mother feeding baby with bottle

Scientific Article

An Overview of Clinical Presentation, Possible Causes of and Treatment Options for Infant Colic

Prof. Dr. Reinhold Kerbl


Infant colic, or three month colic, usually occurs during the first three to four months of life and is exhibited by sustained crying, whining, restlessness and tucking of the legs. When visiting a paediatrician, parents of affected babies mention they have the feeling that the child is in pain.

Definition of Terms

In 1954, a definition of so called “colicky infants” from Wessel et al., was published in Pediatrics. This distinguishes between “Wessel colic” and “non-Wessel colic”. “Wessel colic” refers to when a baby cries or fusses at least three days a week for three hours. If this occurs less often, it is known as “non-Wessel colic”. These definitions are valid to this day and help to establish objective criteria.

Occurrence

Several studies about the frequency and occurrence of infant colic have yielded very different results. A Scandinavian study (Canivet et al., 2002) noted a prevalence of 9.4% with 2.3% Wessel colic. A Turkish study (Ciftci et al., 2007) showed a much higher percentage with an overall prevalence of 75.8% and 51.1% “Wessel babies”. And finally, according to a study from Iran (Talachin et al., 2008), 20.4% of all infants suffer from Wessel colic.

One can only speculate about the reasons for such large fluctuations. It may be possible that genetic or ethnic factors have an effect while varying infant care practices (i.e., dietary) may also justify the differences. There is also the chance that it may be due to a differing subjective perception of temperament. 

Possible Causes

So far, we can only speculate about the true origin of infant colic. There are various explanations with very different views. Numerous works see infant colic as a "behavioural problem" or even as a transitional stage of early childhood development. In many cases, the mother-child interaction is brought into play in this context. Another approach considers infant colic primarily a “dietary problem”, based on the premise that non-breastfed babies are about twice as likely to suffer from colic as breastfed babies. Some works also discuss an “allergic origin” (i.e., through bovine IgG). Lastly, infant colic is often interpreted as an “air or gas problem” since a distended abdomen is frequently observed in affected babies.

Natural Course

Generally speaking, most cases of infant colic are self-limiting and disappear between the ages of four and seven months. However, some studies found that babies with infant colic increasingly tend to suffer behavioural problems and subsequent complaints in the long term. According to a Swedish study (Canvet et al., 2000), even after four years, affected children display cumulated negative emotions, eating disorders and abdominal pains. A study from the USA (Neu et al., 2002) asserts that affected children of school age still have inadequate stress reactions in certain situations. Against this background, treatment seems clearly indicated.

Various Treatment Options

There is also disagreement regarding the recommended measures and treatment options. Initially, parents usually follow recommendations from friends and family to calm the baby. These include carrying the baby around, rocking in the pram, going for a drive, patting on the back and belly massages (sometimes using a topical anti-bloating cream). The effectiveness of these methods is likely based on a placebo effect and the satisfaction of having done something. Often, changes in diet and administering fennel tea are tried in an effort to remedy dietary imbalances. The placebo effect cannot be ruled out here either. 

Pre and probiotics also present a potential treatment option though there is no objective proof of effectiveness thus far. Simethicone is also often used therapeutically. Although the effectiveness has not been proven, it is at least free of side effects. Last but not least, there are homeopathic and other complimentary medical or psychotherapeutic approaches (outpatient clinics for “cry-babies”).

The transition to a vented bottle may be attempted to eliminate “air swallowing” as part of the cause of infant colic. In one study, our research group at the Leoben regional Hospital in Austria observed a significant reduction of bloating, tucking the legs, crying and severe regurgitation within two weeks of switching to the MAM Anti-Colic bottle.

For this reason, switching to a vented baby bottle may be recommended as a helpful treatment method.

Prof. Dr. Reinhold Kerbl

Paediatrician

Dr. Reinhold Kerbl is the head of the paediatric department at the Leoben Regional Hospital in Austria and one of the leading specialists in the field of children’s medicine in the German-speaking world. Prof. Kerbl has received a number of awards for his work.