infant colic

[jonheatley]

As a GP and father of three boys all healthy (thank goodness) I would like to pass on my thoughts about colic. It is so common as to be regarded as normal behaviour and if your infant misses it count your blessings.
The new baby is used to perfect comfort in the womb so the first year or two can be quite a challenge for them to adapt. Thus they will scream if tired or hungry or uncomfortable in any way. The bowels need to adapt to the business of digesting food whether breast or bottle milk and this will cause mild abdominal discomfort - ie colic. Nothing can really remove this mild discomfort and after a while the baby gets used to it and the colic/screaming stops. Therefore although it sounds harsh they have to learn to deal with it. This means that being anxious about it and trying desperately to reduce the distress is probably going to make it persist longer and cause the poor parents a lot of angst. No baby has come to harm from it and they are much tougher on the whole than their parents. I remember admitting a screaming 5 month old one christmas afternoon as his parents had blended up a normal christmas dinner and fed him that from a bottle! He created for hours until he had digested it then was back to his usual happy self..

[AndHarry]

Christmas Dinner in a bottle sounds like something you would get from McDonald's!

[Mycatistoosexy]

My son had colic. He screamed solidly for 3 hours a night (he cried most of the day but solidly through the evening).

Doesn't make it any easier for the parents knowing there is nothing you can do.

[Ragusa]

I had countless HCPs telling me that if only I would relax and lose the anxiety the 'colic' would pass sooner.

Complete shite. Baby had milk allergy and oesophagitis. Prob in the minority I realise, but it isn't slways the case that the baby will "get used to it".

[Becky5W]

My baby girl has colic and it's horrible not being able to do anything to help her! We have just bought the dr brown bottles and I've only just started her on them today and already seems much more settled! Fingers are crossed!!

[jonheatley]

in the old days we used to be able to prescribe a drug called merbentyl which stopped gut contractions and its effect was dramatic but in rare cases it could cause complications so its no longer available. It showed that most cases were due to painful gut movements and now I'm afraid we have to let nature do its thing knowing it will pass but yes, its pretty stressful for the parents. Knowing it is harmless should help a bit.

[Ragusa]

I do agree that colic, whatever it is, is usually harmless and passes.
But please, GPs, listen carefully to parents when they say that they think something else might be going on.

I have lost count of the number of people whose legitimate concerns have been unhelpfully brushed aside and filed under 'colic' or 'over-reacting first-time parent'. It is not at all helpful to be told 'it's normal' and 'it shall pass' if it isn't normal and would pass much quicker with intervention. Sorry, personal bugbear of mine and I might be going on .

[Ragusa]

I also think it would be helpful in the management of colic if GPs underwent more mandatory training on the normal course of infant feeding.

Sometimes there are contribtuing factors to colic - such as tongue-tie, ineffective milk transfer, formula over-feeding, breastmilk overuspply or forceful letdown, etc etc etc. None of these were ever mentioned to me in connection with my first baby's colic, or my second baby's colic-that-wasn't.

What do you think, jon?

[roamingwest]

I totally agree with posters who advocate that GPs should out rule other causes of distress before diagnosing colic. As two doctors (not GP or paeds) my husband and I put up with 'colic' for 8 weeks before finally getting a posterior tongue tie dx and treated. My baby's distress disappeared in 72 hours once her latch improved.

All my GP friends have now had a crash course on tongue tie! Colic should be a diagnosis of exclusion, not a catch-all.

[roamingwest]

Also, I think (in my limited experience) that GPs underestimate sometimes the value of lactation consultants. I sought one out independently (who had my baby sorted within a week) but I was shocked that so few of my GP friends were even aware of their existence (nor was I until I required one!). That's in rep of Ireland though, I hope the situation is better in the UK.

[Ragusa]

Ha! No! no better in England. One GP I saw told me lactation consultants were "the bane of his life" . Quite how their work could affect his life to such a degree is something I have always wondered.

[roamingwest]

I'm sure 'twas meant in the nicest possible way! GPs speak similarly of specialist palliative nurses etc but wouldn't be without them!

Anyway back to colic - any thoughts OP?

[roamingwest]

I'm sure 'twas meant in the nicest possible way! GPs speak similarly of specialist palliative nurses etc but wouldn't be without them!

Anyway back to colic - any thoughts OP?

[Ragusa]

Heh! It really wasn't. He was quite cross when I told him what the LC had suggested, and dismissed it with a wave of his hand. NB - LC was correct in her advice as it turned out, whereas he was woefully misguided .

