Baby colic and crying: what helps, and why gripe water will not

Colic is long bouts of crying in a healthy young baby, often in the evening, that nothing seems to settle. It usually starts at 2 to 3 weeks, is worst around 6 weeks, and fades by 3 to 4 months. It is hard on families, but it is not a disease and it ends. Gripe water, colic drops and reflux medicines do not cure it.

What is colic in a baby?

Colic is a pattern of long, hard-to-soothe crying in a baby who is otherwise healthy, feeding and growing well.¹

The classic "rule of threes" is crying for more than 3 hours a day, on more than 3 days a week, for more than 3 weeks.¹ It goes back to a 1954 study of "paroxysmal fussing".² Few parents keep a stopwatch, so in practice doctors look at the pattern: long bouts of crying that start and stop for no clear reason, which parents cannot settle, in a baby who is otherwise well.

Colic is something we name only after a doctor has checked the baby and found nothing else wrong.¹

How much crying is normal for a newborn?

A lot more than most families expect. In the first 6 weeks, babies fuss and cry for about 2 hours a day on average.³

A review of diary studies in more than 8,000 babies found average crying and fussing of about 2 hours a day in the first 6 weeks. By 10 to 12 weeks this fell to just over 1 hour a day.³ Some healthy babies cry much more than the average and some much less.

So a baby who cries for an hour or two every evening, but feeds well, gains weight and has calm spells, is most likely normal. That is worth hearing, even if it does not make the evenings easier.

When does colic start, and when does it stop?

Colic usually begins in the first few weeks, peaks around 6 weeks, and settles by 3 to 6 months.¹

In the large review of diary studies, colic was found in about 1 in 5 babies in the first 6 weeks, about 1 in 10 at 8 to 9 weeks, and fewer than 1 in 100 by 10 to 12 weeks.³ In other words, for most families the worst is over by about 2 to 3 months.

Crying that is still severe after 4 months, or that starts after that age, is less typical of colic. Ask your doctor to see the baby.

Why do babies cry so much?

Crying is how a baby tells you she needs something: food, comfort, sleep, a clean nappy, or simply to be held.

Check the simple things first:

• Is she hungry? Young babies feed often, and long runs of evening feeds are common.
• Is her nappy wet or dirty?
• Is she too hot or too cold? Feel her chest or the back of her neck.
• Is she overtired, or overloaded by noise, light and visitors?
• Is a hair wrapped tightly around a finger, toe or the penis?

Often none of these is the answer. Young babies also cry because their brains are still learning to calm down after they get upset. That skill grows a lot by 3 to 4 months.

What causes colic? Is it gas?

Nobody knows the exact cause of colic.¹ Gas is probably a result of the crying more than the cause of it.

Ideas that have been studied include changes in gut bacteria, cow's milk protein, an immature gut, feeding technique and smoking in the home.¹ None explains every case.

A crying baby's face looks pained, her legs pull up and her tummy feels tight. But that is what hard crying looks like in a small body. Babies swallow air while they cry, so the wind that comes out afterwards is not proof of tummy pain. Colic is also equally common in breastfed and formula-fed babies, in boys and girls, and in rich and poor homes.¹ This is why Dr Dutta does not blame the mother's lunch.

What is PURPLE crying?

The Period of PURPLE Crying is a parent education programme about the normal peak of crying in early infancy.⁴ Each letter stands for one feature.

• Peak of crying: it builds week by week and peaks at around 2 months.
• Unexpected: bouts come and go for no clear reason.
• Resists soothing: she may keep crying whatever you do.
• Pain-like face: she looks in pain even when she is not.
• Long lasting: bouts can go on for hours.
• Evening: crying clusters in the late afternoon and evening.

The word "period" matters most: it is a phase, and it ends. In a trial of nearly 2,800 mothers, those given the PURPLE materials knew more about normal crying and about the danger of shaking.⁴

How can I calm a colicky baby?

No single trick works for every baby. A calm routine that you repeat works better than switching methods every two minutes.

• Hold her close, skin to skin if you like, and walk with a slow, steady rhythm.
• Use steady background sound: shushing, a fan, or the kitchen chimney.
• Try gentle rocking, a pram ride on the terrace, or a car ride if that suits your family.
• Give a warm bath, then move to a dim, quiet room.
• Cut down evening stimulation from many relatives passing her around.
• Offer a feed, or a dummy if you use one once breastfeeding is settled.

Some of this works for a few minutes and then stops working. That does not mean you are doing it wrong. Parental support and reassurance are the main treatment doctors offer for colic.¹

What are the 5 S's for calming a baby?

The 5 S's are swaddling, side or stomach position while held, shushing, swinging and sucking. In one trial they reduced pain scores and crying time after vaccines in 2 and 4 month olds.⁵

Many parents find them useful for colic too, although proof for colic itself is weaker. Two cautions matter:

• The side or tummy position is only for a baby held in your arms while awake. Once she sleeps, put her on her back in her cot.⁶
• Swaddle snugly at the chest but loosely at the hips, and stop once she tries to roll.

Does gripe water help colic?

No good trial shows that gripe water reduces colic, and Dr Dutta asks families not to use it.

