It’s estimated that up to one-in-five babies in the UK suffer from infant colic, generating fear and confusion in their exhausted carers. GP and Endoscopist, Dr Sophie Nelson, surveys the signs, causative factors and impact, and how we can support the parents of babies with colic.

When a newborn baby has been crying for more than three hours a day, for more than three days a week, for at least three weeks, it could be a sign of infant colic. Colic is an emotional condition that leaves parents exhausted and often desperate for reassurance. The conditions for infant colic’s diagnosis remain vague and its treatment options are debated still. How, then, can healthcare professionals help in such a fraught arena? What can they advise, and how can parents of a colicky baby be reassured?

Commonly observed in babies aged under six months – when infants will cry more than at any other time in their lives – colic is defined as perceived excessive crying in babies who otherwise appear to be healthy. Unsurprisingly, few parents agree on how much crying is considered ‘excessive’; statistics have shown that the average time spent crying for a baby under three months is a little over two hours per day. After three months this total halves.

The aforementioned ‘rule of three’ diagnosis can sometimes be helpful, but there are other symptoms to consider. If crying is worse in the evening, if they clench their fists, if they go red in the face, draw their knees to their chest, arch their back, or have an excess of wind, all while experiencing no failure to thrive in any other capacity, then these are signs that a baby could be suffering from colic. After six months, infant colic usually disappears as mysteriously as it arrived.

Causes and Treatment Considerations

The causes of colic are unknown, but it has been suggested that trapped wind, indigestion, or food allergy could all play a role. In addition to digestive problems, more controversially, behavioural issues such as family tension, parental anxiety, or inadequate parent-infant interaction have also been explored as causative factors for infantile colic.

Almost always diagnosed by the parents and treated at home, it is difficult for research into colic to be standardised. Furthermore, research pools are rarely large enough to provide conclusive evidence, thereby adding to the inconclusive nature of diagnoses and treatment of the condition.

Results of testing are gathered from parental perception in a chaotic home life environment and as a result are anecdotal and problematic. In a real-world evidence study, 4,004 parents of children with colic were asked about their experiences of the condition; over 75 per cent had either diagnosed colic in their child themselves, or a friend or relative had done so; only 24.3 per cent of the cases had been diagnosed by a healthcare professional of some description.

As far as treatment is concerned, the NHS website states that parents of children with colic do not need to see a doctor and does not endorse medicines, focussing more on physical and environmental options, including how to hold or rock the baby and the use of soothing background noise.

NICE guidelines recommend that parents be given advice, reassurance and support and suggests that medical options be considered only if parents feel unable to cope.

However, there are a variety of over-the-counter treatments formulated to improve the symptoms of colic that are widely bought and used, and which parents often report have a positive impact on their babies. Simethicone (an anti-foaming agent), gripe water, lactase drops (to aid the breakdown of lactose in formula and breastmilk) and probiotic drops are all available from pharmacies and bought in vast numbers each year.

Despite NICE advice, of the 4,004 parents involved in the aforementioned real-world evidence study, more than two-thirds (69.7 per cent) of respondents, who had made use of a simethicone suspension, either on its own or alongside another treatment, reported improvements in the signs of infant colic within one day. Almost all (93.2 per cent) considered that its use was associated with either complete resolution of the condition or had some effect on its symptoms.

Advising anyone on how to manage crying babies remains a touchy subject to navigate. By the time parents come to their pharmacist or GP for advice, they can be sensitive, exhausted, and verging on desperate. These anti-colic products, found in most pharmacies, can provide reassurance to parents that they are doing something to help, which can in turn lessen the stress they may be transmitting to their newborn. The support of friends and family is also a massive comfort to new parents. When this kind of relief isn’t available, charities like Cry-sis can step in. Founded with the aim to provide assistance to parents of inconsolable babies, Cry-sis began life in 1981 as a support group. It is now a helpline open to parents seven days a week.

Awareness and Reassurance

As part of Colic Awareness Month last September, Cry-sis have engaged in a number of projects to raise awareness of colic among parents and healthcare professionals, including producing a new patient leaflet, due to be printed and distributed among 3,000 GP practices, offering advice on how to manage crying babies. The leaflet includes information on colic, advice about how to tell if your baby is unwell and tips on how to soothe a crying baby. It is their hope that spreading awareness on the subject of infant colic will reassure parents that they are not alone, at a time that can feel very lonely.

Though the diagnosis of colic is difficult, the distress experienced by parents is very real and it is important not to dismiss. The new patient leaflet closes on advice to parents about how to handle feeling overwhelmed, including putting the baby down and leaving the room for a little while. The early months of a newborn’s life can be frightening, particularly if it is the parents’ first child and healthcare professionals can often be a port in the storm when it comes to reassurance.

About the Author

Dr Sophie Nelson is a salaried GP in Wilmslow, Cheshire. She also works as a GPwSI at Manchester Royal Infirmary, both in outpatients clinics and the endoscopy suite. She graduated from the University of Manchester in 2006 and is a member of The Royal College of General Practitioners and The Royal College of Surgeons of Edinburgh, and has a Masters degree in Surgical Sciences from Edinburgh University.