What is colic?

The official definition of baby colic, also known as infantile colic, is when an infant who isn't sick or hungry (excessively) cries for more than 3 hours a day, more than 3 days a week, for at least 1 week or more than 3 weeks — without any obvious cause.

It's a common problem that affects one-fifth of all babies, usually between the second and fourth weeks, and often gets better by around 3 or 4 months of age.

Colicky babies cry inconsolably, often screaming (high-pitch cry), go red in the face and may also draw their knees up if they have trapped winds. They may also be bloated, but not always, indicating that many factors may be involved.

One of the hallmarks of infantile colic is that babies with colic are healthy, eating well and growing as they should but cry in spells. The spells typically happen at the same time every day and can last for a few hours each day for several weeks (usually up to 3 months).

Because there is no obvious cause the episodes can be very distressing for both baby and parent and may also disturb the sleeping patterns of the baby (as well as those of the parents).

Typical signs and symptoms

Infants may cry more often in the afternoon and evening, indicating that there may be some dietary factors involved (as adults, they may experience symptoms the more food they ingest). You may suspect colic if:

• it's hard to soothe or settle your baby — distinctive, intense crying (high pitched, piercing sound) that may seem more like screaming (or an expression of pain) for a long period of time,

• they clench their fists.

• they go red in the face.

• they bring their knees up to their tummy or arch their back (especially if they are also bloated, and/or constipated).

• their tummy rumbles or they're very windy.

Suspected causes

The digestive system of a newborn is yet to be fully developed. Their gut is not yet the tight wall it is supposed to be once they’re older. Their gut is leaky to let the larger molecules, like proteins, enter the bloodstream and be used by the body. Assimilation, therefore, is a lot easier and is less taxing on the body.

Their gut is also being populated with a more diversified microflora crowding every available space. The process is easier or more difficult depending on the mode of delivery (e.g., vaginal birth or c-section), the diet of the mother, the health status of the mother, as well as the mental state of the mother (e.g., stress, anxiety disorder or postnatal depression, indoors/sedentary lifestyle) and her habits (e.g., smoking, heavy alcohol consumption, drugs, including painkillers — and the health of the baby (e.g., repeated courses of antibiotic, food intolerances, or particular health condition).

Following the development of new technology and petrochemical derivatives, and processing methods, changes in eating patterns have been leading to an increase in the consumption of ultra-processed foods (UPFs). A tsunami of research is demonstrating the negative impact on the quality of our diet and generating a risk of harm to the health of the adult population, however, research on the impact of UPFs on maternal-child health was still to be “proven by science”.

According to a very recent study paper published in Frontiers in Nutrition (June 2022), Ultra-processed foods (UPFs) are foods of little or no nutritional quality and often contain high amounts of saturated fat, trans fats, salt, additives, preservatives, colourings, and flavourings.

These foods have become increasingly present in our diet and have played their part in the recrudescence of several non-communicable diseases, such as obesity, type 2 diabetes, heart disease and cancer, in the last few decades.

These foods may impact our health at any stage of our lives but may pose a greater problem for those who are pregnant since UPFs may negatively affect both mother and child.[1]

The results from the above-mentioned paper showed that higher dietary intake of UPFs was associated with gestational weight gain, early weaning, lower diet quality, alterations to metabolism in the baby and increased weight in the baby. The researchers concluded that UPFs negatively affected nutrition and disease in the mother and child. Due to the problems that UPFs pose to a newborn and infants, these may play a key role in severe and recurring infantile colic (as well as a multitude of other symptoms).

Research shows three possible causes:

• Immaturity of bile acid mechanisms that alter intraluminal and absorptive mechanisms,

• Immaturity in motility, and

• Alterations in the microbiome.

