Colic

What is colic?

Colic is the term used when your otherwise healthy baby cries excessively and can't be soothed (NICE 2017).

All babies cry, of course. But crying is described as "excessive" if it totals three hours a day and happens more than three days a week for at least one week. This sort of crying is also sometimes called persistent crying, or part of the period of PURPLE crying® (NICE 2017, Purple Crying nd).

Whatever you call it, excessive crying is bound to be upsetting. Trying to comfort an inconsolable baby over many hours is hard work. At times you may feel helpless. It may be enough to drive you to tears of your own. But you're not doing anything wrong, and your baby usually won't be crying for any particular reason.

This phase of crying is very common and it will pass. It usually starts between two weeks and four weeks and will probably be over by the time your baby's about four months old (Purple Crying nd).

How can I tell if my baby has colic?

If your baby cries excessively, but is otherwise healthy and feeding well, it's likely that he has colic (NICE 2017). Your baby may be diagnosed with colic or persistent crying if:

• he has frequent bouts of intense and inconsolable crying
• he pulls his legs up to his tummy, clenches his fists and arches his back when crying
• he cries most often in the late afternoon or evening
• his face gets red and flushed when he cries
• his tummy is rumbly or he has wind
  (Newson 2015, NHS 2015, NICE 2017)

Should I take my baby to the doctor?

If your baby is crying excessively and nothing seems to be calming him down, take him to see your doctor. Try to keep a note of his bouts of crying and any other symptoms, and his feeds. Take this with you when you visit your doctor and whenever you see your health visitor, as it could help them work out if there could be a particular cause of his crying (NHS 2015, NHS 2016).

Your doctor will assess your baby's symptoms and check that nothing more serious is causing his crying (NICE 2017b). You should seek immediate advice from your GP if your baby:

• has a weak, high-pitched, continuous or abnormal-sounding cry
• is floppy when picked up
• isn't feeding
• has breathing problems, such as breathing very quickly or grunting while breathing
• is less than three months old and has a fever of 38C, or is three to six months old, and has a fever of 39C
• turns blue, goes very pale or blotchy
• vomits green fluid
• has blood in his poo
• takes much less fluids than usual or is having fewer wet nappies than usual
  (NHS 2015)

Read more about when to call your GP.

If your baby has any of these symptoms and your GP is unavailable, call 111 for advice (NHS 2015).

Even if your baby shows no obvious signs of illness apart from his excessive crying, it's still a good idea to see your doctor. She will examine your baby to make sure there is no underlying problem that’s causing his crying (NHS 2015) such as:

• An allergy or temporary intolerance to formula milk, or something you've eaten or drunk that's got into your breastmilk.
• Reflux, which is when your baby brings up feeds or vomits after feeding.
• Constipation.
• Wind, which can be caused by your baby swallowing too much air when feeding.
  (NHS 2015, NICE 2017d)

In these cases, your GP will advise the best course of action to help you ease your baby's symptoms.

Why does my baby cry so much?

We still don't know why some babies cry so much more than others. Experts have suggested that colic may just be at the extreme end of normal crying, which usually peaks in the first two months (St James-Roberts 2011, NICE 2017).

So while some babies only cry a little, your baby may just naturally cry a lot more in the early weeks of his life. This phase will pass. If you have a colicky baby, you'll be relieved to hear that his crying and fussing is likely to decrease by eight to nine weeks of age. By three to four months, his colic should have improved considerably, if not gone altogether (NICE 2017, Wolke et al 2017).

Colic is just as common in breastfed babies as in formula-fed babies.

You may have heard from family and friends that boys are more likely to suffer from colic than girls. This isn’t the case. Colic is equally common among baby boys and baby girls (Newson 2015).

There are various theories about why colic happens. Some experts think that babies persistently cry because their tiny digestive systems are still maturing, making indigestion and wind more of an issue.

Research into colic is still ongoing and it's hoped that more will be understood about the causes in the future. Rest assured though that it's unlikely that your baby's in pain or you've done something wrong (NICE 2017). While it may be hard to cope with, he may just cry for no obvious reason at all.

How can I soothe my colicky baby?

