Infant Colic: Helping out New Parents
May 17, 2013
By Barret Procyshyn, Pharmacist at the Dauphin Clinic Pharmacy
As a pharmacist, I get to see a lot of very cute babies and infants. Some of my fiances best friends have also either recently had babies or are soon to give birth. So far our friends seem to have very good babies and even though I am not yet a parent, in my opinion they do not seem to cry all that much. However; this is not always the case, especially when infant colic is present.
Colic is reported to occur in approximately 10-20% of healthy infants. Colic usually follows the rule of three which defined as unexplained bouts of crying and fussing lasting more than three hours a day, for more than three hours a week, for greater than three weeks. Colic is often also associated with clenching of the fists, reddening of the face, abdominal bloating and sometimes vomiting. Colic occurs in both breast fed and formula fed babies, most commonly in infants aged 4-6 weeks.
The exact cause of colic is unknown, which can be very frustrating for parents because they may not be able to pinpoint a cause. There are a few proposed categories of causes which include organic, behavioral and psychological. Organic causes include things like carbohydrate intolerance, gas, impaired stomach motility and possible food allergy. Behavioral and psychological include things like improper feeding, exposure to cigarette smoke and difficulties in parent-child interactions. Organic causes are likely the most significant. Gas and digestive intolerances are quite common, even if the infants symptoms are not severe enough to classify as colic. Newborn gas is a natural by-product of digesting lactose, proteins and other nutrients from food. Breast milk may also contribute to higher rates of stomach cramping, leading to increased fussiness.
Monitoring a baby showing signs of colic is an extremely important step in symptom improvement. A colic diary documents crying and fussing spells, which can then be used to create some management strategies. Parents can log behaviors and look for patterns, which will enable them to modify things like feeding and sleeping times to try and improve the situation. The diary may also give parents a sense of control and understanding of the situation, which is very important.
Treatment goals include ensuring the child is eating well, not dehydrated, sleeping well and most importantly we try to decrease crying episodes. Because the child cannot communicate properly it is also important to consult a family physician to ensure there are not any underlying causes contributing to the symptoms. While finding the cause of colic can be frustrating, treatment can be even more frustrating. Non-drug measures should always be tried first. Various types of massages can be tried including whole body gentle massages and belly massages, gently performed in a clockwise spiral motion. Sometimes babies who show gastric distress may find some relief in having their legs pushed gently back and forth in a bicycle type motion. Warm water baths may help relief bowel spasms, but parents must be very careful with the temperature of the water used.
If using a medication is deemed necessary, the lowest effective dose should always be used. Medications should only be given to treat symptoms when necessary. Giving sucrose (sugar) dissolved in water is sometimes recommended, but effectiveness is not well studied. Sucrose is believed to have a pain relieving effect, but its duration of action seems short at about 30 minutes. Simethicone (Ovol) works to allow gas bubbles to be more easily released by the baby. The effectiveness of simethicone in colic is often doubted, but it is safe for babies, and can be worth a try for some infants. An over the counter product called Kolik combines a probiotic, sodium bicarbonate and oil of fennel, all which may have some benefit.
Probiotics have significantly increased in popularity for treatment of colic. While data is limited, probiotics have shown to provide significant reduction in crying times. Probiotics are also accepted as being very safe for babies and infants. Probiotics have shown to help promote digestive health when health conditions such as infant colic arise. Biogaia is a probiotic which has shown to reduce the average crying time by as much as 56%, although some may question the quality of this data. From my experience with parents in the pharmacy, this medication does have some definite benefit.
Some treatments which may be suggested, but not recommended include: Benydryl, due to sedation, constipation and urinary retention; Sedatives, due to the risk of excessive sedation and limited benefit; and although gripe water is commonly used, it may only increase flatulence.
Small infants are very delicate and we need to be cautious when using medications. If you ever have any medication questions or questions on an illness regarding your infant, your pharmacist can help.
As always if you have any questions or concerns about these products, ask your pharmacist.
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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.