An important part of digestion, the biliary system is responsible for a bunch of processes, such as the breakdown of fats (into tiny droplets and then into essential fatty acids which can then be assimilated by the intestinal cells together with fat-soluble compounds, including fat-soluble vitamins — e.g., Vitamin A, D, E, K), the elimination of cholesterol, deactivated neurotransmitters and hormones, various toxins and metabolic waste products. Bile is a mild laxative and also displays antibacterial properties.

Since infants do not yet have a fully mature biliary system, their bodies may have more difficulties completing all the above processes.

Also, the diet of a newborn is exclusively made of milk (breast milk or formula, depending on the circumstances), and therefore, stools should typically be on the liquid side. Yet, some babies experience bouts of constipation and perhaps alternated with diarrhoea (the only way waste can be excreted is by liquid sipping around compacted tools).

The diversity of their microbiota is still “under construction” and, therefore, is impacted by any ingredients provided by the milk the baby drinks (intentionally-added —e.g., balanced, nutrient-dense diet, and food additives like gluten, conventional cow’s milk or soy formula, and colourings, to just name a few, and unintentionally-added — e.g., BPA, DTT, PCBs, heavy metals, stress hormones, and more that makes the diet of the breastfeeding mother).

Pregnancy is a vital part of making a baby from scratch, especially the third trimester, a time dedicated to brain development.

The level of stress of the mother may impact the later phases of development due to the high concentrations of stress hormones in the circulation, which are then able to cross the placenta. The higher the concentrations, the greater the impact — so much so that the blueprint may be erased and redone completely, the extent of which will be felt in his/her entire life and predispose him/her to metabolic and cognitive disorders at any time in their life.

Energise - 30 days to Vitality explain in more detail this important part of foetal development.

It is not surprising that conventional cow’s milk formula has been shown to cause infantile colic.[2,3] Considering all that the milk contains, there may be a multitude of toxicants and problematic compounds a (fully) breastfed infant wouldn’t necessarily be exposed to.

Cow’s milk proteins have also been proven to cause allergic reactions and hypersensitivities are also on the rise.[4] One of the main reasons could be that the milk proteins of a cow are much bigger than that of humans and, therefore, be problematic for an infant to digest. Studies have also shown that dairy products consumed by the mother also affect the foetus, which is characterised by the delayed passage of meconium and early onset infant constipation.[5]

Soy formulas are known to contain high levels of aluminium,[6,7] so if you are looking to supplement the diet of your baby with such formulas, choose the best you can afford from a company you can trust and clearly label their products for heavy metals and other junk.

While soy baby formulas may represent a health problem, the most heavily contaminated products with aluminium tend to be those addressing allergies and intolerance.[8]

Four studies provided insufficient evidence for the use of soy formula in the treatment of colic.[9] In addition, The American Academy of Pediatrics recommends against the routine use of soy formula in the management of infantile colic, because soy can be an allergen.[10]

If it wasn’t enough, any type of baby formula may become toxic if warmed in a microwave. The issue is not about changes in nutrient profile (e.g., nutrient loss) but the molecular structure of proteins, and the production of acrylamide and neo-formed contaminants,[11] which are in addition to those that may also occur during processing.[12,13] More research is needed to confirm if indeed warming infant formulas using high-powered microwaves is a problem for health.

Key recommendations

It may be important to consider some of the triggers, and those include those imported from the mother’s diet. Here are a few recommendations that may help relieve colic symptoms:

• Elimination of allergens (e.g., cow's milk, eggs, fish, peanuts, soy, tree nuts, wheat) from the diet of breastfeeding mothers

• Switching formula-fed infants to a hydrolysed and hypoallergenic formula (easier to digest)

• Supplementation with probiotics such as Lactobacillus reuteri (strain DSM 17938 — may reduce crying in breastfeeding infants with colic. It should not be given to formula-fed infants with colic).[14,15,16] Supplementation is recommended for 3 months.

