comfort the infant during crying episodes will help to soothe the
infant until the symptoms of colic subside, typically at three to four months of
age.

Perspective and Prospects

One theory holds that infantile colic is related to a familial prevalence of irritable bowel syndrome, also called irritable colon or spastic colon, although the evidence for this theory is limited. Diagnosis of colic is made after carefully reviewing the familial history of the infant and performing a thorough physical examination to rule out any organic causes. Although treatment is limited, most babies outgrow the symptoms of colic by three to four months of age. In the absence of an organic disease or unexplained weight loss, colic is self-limited with no long-term adverse effects on the child's development or future health.

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