The persistent nature of colic means there are likely to be times when your baby cries, no matter what you do. Be prepared for soothing methods to work well one day, but not the next. If your doctor has ruled out a treatable cause for your baby's crying, you're back to coping with the colic however you can. Although this can be hard, there are plenty of tips to test out:

• Feed your baby whenever he seems hungry, rather than trying to time his feeds. This is called responsive feeding.
• Allow yourself time to tune in to your baby's signals. This may help you to recognise his pre-cry cues. You can then offer a feed or sleep before his crying gets more intense. However, your baby may move straight into full-blown crying without giving any signals. If so, try calmly holding him or giving him skin-to-skin contact before he settles to feed (Douglas and Hill 2011, NICE 2017c).
• Burp your baby after every feed. Hold him over your shoulder, sit him upright on your lap or place him face down on your lap. Then gently pat or rub his back to bring up wind (NICE 2017c).
• Massage his tummy gently with clockwise movements to help move along trapped wind and poo (NHS 2015b).
• Use a dummy. Your baby may be soothed by sucking. Some babies use their fingers or a thumb to suck on instead (NHS 2016).
• Play white noise to him. Repetitive noise may recreate the whooshing sounds in your womb. The sound of a vacuum cleaner, your hair dryer, a ticking clock or a white-noise app may work (NICE 2017c).
• Take him for a drive in the car or a walk in a pram. The vibrations from the road or pavement will soothe some babies (NICE 2017c).
• Rock your baby. Recreate the swaying motion he enjoyed in your womb by babywearing or rocking him in a bouncy chair (NICE 2017c).
• Quieten things down and dim the lights. Lots of activity or being passed from person to person could over-stimulate your baby.
• Try a warm bath. Your baby spent months immersed in warm amniotic fluid and may find it comforting (NICE 2017c).

If your baby gets very windy, you could try these tips to reduce the chance of him getting indigestion after feeds:

• If you're breastfeeding, try to keep your baby as upright as possible, or place him on your tummy and feed him in a laidback position. If your milk is flowing strongly, this will help to stop your baby taking big gulps and swallowing too fast (LLLGB 2016).
• Try having short breaks during feeds, so he can burp if he needs to. When he's finished feeding, gently rub or pat his back to bring up any wind (NHS 2015c).
• If he is bottle-fed, make sure he isn't swallowing air from the bottle. Try to sit him upright and tilt the bottle enough so that the milk covers the entrance to the teat. You could also try an anti-colic bottle (NHS 2015b).
• A growing number of studies have found probiotic drops containing lactobacillus reuteri helpful in reducing colic in breastfed babies (Sung et al 2018, Johnson et al 2015, Chau et al 2015). However, there isn’t enough evidence yet to say whether or not they're effective for formula-fed babies (Halpern et al 2016, NICE 2017c, Sung et al 2018), so your doctor is unlikely to recommend trying this until we know more.

Babies like routines, so always following the same pattern of care, such as the times of day you feed him or play with him, may also help. Then your baby will become used to what happens next and be more settled in general (Newson 2015).

Friends and family are bound to be concerned for you and your baby. You're likely to hear lots of theories and advice about what to do. Some suggestions can be hard to follow, such as excluding certain vegetables if you're breastfeeding. Others, such as cranial osteopathy, can be expensive. There’s also very little evidence that cranial osteopathy actually works (Guillaud et al 2016).

No single soothing technique helps all babies, so it's often a case of trying different things to see what works for your baby. If you feel that nothing is helping and you're getting stressed, put your baby in his cot or Moses basket and take a break for a few minutes (NICE 2017c).

Set a timer on your phone if it helps you to be disciplined about giving yourself time out. Looking after your own wellbeing is a vital part of coping with colic.

Is colic harmful?

No. Colic won't harm your baby. It may actually be more painful for you and your partner to cope with your baby's constant crying. The best thing to do is to stay as calm as possible and remind yourself that he'll grow out of this phase (Newson 2015, Douglas & Hill 2011).

High-pressured situations caused by relentless crying can lead to frustration and anger or depression. In rare cases, some parents have been known to take actions that they regret, such as shaking their baby (Fujiwara et al 2016, Barr 2012).

If you're struggling to cope, don't be afraid to seek help from your GP or talk to your health visitor. Remind yourself that your baby's crying is not your fault, and that he won't hurt himself. This phase will pass. Just give it time.

You aren't alone. Talk to other mums coping with colic in our community and discover tried-and-tested ways of comforting your baby.