• Increased consumption or supplementation may be considered for the breastfeeding mother, including peppermint (Mentha piperita) and various herbal teas (e.g., fennel, chamomile, vervain, lemon balm, and liquorice), which are shown to decrease crying time in some studies. Fennel (and fennel seeds) and other carminatives can also be consumed as part of a balanced diet.[17-20]

• Avoid anticholinergic drugs (due to their serious side effects — which include breathing difficulties, seizures, syncope, asphyxia, muscular hypotonia, and coma).[21]

• The mother should be reassured that it is not her fault and it is not a result of what she has or has not done to her infant. Other recommendations to the mother (and the other parent or carer) include checking for hunger when crying, checking the nappy, avoiding carrying and holding the baby for long periods, trying to establish a regular pattern during the day and not intervening immediately when the infant cries. Giving time for the mother to rest is also vital, as constant crying due to infantile colic can be extremely difficult to handle and can lead to exhaustion and a lot of anxiety.

Since a mother knows her baby the most, many more recommendations can also provide relief and support for their baby. If in doubt, these can be discussed during a consultation.

You may also like to keep a food diary to identify the culprits. Remember that colic-causing foods may enter the breast milk and upset your baby. Typical foods include dairy products (e.g., milk, cheese, yoghurt, and ice cream), grains (especially corn and wheat), caffeine, spicy foods, and legumes (such as peanuts and soy). Some foods known to produce gas may also be problematic, such as broccoli, onions, Brussels sprouts, cauliflower, and cabbage.

Favour slow-cooked foods, such as soups and stews, and avoid too much raw food too early on or giving foods that are just been taken out of the refrigerator or freezer.

1. Keep a food diary

Keep track of what you eat and when and how long your baby cries inconsolably or experiences colic episodes to identify associations between food and discomfort. Also note any changes in your baby's behaviour, such as fussiness, weeping, bloating, constipation and/or diarrhoea, sleep difficulties, or reddening around the anus.

2. Follow an elimination diet

Eliminating the foods responsible for your baby’s colic for a duration of 7 days to 2 weeks may be necessary to reduce the severity of colic and crying. If you notice an improvement, or if the symptoms (and crying) have disappeared, then you may reintroduce those foods back into the diet. Foods you may want to eliminate include berries, grapes, stone fruit, strawberries, mangoes, cabbage, tomatoes, lentils, garlic, pineapple, broccoli, Brussels sprouts, cucumber, radish, cauliflower, raw onion, yeast and stimulants (caffeine). Also, check the medicine you are taking for side effects.

3. Incorporate soothing foods

There are some foods that may encourage a healthy gut and help prevent symptoms of colic. If your baby doesn’t react to those you may incorporate the following into your diet: apples and pears (contain sorbitol and may produce gas, so a little suffice), asparagus, carrot, celery, kale, corn, bananas, papaya, celery, beetroot, pumpkin, zucchini, and mushrooms. Some teas can also help as discussed previously (e.g., chamomile, dandelion, fennel and cardamom). You may also consider 24-hour bone broths and a little apple cider vinegar.

4. Monitor symptoms

Reintroduce food one by one (no more than 1 food per day). If the symptoms return within 24 hours, remove it from your diet temporarily (at least for the next 6 weeks). Repeat the test once again if necessary. Most babies are only temporarily intolerant of certain foods, so continue to follow a nutrient-dense diet.

If you do see any improvement, it may be important to test your baby for food allergies (IgE test) or hypersensitivities (IgG test). You (the breast-feeding mother) may also have such reactions and, therefore, affect your gut microflora (bacteria are also presented by dendritic cells from the gut to the breast milk) and also the quality of your milk.

Furthermore, gut dysbiosis may also play a pivotal role in making you feel more tired and more anxious, making it more difficult for you to handle your baby’s crying. So healing your gut before pregnancy and any time thereafter may help you re-establish balance in your body and benefit your baby too.