A study of 335 mothers in Puducherry found that about 64% gave their babies gripe water. Babies who got it had more colic, vomiting and constipation, not less.⁷ That kind of study cannot prove cause, but it gives no sign of benefit. Giving any liquid other than milk in the early months also replaces feeds and breaks exclusive breastfeeding.⁷

Herbal products for colic have only small, flawed trials behind them, and a Cochrane review concluded that herbal agents and sugar cannot be recommended.⁸ Home ghutti mixtures have unknown contents and doses, and Dr Dutta would avoid them. Hing paste on the tummy is harmless on the skin, but there is no evidence it helps.

Do colic drops like simethicone work?

No. In trials, simethicone (the anti-gas drop sold for colic) worked no better than a dummy liquid.^9,8

In a careful crossover trial of 83 babies with colic, parents reported improvement just as often with the placebo as with simethicone.⁹ A Cochrane review found no evidence to support it.⁸ The drops are not harmful, but they cost money and add a step to every feed. Dr Dutta does not prescribe them.

Do probiotic drops help colic?

One probiotic, Lactobacillus reuteri DSM 17938, reduced crying in breastfed babies with colic, but not clearly in formula-fed babies.¹⁰

A pooled analysis of 345 babies found that this probiotic cut crying and fussing by about 25 minutes a day at 3 weeks compared with placebo. The effect was strong in breastfed babies and not significant in formula-fed babies.¹⁰

Other probiotic strains do not share this evidence, so check the label. Dr Dutta sometimes suggests a 3-week trial for a worn-out family with a breastfed baby, with the clear message that it may not work.

Should my crying baby take reflux or acid medicine?

No, not for crying alone. Acid-blocking medicines such as omeprazole do not reduce crying in otherwise healthy babies.^11,1

In a trial of irritable babies with reflux, omeprazole lowered acid in the food pipe, but crying fell just as much on placebo. Babies improved with time either way.¹¹ Joint North American and European guidelines advise against these medicines for crying and distress alone in infants.¹² They carry side effects, including more chest and gut infections, so they need a real reason.

Should I stop dairy or change my baby's formula?

Usually not as a first step. A US review lists a maternal low-allergen diet for breastfed babies and a hydrolysed formula for formula-fed babies among colic treatment options, but the evidence for them is modest.¹ Dr Dutta finds these trials most worthwhile when crying comes with other signs of cow's milk protein allergy.

Signs that point towards allergy include vomiting, blood or mucus in the stool, eczema, poor weight gain and a strong family history of allergy. In that case, a trial of strict avoidance for a few weeks, then reintroduction to check, is the usual plan.¹³ For breastfed babies the mother removes dairy. For formula-fed babies a hydrolysed formula (in which the milk protein is broken down) is an option.¹

For crying alone, cutting out milk, curd and mishti for months costs mothers a lot and rarely helps. Changing formula every week, or stopping breastfeeding, usually makes things harder.

What should I do if I feel I might lose control?

Put your baby down safely on her back in the cot, close the door, and step away for 10 minutes. A crying baby in a safe cot is safe.

Feeling angry, desperate or helpless when a baby cries for hours is normal. It does not make you a bad parent. Crying is the most common trigger for shaking a baby. Reports of shaken baby cases rise and fall with the normal crying curve, peaking in the first months of life.¹⁴

• Breathe. Drink a glass of water. Go to another room.
• Call someone: your partner, a friend, your mother, your doctor.
• Go back only when you feel calmer.

Please tell everyone who looks after your baby, including grandparents, older children and household help.

Why is shaking a baby so dangerous?

Shaking can cause bleeding in and around the brain. The results range from learning problems to blindness, fits, severe disability and death.¹⁵

A baby's head is heavy and her neck muscles are weak. When she is shaken, the brain moves inside the skull and blood vessels tear. This is called abusive head trauma.¹⁵ It can happen in a few seconds of frustration, and it is entirely preventable.

Never shake a baby, not even a little, not even in play. Tossing a young baby in the air "for fun" is also unsafe.

How can our family cope with a colicky baby?

Share the load. Colic is a household problem and it needs a household rota.

• Take shifts. One adult rests, with earplugs if needed, while another holds the baby.
• Let grandparents help with cooking and washing, not only with advice.
• Keep evenings quiet. Fewer visitors in the colic weeks is a fair request.
• Get outside in daylight once a day if you can.

Watch for low mood in yourself and your partner. Long weeks of crying and broken sleep can tip a parent into depression, and fathers can be affected as well as mothers. If you feel hopeless, cannot sleep even when the baby sleeps, or have frightening thoughts, tell your doctor. That counts as a medical reason for a visit.

When should I take my crying baby to a doctor?

Colic is only for babies who are otherwise well.¹ Go to hospital now if your baby under 3 months has a temperature of 38 degrees C or more, or feels unusually cold. See a doctor urgently, the same day at the latest, if crying comes with any of these:

• a weak, high-pitched or moaning cry, or a baby who is floppy or very sleepy
• poor feeding or far fewer wet nappies
• green vomit, forceful vomiting, or blood in the stool
• a bulging soft spot on the head
• a swelling in the groin or scrotum
• sudden screaming spells with pale skin and drawn-up legs in a baby who was settled before
• crying when a limb is moved or the baby is handled

Book a routine visit if crying is getting worse after 8 weeks, if she is not gaining weight, or if you are not coping. Often the most useful thing Dr Dutta does in a colic visit is examine the baby, tell you she is healthy, and help you plan the next few weeks.