Colic

Also indexed as: Abdominal Pain (Infants)

Colic is a common problem in infants, where the baby is healthy but has periods of inconsolable crying, apparently caused by abdominal pain. Colic usually develops within a few weeks of birth and disappears by the baby’s fourth month.

Checklist for Colic

Rating Nutritional Supplements Herbs
2Stars   Chamomile
Chamomile, vervain, licorice, fennel, lemon balm (in combination)
1Star   Caraway
Cinnamon
Fumitory
Garden angelica
Hyssop
Peppermint
Yarrow
See also:  Homeopathic Remedies for Colic
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of colic? Colic may cause infants, typically less than four months old, to cry inconsolably. The attacks usually occur in the late afternoon and evening, sometimes lasting for hours. During a colicky period, babies may bring their knees up, clench their fists, grimace, hold their breath, and generally be more active.

How is it treated? The conventional treatment is to provide comfort for the babies until they outgrow this difficult period. Sometimes, anti-gas medicine containing simethicone (e.g., Di-Gel®, Mylicon®, Phazyme®) helps to reduce symptoms. Feeding babies while they are sitting up or burping them more frequently may help prevent colic if too much air is being swallowed during feedings.

Dietary changes that may be helpful: Allergies may be responsible for colic in some infants.1 2 If the child is fed with formula, the problem may be an intolerance to milk proteins from a cows’ milk-based formula.3 Switching to a soy formula may ease colic in such cases.4 Infants who are sensitive to both milk and soy may be given a hypoallergenic formula containing extensively hydrolyzed proteins. However, some children are sensitive even to these formulas.

A true food protein intolerance in infants may result in persistent distress attributed to irritation of the esophagus caused by reflux (partial spitting up). These infants may respond to an amino acid-based formula. In a clinical trial, infants who were intolerant of soy and extensively hydrolyzed formula, and who had failed to respond to various formula changes, were switched to an amino-acid formula (Neocate).5 After two weeks, all the infants receiving the amino acid-based formula showed less distressed behavior and fewer symptoms of reflux.

If a baby is breast-fed, certain foods in the mother’s diet may provoke an allergic reaction in the baby. Cows’ milk consumed by a breast-feeding mother has been shown in some,6 but not all,7 studies to trigger colic. Cows’ milk proteins, which may trigger allergic reactions, have been found at higher levels in milk from breast-feeding mothers with colicky infants than in milk from mothers with non-colicky infants.8 Changing to a low-allergenic formula or restricting the mother’s diet to exclude certain allergy-triggering foods significantly reduced colic symptoms in the infants in one double-blind trial. 9 A healthcare provider can help determine which foods eaten by breast-feeding mothers may be contributing to colic.

Lifestyle changes that may be helpful: All infants, particularly those with colic, need to be fed on demand and not by a specific clock schedule. Often a baby’s cry is triggered by discomfort caused by low blood sugar. Unlike adults, infants do not have a carefully regulated ability to maintain healthy blood sugar levels in the absence of food. This physiological shortcoming of infants can be solved only by feeding on demand.

In one trial, parents were taught not to let babies cry unnecessarily but rather to attempt feeding right away in response to the infant’s cry.10 If that failed, parents were taught to try to respond to the cry in other ways, such as holding the infant or providing the opportunity to sleep. These parents were also given the solid medical advice that overfeeding is never caused by feeding on demand nor will the baby be “spoiled” by such an approach. As a result of this intervention, colic was dramatically (and statistically significantly) reduced, compared with a group of mothers given different instructions.

Herbs that may be helpful: Carminatives are a class of herbs commonly used for infants with colic. These herbs tend to relax intestinal spasms.

Chamomile is a carminative with long history of use as a calming herb and may be used to ease intestinal cramping in colicky infants. A soothing tea made from chamomile, vervain, licorice, fennel, and lemon balm has been shown to relieve colic more effectively than placebo.11 In this study, approximately 1/2 cup (150 ml) of tea was given during each colic episode up to a maximum of three times per day.