References

1. de Oliveira, PG. et al. (2022). Impacts of Consumption of Ultra-Processed Foods on the Maternal-Child Health: A Systematic Review. Frontiers in Nutrition. 9, 821657. doi: 10.3389/fnut.2022.821657

2. Jakobson, I. Lindberg, T. (1983). Cow's milk proteins cause infantile colic in breast-fed infants: A double-blind crossover study. Pediatrics. 71(2), pp. 268–271. doi:10.1542/peds.71.2.268

3. Lothe, L. Lindberg, T. Jakobson, I. (1982). Cow's milk formula as a cause of infantile colic: A double-blind study. Pediatrics 70(1), pp. 7–10. doi:10.1542/peds.70.1.7

4. Høst, A. (1994). Cow's milk protein allergy and intolerance in infancy Some clinical, epidemiological and immunological aspects. Pediatric Allergy and Immunology. 5(56), pp. 5-36.

5. Madala, A. et al. (2022).Case reports of cow's milk protein allergy presenting as delayed passage of meconium with early onset infant constipation. Frontiers in Pediatrics. doi:10.3389/fped.2022.858476

6. Chuchu, N. et al. (2013). The aluminium content of infant formulas remains too high. BMC Pediatrics. 13, 162. doi:10.1186/1471-2431-13-162

7. Burrell SA, Exley C. (2010). There is (still) too much aluminium in infant formulas. BMC Pediatrics. 10, 63. doi:10.1186/1471-2431-10-63

8. Redgrove, J. et al. (2019). Prescription infant formulas are contaminated with aluminium. International Journal of Environmental Research and Public Health. 16(5), 899. doi:10.3390/ijerph16050899

9. Iacovou, M. et al. (2012). Dietary management of infantile colic: a systematic review. Maternal and Child Health Journal. 16(6), pp. 1319-1331.

10. Bhatia, J. Greer, F. (2008). Use of soy protein-based formulas in infant feeding. Pediatrics. 121(5), pp. 1062-1068.

11. Laguerre, JC. et al. (2011). The impact of microwave heating of infant formula model on neo-formed contaminant formation, nutrient degradation and spore destruction. Journal of Food Engineering. 107(2), pp. 208-213. doi:10.1016/j.jfoodeng.2011.06.021

12. Rannou, C. et al. (2016). Mitigation strategies of acrylamide, furans, heterocyclic amines and browning during the Maillard reaction in foods. Food Research International. 90, pp. 154-176. doi:10.1016/j.foodres.2016.10.037

13. Liu, L. et al. (2020). Safety considerations on food protein-derived bioactive peptides. Trends in Food Science & Technology. 96, pp. 199-207. doi:10.1016/j.tifs.2019.12.022

14. Johnson, JD. Cocker, K. Chang, E. (2015). Infantile colic: Recognition and treatment. American Family Physician. 92(7), pp. 577-582.

15. Anabrees, J. et al. (2013). Probiotics for infantile colic: A systematic review. BMC Pediatrics. 13, 186.

16. Sung, V. et al. (2013). Probiotics to prevent or treat excessive infant crying: Systematic review and meta-analysis. JAMA Pediatrics. 167(12), pp. 1150-1157.

17. Alves, JG. et al. (2012). Effectiveness of Mentha piperita in the treatment of infantile colic: A crossover study. Evidence-Based Complementary and Alternative Medicine. 2012, 981352.

18. Weizman, Z. et al. (1993). Efficacy of herbal tea preparation in infantile colic. Journal of Pediatrics. 122(4), pp. 650-652.

19. Alexandrovich, I. et al. (2003). The effect of fennel (Foeniculum vulgare) seed oil emulsion in infantile colic: A randomized, placebo-controlled study. Alternative Therapies in Health and Medicine. 9(4), pp. 58-61.

20. Savino, F. et al. (2005). A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants. Phytotherapy Research. 19(4), pp. 335-340.

21. Lucassen, PLBJ. et al. (1998). Effectiveness of treatments for infantile colic: Systematic review. BMJ. 316, 1563