Abdominal colic in babies: why is my healthy baby crying?

No one wants to hear their baby cry. Over a prolonged period, without a clear reason, it can be even more stressful for parents trying to understand what is wrong with their otherwise healthy baby. Abdominal colic is common in new born babies, but what causes it and how can it be treated? Revered consultant paediatrician and neonatologist Dr Sunit Godambe, who sees patients in London, shares his expertise on the condition.

What is abdominal colic?

Abdominal colic, also known as infantile colic or trapped wind, is defined as inconsolable and persistent crying in babies, that can’t be soothed. It was initially defined as episodes of crying for more than three hours a day, for more than three days a week, for three weeks in an otherwise healthy child.

Colic is diagnosed when a baby younger than five months old experiences reoccurring and prolonged spells of irritability and crying without a clear cause or evidence of fever or illness. The crying occurs often in the evening. Colic is reported to occur equally in babies of both sexes, who are breastfed and bottle-fed. Colic is more common in the first six weeks after birth and usually stops at around six months old.

What causes abdominal colic?

The cause of colic is unknown. It is thought to be mainly due to the ongoing maturation of a new born gut. Some people consider over-and under-stimulation as a cause of infant irritability or colicky pain, and others believe it is caused by gastrointestinal discomfort or intestinal cramping.

Aerophagia, or swallowed air, has also been implicated as a cause of colic. Hence babies with blocked noses experience an increase in symptoms of colic. Microbiome dysbiosis has also been suggested as a cause for colic and some babies do show improvement in their symptoms with the addition of probiotics. Physiologically, intestinal mucosal immaturity and ongoing postnatal maturation of the intestine in the first few months of life seem to be the most likely explanation for colic.

What are the main symptoms and causes?

The main symptom is intense or inconsolable crying, especially in the evenings between 4 pm and 10 pm, usually for more than three hours a day. Other symptoms include:

• clenched fists
• flushed, red face
• straining when trying to open bowels
• no bowel movement for more than two days
• arching of the back
• squirming
• windy tummies
• posseting
• drawing knees up to their tummy

Is abdominal colic a symptom of abdominal pain?

Abdominal colic is a symptom of intestinal spasm or abdominal pain. This is due to overdistension of the stomach due to the stomach filling with milk and air. The trapped wind prevents the passage of stools and this can further cause pain. Sometimes, the babies tend to pass small but frequent stools with the passage of wind and this can lead to nappy rash.

Occasionally, due to forceful passages of wind, babies have explosive and liquid stools. The colour of the stools can be yellow or green. Persistent dark green stools should get checked out as it could be a presenting symptom of gastrointestinal infection.

Does abdominal colic require immediate medical attention and treatment?

Abdominal colic does require medical attention. It can cause anxiety in parents and caregivers. Simple interventions, like bicycle exercises an hour after every feed, tummy time with legs folded inwards, and gentle tummy rub with oil, will help with colic.

When a baby is crying excessively, it is best to hold the baby upright and rock the baby gently to relieve the pain and distract the baby rather than feed the baby frequently. Feeding the baby frequently or cluster feeding during crying episodes can worsen the colic and make the baby more uncomfortable. If the baby uses a pacifier, it is better to use a pacifier to distract the baby rather than feed them.

As colic is physiological, the role of medication is limited. Simethicone (Infacol drops, colicaid drops, gripe water, etc) is harmless but does not treat colic. Some experts have suggested the role of lactose in colic and using a formula with reduced lactose has been tried to reduce colic. Similarly, Colief Infant Drops break down lactose into glucose and galactose, reducing the amount of lactose in milk, and making it easier for babies to digest.

What underlying condition(s) might it indicate?

Abdominal colic is a physiological and benign condition in babies due to ongoing postnatal maturation of intestines. Less than five percent of babies with excessive crying have an underlying organic cause. It is always important to see a doctor to make sure that the crying is due to colic and not any other cause. Accompanying symptoms that should raise alarm are fever, lethargy, or poor feeding. Gastro-oesophageal reflux should be ruled out if colic is accompanied by posseting or arching of the back.

Dr Sunit Godambe is an esteemed consultant paediatrician and neonatologist who treats patients in London. If you would like to book a consultation with him, you can do so by visiting his Top Doctors profile today.