Hyssop has mild sedative properties and may also be helpful in relieving colic, but research is lacking. Though no definitive information on hyssop supplementation is available, 1 teaspoon of hyssop herb steeped in 1 cup of just-boiled water in a closed container for 15 to 20 minutes, then given in sips from a bottle over a period of 2 to 3 hours may help calm colic.

Caraway, like chamomile and fennel, relieves intestinal cramping and, in this way, may ease symptoms of colic. One tablespoon (15 grams) of caraway seed is mixed with 8 oz (240 ml) of just-boiled water and steeped in a closed container for at least 10 minutes. Three ounces of vegetable glycerin is added, and the resulting mixture is stored in a bottle in the refrigerator. Up to 1/2 teaspoon (2.5 ml) of the liquid may be given every 30 minutes to a colicky infant or given 15 minutes before feeding.12

Several other gas-relieving herbs used in traditional medicine for colic are approved in Germany for intestinal spasms.13 These include yarrow, garden angelica (Angelica archangelica), peppermint, cinnamon, and fumitory (Fumaria officinalis). These herbs are generally given by healthcare professionals as teas or decoctions to the infant. Peppermint tea should be used with caution in infants and young children, as they may choke in reaction to the strong menthol.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: The symptoms of colic may be linked to mild biomechanical disturbances of the spinal joints and may respond to manipulation. A large, preliminary study of infants treated by chiropractic manipulation for colic reported marked improvement, often after one treatment.14 This echoed an earlier study in which questionnaires sent to parents of 132 infants under chiropractic care revealed that 91% of the respondents observed improvement in their babies’ symptoms after two to three manipulations.15 In a controlled trial, infants were treated daily for two weeks either with a placebo medication or with a series of three to five treatments using gentle “fingertip” spinal manipulations.16 Those treated with manipulation experienced a 67% reduction in daily hours of colic, compared with only a 38% reduction in infants on medication.

References:

1. Sampson HA. Infantile colic and food allergy: fact or fiction? J Pediatr 1989;115:583–4.

2. Hill DJ, Hosking CS, Heine RG. Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment. Ann Med 1999;31:272–81.

3. Lothe L, Lindberg T. Cow’s milk whey protein elicits symptoms of infantile colic in colicky formula-fed infants: a double-blind crossover study. Pediatr 1989;83(2):262–6.

4. Lothe L, Lindberg T, Jakobsson I. Cow’s milk formula as a cause of infantile colic: a double-blind study. Pediatr 1982;70(1):7–10.

5. Hill DJ, Heine RG, Cameron DJ, et al. Role of food protein intolerance in infants with persistent distress attributed to reflux esophagitis. J Pediatr 2000;136:641–7.

6. Jakobsson I, Lindberg T. Cow’s milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatr 1983;71(2):268–71.

7. Evans RW, Fergusson DM, Allardyce RA, et al. Maternal diet and infantile colic in breast-fed infants. Lancet 1981;49:1340–2.

8. Clyne PS, Kulczycki A. Human breast milk contains bovine IgG. Relationship to infant colic? Pediatr 1991;87:439–44.

9. Hill DJ, Hudson IL, Sheffield LJ, et al. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol 1995;96:886–92.

10. Taubman B. Clinical trial of the treatment of colic by modification of parent-infant interaction. Pediatr 1984;74:998–1003.

11. Weizman Z, Alkrinawi S, Goldfarb D, et al. Efficacy of herbal tea preparation in infantile colic. J Pediatr 1993;122:650–2.

12. Bove M. An Encyclopedia of Natural Healing for Children and Infants. New Canaan, CT: Keats Publishing, 1996:106.

13. Schilcher H. Phytotherapy in Paediatrics. Stuttgart: Medpharm Scientific Publishers, 1997, 80.

14. Klugart N, Nilsson N, Jacobsen J. Infantile colic treated by chiropractors: a prospective study of 316 cases. J Manip Physiol Ther 1989;12:281–8.

15. Nilsson N. Infant colic and chiropractic. Eur J Chir 1985;33:264–5.

16. Wiberg JM, Nordsteen J, Nilsson N. The short term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manip Physiol Ther 1999;22:517–22.