[roamingwest]

Ah well I do feel sorry for GPs sometimes as they're expected to be experts in all areas of medicine....which is just impossible!

Having said that, the best GPs recognise they don't know everything and respect the expert advice they get from others. Like the example I used before, specialist palliative care nurses see it as a major part of their role to build relationships with and educate GPs, district nurses, HVs etc. Maybe lactation consultants could adopt a similar approach? For example, they could have contacted your GP directly and explained their thinking re your baby's condition, rather than leaving it up to you to pass on the info second hand?

I would be really interested to hear what any lactation consultant would have to say? I think they might be underselling yourselves as health care professionals

[roamingwest]

Themselves obvs

[Ragusa]

That's a good pointabout LCs, roamingwest. They do seem to be out on a limb a bit.

I do sympathise with GPs having to be jack of all trades.... it's the ones who give the impression that they know everything that rub me up the wrong way. My own regular GP is rather fabulous and extremely handsome, although that doesn't matter, no, not at all

[jonheatley]

I have never heard of a lactation consultant and will ask about them. The NCT breast feeding adviser steps into that role around here. I try to be as open as possible to help and information from whatever source, but my recent experience is of desperate parents convinced there is something seriously wrong with their child with colic. They go to the local hospital and attend paediatric clinics and they are started on all sorts of drugs such as ranitidine, metaclopramide and gaviscon to treat the reflux in the hope it will help; but after an initial improvement the colic invariably comes back only to disappear after a couple of months with no specific intervention. I want to try to explain and reassure young parents that the great majority of infants have colic pure and simple and that it goes with no specific treatment.
Aren't we in danger of over medicalising something and giving these normal infants a lot of drugs? From some of the threads it would seem that every child with colic has something seriously wrong and certainly that is the belief of most parents today. This does not help them deal with what is without doubt a distressing but a normal developmental stage.

[LizzyDay]

For what it's worth, I apparently had severe colic and sickiness as a baby and as far as I know my mother just rode it out. It was a difficult time though.

When I had my DD, she had lots of digestive problems (culminating in failure to thrive, paed referrals etc) and it turned out to be a cow's milk protein allergy. It's probable that I have/had a similar sensitivity which is what was causing the 'colic' that I suffered.

Personally I think HCPs should be more aware of the possibility of allergies/sensitivities in young babies, especially to milk, which lets face it is what they drink. Even breastfed babies are exposed to CMP if the mother has it in her diet.

[LizzyDay]

www.gpnotebook.co.uk/simplepage.cfm?ID=-268042236

adc.bmj.com/content/92/10/902.full

More about CMP allergy for anyone interested.

[LizzyDay]

From the second article:

"CMPA is easily missed in primary care settings and needs to be considered as a cause of infant distress and diverse clinical symptoms.3 Accurate diagnosis and management will reassure parents. CMPA can develop in exclusively and partially breast-fed infants, and when CMP is introduced into the feeding regimen. Early diagnosis and adequate treatment decrease the risk of impaired growth."

[LizzyDay]

And

"CMPA has also been related to infantile colic. However, colic has numerous aetiologies which should be considered during the differential diagnosis. However, there is a subgroup of about 10% of colicky formula-fed infants in whom the colic episodes are a manifestation of CMPA"

[JiltedJohnsJulie]

Can remember the HCPs coming out with this condescending trite rubbish when DS screamed 24/7. It turned out that he had tongue tie. Not that any of them were motivated enough to check for it or even discuss the possibility. Couldn't feel more let down by the lack of care we received over DS colic. It wasn't you was it OP?

[mawbroon]

YY to tongue tie being the cause of some cases of colic

Dr Kotlow

[roamingwest]

I wonder if there has been any well designed epidemiological type study looking at colic - if you add up all the babies with tongue tie, CMPA, reflux etc, what is the proportion of babies left with genuine, no-underlying-cause colic. Would be a v interesting (albeit difficult to design to achieve rigour) study for a GP interested in colic - what do you think OP?

[roamingwest]

Also (really getting into this thread, it's such an interesting and relevant topic!) Jon (OP), for those babies that you are sure have true colic with no underlying cause, can I advise that you recommend to your patients a book / DVD called 'The Happiest Baby on the Block.' A US paediatrician (Harvey someone, can't remember now) with simple tips on how to settle crying babies. V v useful.