Abdominal pain (Colic) in babies
What is the definition of colic in babies?
According to the text book –
1- Recurrent events of crying, discomfort and restlessness occurring without an apparent reason, with no possibility in predicting them or avoiding them.
2- Symptoms begin and end before 5 months of age.
3- The baby does not have any background illness (such as failure to thrive, current febrile illness etc.)
4- An addition for research purposes – duration of the events is over 3 hours for at least 3 days or more in a week.
Another nice definition is according to the rule of 3- a happy thriving baby, events that starts at 2-3 weeks of life, last at least 3 hours, at least 3 days a week, for at least 3 weeks and passes without any treatment when the baby is about 3-4 months old.
Practically, forget the text books, these are babies – they will cry, sometimes for long periods (sometimes hours), when the baby is a few weeks old (but sometimes earlier). Most parents can point to the abdomen as the source of discomfort.
Remember that abdominal pain in babies (often known as just flatulence or colic), are a part of a bigger episode in pediatrics called restlessness in babies. Since this subject interest a lot of parents, I wrote this specific chapter about colic.
What is the prevalence of colic?
According to the text books, abdominal pain is prevalent in about 20% of babies. In real life, there are only a few families in which babies do not have abdominal pain at some point or another.
What is the cause for colic in babies?
There is no known cause or triggers.
We all say that the intestines are adjusting to food, or expressions such as “intestinal maturation”. It makes sense but it has not been proven as true. Other works even say that abdominal pain are like migraines in babies, meaning – a neurological problem.
This mystery will not be solved soon – it is a given situation.
What is typical for colic and what conditions we cannot miss?
What’s typical? Fluctuations throughout the day. Most families report exacerbation during the evenings or early nights. Some families know to tell that from 07:00-09:00 PM or at specific times, abdominal cramps will be coming. In addition, there is a relieve after passing of stools.
What can’t we miss? It is true that colic is the most common and most benign reason for abdominal pain in babies, but it is not the only reason. It is important to say – it is a ruling out diagnosis. It means that we need to think thoroughly and make sure we don’t miss any other diagnosis before determining it is colic.
It has to be a baby that gains weight, achieves developmental milestones, with a benign physical examination, normal stools (no blood or mucus), and no other background illness.
So, if the abdominal pains are severe and you have a concern, go and see a pediatrician and let him make the diagnosis. And most importantly – be happy about this diagnosis since it will be OK, and there are worse diagnoses that can be made.
What helps colic?
There are a few things that can help:
Relive by touch and repetitive movements: holding the baby and giving him a gentle massage of the abdomen (clockwise), and also – rocking the baby or driving him in his stroller or in a car.
Calming the system (the family as a whole and especially the parents): if you will understand it is just flatulence or abdominal cramps, (no disrespect, I was also mad as hell walking from one side of the living room to the other trying to calm my babies at 2:00 AM), a benign condition for a given time with no damage or complications, you will feel batter. The pediatrician job in this case is to calm and reassure you.
A fixed schedule: proven to be helpful! Keep a regular wake times, as well as meal and bath times.
Time with yourselves: forgive me, but parents of babies can (physically and mentally) go out for one night a week to forget a bit about the frustrating abdominal pain. They will be calmer when they return.
What does not help?
Everything you and I tried in the past.
Changing formula: although most parents (in families where babies are not exclusively breast fed) will find themselves thinking about changing formula to a brand with a fancier name – most of the time there is no medical reason to do so. Changing the formula just gives the feeling that something is being done, trying to coup with the baby’s distress (“a new broom is a better broom”), it buys some time but does not really makes a difference.
Medication to relieve flatulence: again, nothing really helps in the long run. It is true, that most of these “medication”, sold without prescription, have sugar inside, which soothes the baby for a few minutes. They do not really change the course of the abdominal pain, they just give the feeling like we are doing something.
Homeopathic medications: you probably have a friend that recommends this herbal concoction or another, a special oil with a rare ingredient (which always has a very beautiful and natural names). Deep inside you know that this is nonsense.
I remind you that it is also hard for a pediatrician to face a family wanting solutions for the restless baby, and just saying – “there nothing to do”. But the main message here and the correct “treatment” is reassuring and calming the family.
Can probiotics help in this context?
Probiotics is a name for a variety of friendly bacteria given orally in different indications. Most strains of probiotics that were tried in the context of colic have not shown any promising advantage. There are some good randomized control trials, including meta-analysis reviewing several studies that showed a specific brand of lactobacillus (L. reuteri DSM 17938) that was proved to improve colic symptoms in breast fed babies.
So, in breast fed babies (exclusively or not), you can consider trying the few preparations (or formula) that contain this specific bacteria.
How about pain relievers in colic babies?
On hard night when frustration grows, I most certainly recommend giving the baby age adjusted pain reliever. All parents who give these medications – you are not causing any damage. I do not suggest starting a permanent treatment regimen with paracetamol until the child begins pre-school, but here and there – certainly.
A few more words regarding a larger aspect of restlessness and abdominal pain in babies:
Restlessness and crying are unfortunately an inseparable part of raising healthy babies. Crying for example, is one of the ways a baby signals his parents that he needs something. So, it is difficult to say where the line is between normal and abnormal restlessness. I would suggest parents to turn to their pediatrician in cases of restlessness beyond normal.
Most of this is up to you parents – you cannot expect stressed parents to raise a calm baby. A baby that is restless needs calm parents, a fixed schedule and not a stressed family.
Easier said than done, I know. Good luck!