Does my baby have colic?

Know the signs and get help

Your Baby & Toddler - - Contents - BY LORI CO­HEN

Y ou’ve got the check­list to go through when your baby is cry­ing. He’s hun­gry? Nope. He’s tired. Nope. He needs a nappy change? Def­i­nitely not. Could it be a case of colic? It’s a di­ag­no­sis that’s of­ten thrown about in the first three months of your baby’s life, but how would your doc go about con­firm­ing this con­di­tion? Un­for­tu­nately, as with your new-mom check­list, it’s a di­ag­no­sis of ex­clu­sion, rather than con­fir­ma­tion, and it af­fects be­tween 10 and 30 per­cent of in­fants world­wide, says

pae­di­a­tri­cian Dr Johnny Lot­ter at Kidimed. “The def­i­ni­tion of colic is ex­tremely broad based and tra­di­tion­ally the def­i­ni­tion that any baby cry­ing for more than three hours a day, hav­ing th­ese episodes for more than three days of the week, and ex­pe­ri­enc­ing the symp­toms for longer than three weeks is de­fined as a col­icky baby. Un­for­tu­nately most ba­bies do ex­pe­ri­ence symp­toms that would de­fine them as hav­ing in­fant colic es­pe­cially dur­ing the first 12 to 16 weeks of age,” says Dr Lot­ter, due to their im­ma­ture di­ges­tive sys­tems.

It may seem there is no logic to what sets your tot off, but Dr Lot­ter says ba­bies with true in­fant colic tend to have cry­ing bouts at cer­tain times of the day and that would in­clude es­pe­cially late af­ter­noons and an evening hours. “The cause and rea­son of this di­ur­nal rhythm is not known and is not re­lated to the in­fant’s sex, or if the mother has other chil­dren, or the par­ents’ eco­nomic sta­tus, education or age,” he says. Yup, colic is a true lev­eller! Dr Lot­ter says you should look out for th­ese pat­terns or symp­toms, to help de­ter­mine if your baby has true colic:

What does it sound like?

Moms with col­icky ba­bies of­ten in­sist that their have dif­fer­ent cry­ing acous­tics than ba­bies with reg­u­lar cry­ing. “They tend to have a more vari­able and higher pitch and that the cry­ing is more ur­gent with the ba­bies look­ing ex­tremely un­com­fort­able and ir­ri­tated with no re­sponse to the nor­mal con­sol­ing,” says Dr Lot­ter.

When does your baby cry?

Their cry­ing has a di­ur­nal vari­a­tion, be­ing worse in the late af­ter­noons and evenings, and oc­curs for no ap­par­ent rea­son.

What does your baby do? “Look for pos­ture changes, pulling and curl­ing up of legs, clenched fists and tense ab­dom­i­nal mus­cles,” says Dr Lot­ter.

How do they feed? “Th­ese ba­bies of­ten have rapid weight gain due to their ex­ces­sive feed­ing in try­ing to help the cramp­ing episodes,” says Dr Lot­ter. The par­ents com­plain that their baby ex­pe­ri­ences lots of flat­u­lence and rum­bling tum­mies dur­ing and af­ter feeds.

When did it start? The con­di­tion of­ten started abruptly af­ter the so-called hon­ey­moon phase, which usu­ally lasts seven to 14 days af­ter birth.

GET­TING IT CHECKED You’re pan­icked, sleep de­prived and the last thing you feel like is a visit to the doc­tor, but Dr Lot­ter in­sists a colic di­ag­no­sis can­not be made with a tele­phonic con­sul­ta­tion and that all ba­bies that are ex­tremely ir­ri­ta­ble should be seen by a med­i­cal prac­ti­tioner and a proper his­tory with phys­i­cal ex­am­i­na­tion should be per­formed. “Spe­cial in­ves­ti­ga­tions are not in­di­cated in th­ese ba­bies, so the blood tests, X-rays, ul­tra­sounds and scans are of no value and should be avoided if there is no clin­i­cal rea­son. A sim­ple urine in­ves­ti­ga­tion dur­ing the of­fice visit might be the only test in­di­cated to ex­clude a blad­der in­fec­tion,” says Dr Lot­ter. He says an un­happy baby that is gain­ing weight well is most likely to suf­fer from colic, but an un­happy baby that has fail­ure to thrive does not have sim­ple in­fant colic.

