Good Baby TipsTips for keeping your baby happy and healthy

What really is colic?

Colic is a very broad and commonly used term by different people in different ways. It is a condition mainly described by symptoms rather than a physiological explanation of what it is. In the 1950s, Dr. Morris Wessel, a well-known New Haven pediatrician, defined an infant with colic as “one who, otherwise healthy and well-fed, had paroxysms of irritability, fussing or crying lasting for a total of three hours a day and occurring on more than three days in any one week for a period of three weeks.” (click for source) Colic crying is often scheduled and happens around late afternoon or early evening. It starts when the baby is about two to four weeks old and usually ends in about three months of age (in some unusual cases it might extend beyond up till six months.) For your baby to be colic it is important that he is otherwise well-fed and healthy. If he has any other medical condition, he might be crying because of that. Before pursuing any treatment for colic, it is important to make sure that your baby is in fact colic.

Symptoms of Colicky Babies:

As colic is a condition primarily described only by its symptoms, it is helpful to keep an eye out for them. Each baby has different symptoms of colic, some exhibit only one while others may show a number of them.

• Colic is not a serious condition. Colicky babies continue to gain weight normally and have no permanent marks on their development because of it. However, it can be difficult on the parents’ nerves to handle a colic baby’s constant crying. A colic baby seems to be in pain which he might exhibit by becoming red in the face, clenching his fists, drawing his legs up to his stomach and then fully stretching them.
• Some colic babies refuse to eat or become very fussy soon after the feed.
• A colicky baby may also lift his head and legs and pass gas.
• Colicky babies might also experience fussiness, irritability, difficulty in sleeping and staying asleep.
• Colicky babies show signs of gas discomfort and abdominal bloating. Their stomachs often become hard and distended.

Colicky crying, but why?

As mentioned, the major characteristic for colic is uncontrollable, extended crying, but due to what? As there is disagreement about what colic really is, there is a lot of difference in opinions about its causes.

• Gastrointestinal discomfort: Most commonly, colic is associated with gastrointestinal discomfort as ‘colic’ comes from ‘colon.’ In the first three months of his life, the baby’s digestive system is still immature and developing till the age of three months. It has not yet developed the bacteria that aids digestion and is only learning to function. Therefore, it experiences spasms that cause colic.
• Immature nervous system: Another suggested cause for colic is a weak nervous system and a tendency of the baby towards general irritability. The baby, with an immature and developing nervous system, gets tensed up due to any external stimulation. Some babies are more sensitive in nature than others (just like adults) and react more to their surroundings. These babies are more prone to crying and becoming irritated due to some sudden change in the environment.  Sometimes it is also believed the colic can arise due to transmission of anxiety and stress from the parents to the baby.
• The baby’s milk: Sometimes colic is also linked to the baby’s milk, whichever he may be taking, breast or bottle. For breast milk, in a few cases, the diet the mother is taking, if it contains volatile chemicals, allergens or other gas producing foods, it may be passed to the infant. For bottle fed babies intolerance for cow milk is sometimes supposed to be the reason for colic.
• Swallowing Air: Babies also swallow air when they are feeding or strenuously crying. This builds up an air bubble that adds to the bloating and discomfort. It is a vicious cycle, the more the baby cries of colic, the more air he swallows and increases his discomfort.
• Crying triggering more crying: It is also thought possible that the baby’s own crying triggers colic crying in the same way a baby is startled by his own startle reflex.
• Gastroesophageal reflux disease (GERD): In some cases it is also suggested that colic is being caused because of undiagnosed GERD. This makes the baby vomit or become fussy after feeding.

All these causes of colic given above are conjectures and debated upon. Several researches have been conducted upon the causes of colic, producing supporting and contradictory results for each of the above causes. These reasons might or might not be the reason your baby has long spells of crying. As the causes of colic are not definitely agreed upon, there is no guaranteed treatment. Treating the colic is basically making the baby and the mother as comfortable as possible.

Treatment of Colic:

Before consulting your doctor for treatment of colic or concluding that your baby is in fact colicky and trying some home remedies, check for the following. These may be things other than colic that might be making your baby cry:

• Is your baby hungry?
• Is he tired and sleepy?
• Is he wet? Is it time to change his diaper?
• Is there a lack of contact between the mother and baby? Some babies want to be cuddled all the time
• Does the baby startle due to jerky movements or sudden noise?
• Is his body temperature normal? He may be too hot or too cold.
• Is he in pain because of something else? For example an open nappy pin or rash?
• Check with your baby’s doctor for other illnesses like fever, vomiting, cough etc.

