health
What about colic?
Colic refers to excessive crying or fussing with no obvious medical cause, in an otherwise healthy baby. According to the Rome IV criteria, a set of diagnostic guidelines used to classify functional gastrointestinal disorders( FGIDs), infantile colic involves: 1. Recurrent crying episodes lasting more than three hours a day, more than three days a week, for over three weeks.
2. Crying starts and stops in a baby under five months old. 3. The baby is thriving and shows no signs of illness.
Colic affects up to 40 % of babies and can happen in any baby, regardless of sex, birth order, or feeding method. It typically starts around two to three weeks, peaks at six to eight weeks, and improves by 16 weeks. Colicky crying is more intense and may occur suddenly, often in the evening, and is associated with physical signs like clenched fists and legs drawn up toward the tummy.
Possible causes of colic
There are four main theories about colic: 1. Altered gut microbiota: A healthy balance of gut bacteria is crucial for digestion and immunity.
2. Altered gut motility: Poor coordination of the baby’ s gut movements may contribute to discomfort.
3. Hypersensitivity to stimuli: The baby’ s brain might be overwhelmed by normal light, sound, and movement, leading to fussiness.
4. Exacerbation of normal crying: Some babies may simply cry more than others.
Feeding difficulties, such as swallowing air, overfeeding, or an improper latch, can also contribute. Family stress or anxiety may further exacerbate the situation.
When to seek help
While colic is generally not harmful, parents should watch for“ red flags” that might indicate a medical issue, such as:
• Blood or excess mucus in the stools
• Poor weight gain
• Eczema or other skin rashes
• Severe vomiting
• Difficulty feeding
These could signal conditions such as cow’ s milk protein allergy, reflux, or lactose intolerance.
Managing colic
Though challenging, colic is physically not harmful to the baby. Some studies on the brain-gut connection suggest that colicky babies might be at a slightly higher risk of developing emotional issues later in life, especially if they do not get enough sleep. While time is the best healer, there are strategies to help ease colic:
1
Watch for any red flags, and make sure the baby is feeding and growing well.
2
Make sure the baby is getting enough milk( 100 – 150ml / kg per 24 hours) and that feeding positions are correct to minimise air intake.
3
Rule out medical causes:
Evaluate feeding techniques:
Consider cow’ s milk protein allergy:
A two-to-three-week trial of a cow’ s milk and dairy elimination diet for breastfeeding mothers, or a specialised formula for formula-fed babies may help. Avoid extreme elimination diets that deprive both mother and baby of essential nutrients.
Addressing potential causes
If there are no red flags, management strategies depend on the possible causes:
Altered gut microbiota:
Gut motility:
Hypersensitivity:
Probiotics like Limosilactobacillus reuteri may help.
Hold the baby upright after feeding and gently pat their back to help release air. A warm bath or tummy massage can also ease discomfort.
Hold and rock the baby gently, provide white noise, or let the baby rest in a quiet room with reassurance that you are nearby.
The first three to four months of parenthood can be challenging, particularly with a fussy baby. Understanding the normal crying curve and recognising when colic might be beyond normal can help manage expectations. Keep in mind that responding to your baby’ s cries is vital for bonding and attachment. Don’ t forget to take care of yourself as a parent – seek help when needed, avoid unrealistic expectations, and remember that this challenging phase will pass. �
REFERENCES: 1. Kesavelu D. Recent Advances in the Management of Infantile Colic.“ Journal of Probiotics and
Health”, 2021 2. Valla L. et al. Association between Colic and Sleep Problems in Infancy.“ BMC Paediatrics, 2021” 3. Gray CL, Van Niekerk E. Food Allergy in a Nutshell, South Africa, 2020 4. Gray C. Dr Gray’ s Real Parenting and Paediatrics. Quivertree Publishers, South Africa, 2025
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