Part 1 of 3:
What is Colic?
This is Part 1 in a three-part series on colic. But first, to quote Dr. Sears: If you are wondering whether or not you have a colicky baby – you don’t! What Dr. Sears means by that is it’s not a mystery: a colicky baby has daily, unexplained outbursts of inconsolable pain with screaming. The mystery is, what is causing the colic? What is causing the pain? It is important to note that colic is a description, not a diagnosis. The colicky baby is described as “the hurting baby.”
The Colicky Baby = The Hurting Baby
That image of the cute baby girl that is the thumb-nail pic for this post: NOT a colicky baby. Way too happy. The colicky baby is a hurting baby.
“Hurting Baby” is an appropriate label. The colicky baby has a typical appearance:
“You’re holding your two-week-old happy baby – the model of a thriving infant, apparently without a care in the world. Suddenly and unexpectedly he stiffens his limbs, arches his back, clenches his fists, and lets out ear-piercing shrieks … Even his face cries ‘ouch’: wide-open mouth, almost a perfect circle, with furrowed brow with tightly closed or widely open eyes, as if yelling, ‘I’m hurt and I’m mad.’”
Frankly, we (we physicians, that is) call it “colic” when we don’t know why a baby is hurting and is inconsolable.
Being a parent of a colicky baby can be a nightmare: because your baby hurts, you hurt! The biggest frustrations of caring for a colicky baby are not knowing the cause; not knowing why something you did yesterday that seemed to soothe your baby is not working today; not knowing when the next inconsolable outburst will occur; and receiving all the advice from family and friends, telling you that you’re doing it wrong. All parents with a colicky baby ask themselves, “Why me? What am I doing wrong?”
Well-Meaning But Mis-Informed Friends
Even more punishing are your well-meaning friends and family giving you advice: “It’s something you ate – it’s in your milk, causing him gas.” “You’re not holding her enough; you’re not bonding.” “You’re holding him too much; you’re spoiling him.” And so on.
Taking the Wind Out of The Gas Myth
ALL babies have tummies full of gas – whether or not they are colicky babies. The fact is that babies gulp a lot of air along with their milk. Just put your hand on the tummy of a baby after feeding. You can feel and hear the gurgles of gas moving around. All babies. Babies gulp even more air when they are vigorously crying. Babies with colic may have even more gas in their tummies – as a result of their crying, not the cause of their colic. Gas may contribute to discomfort for many babies, but does not cause colic.
You’re Not Doing It Wong!
The fact is, colicky babies can spend hours in misery every day. That makes for difficult bonding; they don’t like to be held; they don’t like to be put down; they are simply miserable! It’s not you. You’re NOT doing it wrong! Don’t listen to your well-meaning friends when they share their opinions about how you’re holding your baby; or not holding your baby; or whatever it may be. Smile (if possible), and ignore them. Thank them for their opinion – that’s all it is: their opinion – and reply that you appreciate that their advice works for them and their child. And then continue doing your best. Ignore them, because they did not have a colicky baby. And even if they did have a colicky baby, their baby’s pain may have been caused by something else.
Most Common Causes of Colic
In my experience (and, incidentally, in the experience of Dr. Sears, too), the two most common causes of colic are:
- Gastroesophageal reflux
- Food or formula sensitivities
It’s Up to YOU: BE the Detective
If you have a colicky baby, you should seek the help of your doctor, your pediatrician. But accept that they are unlikely to look at your baby and augur the correct diagnosis. And, since we’re on the subject: don’t immediately give up on your doctor if they can’t determine why your baby is hurting or cannot quickly cure your baby’s colic. To reveal the diagnosis will require some sleuthing. It will require some real detective work. So, before even going to your doctor, become a detective:
(1) Keep a fuss-diary:
- Record in detail all the information that you can about your baby’s painful episodes.
- Include timing (time of day; how long they last; before or after feeding); describe the cry;
- Note any triggers for the episodes; describe all efforts to soothe – has anything worked? What does not work?
- Where do YOU feel the pain is coming from?
- What does your baby look like during the episodes: your baby’s face, neck, abdomen, limbs.
- What are your baby’s feeding details: breast, bottle, air swallowing.
- What changes in feeding have you tried?
- What are your baby’s bowel movements like: hard / soft, how frequent?
- Does your baby have a diaper rash? Is there a red ring of inflammation around your baby’s anus? This can result from food sensitivities.
- What do YOU think the diagnosis is?