If you are sure that your baby is not crying for any of the above reasons, then perhaps he is colic. There is no set treatment of colic; different babies are comforted in different ways. Perhaps one of the following might work for you:

• Avoid overfeeding: Do not over feed your baby in order to make him stop crying. If he is bottle-fed do not urge him to finish his formula. Over feeding may cause gas and stomach aches.
• Reduce amount of air: If your baby is bottle-fed, check the size of the nipple. If it is too big or too small, the baby might be taking in more air than he needs. Also try using a curved bottle or a bottle with collapsible disposable liners. The aim is to reduce the amount of air being swallowed by the baby.
• Switching Formulas: In bottle-fed babies allergies to cow’s milk or soy formulas have also been thought to cause colic. Consult your doctor and if he recommends, try switching to a different formula.
• Changes in a mother’s diet: For breast fed babies there might be something in the mother’s diet causing the colic. Check with your baby’s doctor and with his consultation drop onions, cabbage, cauliflower, spicy foods, caffeine, beans or other gas producing foods from your diet. Eliminating dairy from your diet might also be helpful although you should always check with the doctor. He might not recommend it or give you some calcium supplements.
• Regular Burping: Make sure to burp your baby after every feed to avoid the build up of an air bubble.
• A peaceful environment: When the baby is having a crying episode, take him to a place that is less noisy. Bright lights, a lot of activity, a large number of people around, fatigue and over stimulation, may make the colic episode worse.
• Warm bath/water bottle: Give your baby a warm bath or place a warm water bottle on your baby’s abdominal area. Make sure the water is not too hot by checking it on your hand first and then, for further caution, wrap it in a towel before placing it on the baby. You can also try gently massaging the baby’s stomach and back.
• Try different positions: Some positions are more comfortable for colic babies. For example he might like lying on his stomach in the mother’s lap, or being held with his abdomen resting on the mother’s forearm. As with constipated babies’ cyclic motion, laying a colicky baby on his back and bringing his legs towards his body and pressing his thighs against his abdomen might prove helpful.
• Rhythmic sounds and movements: Colic babies like rhythmic movements and a feeling of closeness. Try rocking or walking your baby or talking him on a car ride.  Rhythmic sounds like those of a dish washer, vacuum cleaner, clothes drier etc. also calm babies down. Some babies also respond well to rhythmic musical tapes.
• Sucking: Allow the baby to suck at the breast, his finger, or a dummy. Sucking in one way or the other sometimes helps babies to calm themselves down.

It is important for parents to allow themselves a break once in a while, as colicky babies can be very taxing on their nerves. Get help and go out for a walk or a movie. Do not feel bad about ‘abandoning’ your baby; you need your time too. It is also important for mothers not to feel guilty about a crying baby. Mothers often tend to feel that way when they can do nothing to pacify their child. Also remember not to feel responsible for the colic, you are not causing it and it is not your fault. Do not let this interfere with the development of a close relationship with the baby. Colic is very common in infants up to 3 months of age, so do not worry, relax and enjoy parenthood

Works and Internet Resources Cited:

• The Complete Pregnancy and Baby Book by Vicki Lansky et al.
• Baby and Child Care by Dr. Benjamin Spock
• The New Parents Guide: http://www.thenewparentsguide.com/babys-and-colic.htm
• T. A. Lawrance at Colic Calm: http://www.coliccalm.com/baby_infant_newborn_articles/baby_colic_treatment.htm
• Medicine Net: http://www.medicinenet.com/colic/article.htm

Every baby is unique when it comes to how many and at what times he has bowel movements. One baby has them at the same time every day; the other always has them at different times. Neither is healthier than the other and there is nothing to be gained by trying to make the irregular one regular in his movements. There is, instead, a chance of upsetting the baby emotionally in the long run.

The function of the large intestine (colon) is to hold undigested and indigestible food and absorb water from it. If, for some reason, the food stays there for longer and an excess of water is absorbed, the stool becomes hard and dry. Conversely, if the food does not stay there for enough time and the appropriate amount of water is not absorbed (as in the case of diarrhea) it can lead to dehydration.

For such a basic function of the human body, there are many misconceptions about bowel habits. Thus, it is important to know what is constipation and what is not.

Is my baby constipated?
Constipation has nothing to do with the number of times a baby has bowel movements, it only has to do with the hardness of the stool. The clearest indication of constipation is when the stool is hard and dry, no matter the number of bowel movements in a day. Other clues you should look for is the number of times your baby has bowel movements. There is no ‘normal’ number for a baby; each baby has his own routine that you will come to know in a few weeks. If your baby is not passing stool as often as he does (especially if he exceeds three days) then he might be constipated. Discomfort at passing stool is a sign of constipation too. However, straining might be normal for a baby, crying means greater discomfort and demands greater attention to the matter.

 
Is there a difference in the tendency of breast-fed and bottle-fed babies to get constipated?
Breast-fed babies rarely get constipated. This is due to the fact that breast milk contains a perfect balance of fats and proteins so the stool it produces is almost always soft. Breast milk is easily digestible and has several helpful types of bacteria that are capable of breaking down some of the otherwise indigestible proteins in milk. Breast milk is a low residue diet and almost all of it is absorbed and used by the baby’s body.