WHAT CAUSES IT?

No spe­cific cause has been iden­ti­fied as yet, but sev­eral hy­pothe­ses are be­ing in­ves­ti­gated, in­clud­ing the as­so­ci­a­tion with gas­troin­testi­nal con­di­tions, parental anx­i­ety, poorly de­vel­oped hor­monal con­trol of the di­ges­tive sys­tem, ex­po­sure to cig­a­rette smoke, pos­si­ble food al­lergy (es­pe­cially cow’s milk al­lergy) and lately there is a fo­cus on the as­so­ci­a­tion on ab­nor­mal in­testi­nal mi­croflora, ex­plains Dr Lot­ter.

The rea­son you want to get it checked out is that your baby’s dis­tress could be caused by some­thing more se­ri­ous, or sim­ple to cure. “Your doc­tor may con­sider gas­troe­sophageal re­flux dis­ease, lead­ing to pain as­so­ci­ated with oe­sophagi­tis, or any other motil­ity con­di­tion lead­ing to poor ab­sorp­tion. Con­sti­pa­tion should be ex­cluded es­pe­cially in the baby that has fail­ure to thrive,” he says. Other con­di­tions that may be in­ves­ti­gated to rule them out are cow’s milk pro­tein al­lergy, lac­tose in­tol­er­ance, in­fec­tions, a stran­gu­lated her­nia, tes­tic­u­lar con­di­tions in boys or in­fant dyschezia (where a healthy baby strains and cries to pass nor­mal soft stools). IS THERE A CURE? Brace your­self: ev­ery­one from your gran to your hair­dresser will have a “rem­edy” for colic, but Dr Lot­ter says while there are many be­nign (un­harm­ful) treat­ments avail­able, most of them are un­proven to work, so try them with care! A trip to a chi­ro­prac­tor may help ease symp­toms and this is pop­u­lar, es­pe­cially if you have had c-sec­tion (the rec­om­mended age to per­form th­ese ma­nip­u­la­tions is at three weeks of age).

“It is ex­tremely im­por­tant for par­ents to re­alise that the con­di­tion is in­no­cent and the use of med­i­ca­tions with po­ten­tial side ef­fects should be avoided,” he says. Seda­tives should never be used, how­ever tempt­ing, but Dr Lot­ter does rec­om­mend the fol­low­ing:

Change your diet – If you are breast­feed­ing, ex­clude high al­ler­gen form­ing food from the diet due to the pos­si­bil­ity of the baby re­act­ing to th­ese food al­ler­gens through the mother’s milk – for ex­am­ple dairy, soy, egg, peanut, wheat and shell­fish. “If us­ing for­mula there are spe­cialised for­mu­las that are for­mu­lated for ba­bies with milk pro­tein al­lergy but they must only be used un­der the su­per­vi­sion of a pae­di­a­tri­cian,” says Dr Lot­ter.

Probiotics – Th­ese have been proven to be safe, but with mixed med­i­cal ev­i­dence dur­ing stud­ies.

Simeti­cone – This is an agent that de­creases flat­u­lence, but it has per­formed poorly in clin­i­cal stud­ies.

Hyo­sine – This is a smooth mus­cle re­lax­ant that is com­monly used for cramp­ing by de­creas­ing the spas­ming of the in­tes­tine. You may have heard of lac­tase en­zyme, which can re­duce flat­u­lence in a lac­tose in­tol­er­ant baby. Dr Lot­ter says that a re­cent study has shown the use of stom­ach acid-re­duc­ing med­i­ca­tion has no role in the treat­ment of colic. YB

AN UN­HAPPY BABY THAT IS GAIN­ING WEIGHT WELL IS MOST LIKELY TO SUF­FER FROM COLIC, BUT AN UN­HAPPY BABY THAT HAS FAIL­URE TO THRIVE DOES NOT HAVE SIM­PLE IN­FANT COLIC

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