(2) Record an episode:
Use your smart-phone to make some video and audio recordings, use a cassette-recorder for audio-only if you must (old-school), but make a recording of some episodes to help your doctor appreciate how devastating these episodes are. Of course, audio with video is ideal so that all the associated body language will help your physician make the diagnosis.
Now you’re equipped to visit your pediatrician with some data that may help them to help your baby.
Is It Reflux?
As I suggested in a recent article here, a colicky baby has reflux until proven otherwise. Be sure to read that article on the symptoms of reflux in babies and children to help you make the diagnosis.
The only thing I will add here about reflux in babies is about testing (I’ll save treatment for Part 2 of this article series). For my own baby, I would not put them through these testing procedures unless the standard treatments – essentially positioning or feeding strategies – had failed, or increasing doses of anti-reflux medication had failed. That is, I personally believe that formal testing is only necessary when we think the diagnosis is reflux, but it is not improving with treatment. Formal testing is always needed if anyone is telling you that your baby requires surgery to cure their reflux.
Testing For Reflux
One of the problems I have with the tests for reflux in babies and infants is that they are notoriously insensitive, and inaccurate. Here are a few of the tests, and why they may not reveal reflux in your baby:
- Barium-swallow x-ray fluoroscopy: this is an imaging study that outlines the esophagus, stomach, and upper small intestines. This study is good for diagnosing abnormalities (obstructions, strictures, or tumors of these anatomic areas), but very poor for diagnosing reflux.
- pH Probe: a pH probe – a thin plastic catheter – is placed into your baby’s stomach through either their mouth or nose, and taped in place on their face for about a day. Electrodes on the catheter measure the pH (the acidity), usually at the end of the catheter, and in the esophagus at a point just above the opening to the stomach. Accurate, reliable readings are achieved only if the electrode that measures the pH is in the correct position. This often requires x-rays to confirm placement, and it requires skill and experience to perform properly in babies. Unfortunately, even if all that goes just right, research suggests that many babies have non-acid reflux.
That is, they do have reflux of gastric juices from the stomach into the esophagus, but the pH of the fluid does not show on the pH probe as acidic. The problem is that some of the enzymes in the gastric fluid can irritate the esophagus and apparently cause significant pain (and even esophageal injury) without showing up on the pH probe.
- Impedance Monitoring: a more recent variation of the pH Probe is the “Multichannel Intraluminal Impedance Test” (MIIT). This involves challenges similar to placement of a pH probe catheter, but the electrodes on the MIIT catheter don’t measure pH or acidity, they measure impedance. That is, they measure changes in the ionic strength of the fluids, so these probes can potentially detect reflux even if it is not acidic. The downside is that they still require sticking a tube in your baby’s nose and leaving it there for a day, and the technique depends on skilled placement of the probe.
- Endoscopy (esophagoscopy): this procedure requires a general anesthetic, and involves placing a lighted telescope into your baby’s esophagus to examine the lining for indications of reflux. When I performed esophagoscopy to look for reflux, I always biopsied the lining to look for microscopic signs of reflux. For examples of these microscopic changes, take a look at our article, published in JAMA Otolaryngology – Head & Neck Surgery, Results of Esophageal Biopsies Performed During Triple Endoscopy in the Pediatric Patient. The downside is the requirement of a visit to the operating room for general anesthetic, but this remains the “gold standard” because it provides definitive evidence of esophagitis resulting from reflux. Certainly, I would perform esophagoscopy to confirm severe, uncontrolled reflux esophagitis before I would consider “reflux surgery” (fundoplication) to treat reflux.
If you have a hurting, colicky baby, the problem is most likely reflux, food sensitivities (or potentially both!). Go through the steps above to help sleuth-it-out, and to help both you and your pediatrician to figure out the source of the hurting.
That’s it for now, this is the end of Part 1 in three-part series on colic. In the next installment – Part 2 – I will review the management, the treatment, for reflux in your baby. Finally, in Part 3, we will consider food sensitivities. Until next time, peace …
Image credits: baby pics are used under license from depositphotos.com
Quote Credits: the quote describing the appearance of the colicky baby is from The Baby Book, by William and Martha Sears, Little/Brown Pubs., 2003 edition, pg. 382.
Hi, I’m Russell Faust, author of this medical education blog.
That wonderful photo of me is by Chris Stranad; here is his site: http://www.chrisstranadphotography.com/Index.html
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