Bottle-fed babies are more likely to become constipated. This could be due to something in the formula composition. Consult your doctor about changing the formula brand. It is important to note however, that the amount of iron in formula milk has no bearing over constipation. Formula milk is also harder to digest so babies receiving only formula milk have lesser bowel movements with a thicker, more greenish kind of stool.

Why is my baby getting constipated?
There could be several causes for constipation: (click for source)

• Formula Milk: As discussed above, if a baby is on formula milk, something in the milk might be causing the constipation. Consult your doctor for suitable changes.
• Diet Imbalances: Constipation is also caused if the diet is imbalanced and does not have enough fiber which passes into the colon and stays there to retain water. This makes the stool softer. A diet without enough fiber does not have the natural softening effect.
• Introduction to Solids: A baby can also get constipated when introduced to solids. This can happen as rice cereal (usually the first solid given) is low in fiber. When a baby is introduced to solids the texture and colour of his stool changes. As the intestines are getting used to this new kind of nutrition the baby might have lesser bowel movements. This does not necessarily mean he is constipated as long as the stool is soft when it appears.
• Dehydration: In warmer climates babies lose more water. Sometimes, due to other reasons, if a baby is not getting enough fluid, it will make his body absorb more water from wherever it can get. This makes the colon absorb excessive water from the food, making the stood hard and dry and difficult to pass.
• A Medical Condition: In a very few cases constipation may be due to some medical condition that the baby suffers from e.g. hypothyroidism, a metabolic disorder, a food allergy or a condition called Hirschsprung’s disease. In some cases constipation can also arise due to some medicines a doctor has subscribed to the baby. In these cases, contact the baby’s doctor for guidance.
• Poor Bowel Habits: Having poor bowel habits means a baby does not have a bowel movement when he feels the urge. As the stool stays in the colon for longer than required, excess water is absorbed leaving it drier and harder. A baby might hold back a bowel movement subconsciously if he has already had a painful experience before. To avoid that pain, he does not want to pass stool. For children being toilet trained, a very strict mother who is very determined to train her child, could be the reason he holds back his stool to assert his independence. Once he does that the stool becomes harder making him more hesitant to make a bowel movement. This can start the vicious cycle of chronic constipation. If a child reacts in this manner it means he is not ready for toilet training yet. It is better to deley it.

How do I treat constipation?

Infant constipation, if it persists, should be brought to a doctor’s notice immediately. There are a few things you can do at home to help the baby with his bowel movements.

• Increasing Fluids: It is helpful to increase the fluids in the baby’s diet. You can do this by making him drink water between the feeding times. You can also introduce fruit juices in his diet e.g. prune, apple and apricot juice. They are rich in sorbitol, a non-digestible sugar that passes through the body to the colon and causes the water to be retained or drawn into the stool mass. Otherwise, chances are that the extra water would only pass out of the body as urine.
• Massaging the Tummy: You can also massage your baby’s tummy in a clockwise manner, starting at the navel and moving outwards. Apply gentle pressure. A little cream or oil on the mother’s fingertips might also help with the massage. Only continue massaging if the baby is comfortable with it.
• Exercising the Baby: It is also helpful to get the baby some exercise. If he has started crawling, let him do a few rounds. If he is not crawling yet, lay him flat on his back and turn his legs in a quick forward cycling motion. Exercising makes the stomach muscles move and puts gentle pressure on the intestines that would in turn, help the easy passage of the stool.
• Giving a Warm Bath: If your baby enjoys bathing, give him a warm bath. It helps him to relax and pass the stool easily. You can also use some cream or vaseline near the outside of the baby’s anus to make it softer.  
• Checking the Formula Milk: If your baby is on formula milk, check if you are preparing it right. Follow the instructions as given on the back of the box. Putting in lesser water and making a thicker mixture can lead to constipation. If the baby’s constipation persists, change his formula milk with the doctor’s consultation. There might be something in that particular brand that is making him constipated.
• Changes in Diet: If your baby is eating a variety of foods you can also boost his fiber in take by adding a spoon of bran to his cereal. You should also cut down on foods that are more prone to causing constipation e.g. rice, bananas, cooked carrots, cheese, yogurt, pasta etc. If your baby is younger and only takes breast milk, increase the number of feeds. If he is bottle fed, give him extra boiled and cooled water.

The Anal Tear:
Sometimes, when the baby passes very hard and dry stool, the anus may get teared. You will be able to see these tears or see blood in his stool. You can apply aloe vera lotion or Vaseline to that area to protect it and help its healing. It is important to alert  your baby’s doctor about these tears and take all steps with his consultation.