Features

When the screaming won't stop

13 May 2019

Colic and persistent crying can be distressing for babies and parents alike, so what is the latest thinking on the causes
and the best way to deal with it?

Crying

Excessive crying in early infancy is not well understood. Colic in a baby is defined by the NHS (2018) less as a condition than a behaviour: crying for more than three hours a day, three days a week, for at least one week. Babies may also show other symptoms, such as bringing their knees up to their abdomen, clenching their fists and excessive flatus or eructation, and it often happens towards evening and into the night. Colic tends to begin when an infant is just a few weeks old, though it usually settles down by the time they reach six months. It can be a torrid and upsetting experience – not just for the babies but also their worried and worn-out parents.

What do we know about the causes of this behaviour? ‘With great certainty, almost nothing,’ says Ian St James-Roberts, professor of child psychology at University College London and a leading expert in infant crying and sleep. Its incidence is something of a mystery as well; depending on the source, anywhere between 10% and 40% of babies experience colic (Johnson et al, 2015).

While years of research have yet to pin down the precise causes of excessive crying, evidence suggests that the root of the problem, in some cases, may lie in the baby’s belly.

 

Lack of evidence

‘A meta-analysis was published about a year ago [Sung et al, 2018], looking at whether colic might be about the gut microbiome and that exposure to some types of environments, including dietary factors, might sometimes cause babies to cry a lot,’ says Ian.

But even this research was far from conclusive. ‘The results are complicated because of the four different studies included; three of them found evidence that this could be the case, but only where babies were breastfed,’ says Ian. ‘And the fourth study didn’t find any evidence for it at all, and that was actually the largest and the best of the studies.’

Complicating matters further, that final study was carried out in Australia, while the others were sourced from Canada, Poland and Italy. ‘One possibility is that there could be something quite different about the diet and gut make-up in Australian babies that causes them to cry.’

 

Potential triggers

Other possible causes of colic are largely related to the gut and the developing digestive system. They include overfeeding, acid reflux, food intolerance, swallowing air when feeding, and a reaction to something in the mother’s diet that is passed on during breastfeeding. Or it may be caused by nervous or tense parents transmitting stress to the baby, or an over-stimulated baby becoming distressed by a bombardment of sensory information.

 

Griping about colic

The traditional treatments that many desperate parents turn to are colic drops and gripe water, which are normally available over the counter. ‘The constituents of colic drops have changed over the years,’ says Ian. ‘At one point they contained alcohol, and various other things have been tried over the years. But I don’t know of any evidence that consistently shows anything helps.’

If the evidence pointing to gut problems was more conclusive, it might be possible to come up with a more effective remedy, but as that proof remains elusive, the issue remains a question of research. ‘Even to say we are close to pinning it down and understanding the causes is probably naive,’ admits Ian. Having accepted this, many researchers have shifted direction over the past few years, and now take the view that this peak in crying during a baby’s early weeks could simply be a part of the normal development of the nervous system. ‘In some ways, it might be wrong to be too fascinated with the idea that there is a problem underlying the crying that has to be fixed,’ says Ian. ‘Instead of that, let’s focus on supporting parents.’


Tips for clients to soothe a baby crying excessively  

  • Try movement, rocking the baby from side to side either face up, or lying on their front along your arm.  
  • Take your baby out in the buggy. Movement and fresh air often helps babies to sleep and it’s easier on your arms than holding a baby all day.  
  • Talk to your baby in a low monotone voice, humming or singing a repetitive tune, it doesn’t matter if you don’t sing in tune. Background noise, music or natural sounds can be downloaded as an app.  
  • Experiment with light levels – low light can be calming for baby – or try a blackout blind.  
  • A warm bath for baby can be helpful with the water above tummy level.  
  • Massage the tummy gently, in a clockwise direction.  
  • Colic remedies from the chemist (check with your GP or health visitor) can sometimes help a baby suffering from excessive wind.  
  • Speak to your health visitor about the best time to start baby massage classes, as they can often help baby to settle and provide a relaxing time for a baby and parent to spend together.  
  • Even if you are tired and stressed, try and handle your baby slowly and calmly so that they feel reassured.

NHS, 2018


A passing phase

This shift of emphasis towards helping parents to cope with colicky babies is significant, says Ian, now that the condition is also understood to be associated with parental anxiety and even depression.

‘There is now enough evidence to show that in extreme cases the crying can be a trigger for infant abuse’

‘Psychological techniques have emerged in recent years for helping people who are under stress to cope and to manage their emotions and behaviour,’ Ian continues. ‘Much of the advice and guidance now looks at how you can think about this differently, what you can do to lessen your feelings of frustration and anger, and what you can do in a practical way to make sure that the baby is not put at any risk, because there is now enough evidence to show that in extreme cases the crying can be a trigger for infant abuse.’

Jan Bullen, head of the charity Cry-sis, says it helps when parents are prepared for what’s ahead. ‘With newborns, parents are tired and anxious, and it can be a bit overwhelming. Then they get into a routine and things ease down a little. But at about six weeks, colic can set in and everything goes haywire again. It’s important to realise this is just another passing phase. Everything changes when you have a baby and you learn to adapt. Colic is just another stage.’

 

Helping parents cope

‘Parents are often sobbing when they ring us up, and our job is to help wind them down’

Jan also says there is no such thing as a typical mum or dad who calls the Cry-sis helpline. ‘We get every sort of parent you can think of. Recently, we even had a nurse saying she could deal with a whole ward of sick children but she couldn’t manage her crying baby. They are often sobbing themselves when they ring us up, and our job is to help wind them down.’

What advice do they give to these parents? ‘It’s a range of things,’ says Jan. ‘Avoid overstimulating the baby, because a tired baby will be even worse. Swaddling can help if you slightly restrict their arms movements, but be careful they are not overheating. Hold babies upright after a feed and gently rub their back. Sitting them in a bath of warm water up to their chest can relax them too. Baby massage is worth a try – some babies love it, some hate it. Various remedies have come into the picture, but we don’t recommend anything, especially not probiotics, without any medical supervision.’

 

Vital reassurance

The key thing for any parent to remember is that after three or four months, the colic begins to die down, possibly because at this point the gut has matured sufficiently. ‘Up to that point,’ says Jan, ‘I think health visitors can help by reassuring mums and dads, letting them know that this is fairly normal and it’s not because they are doing anything wrong.’

Ian offers similar advice. ‘Talk to parents about what the evidence says, and reassure them that almost all the infants that have this condition, whatever it is, and grow out of it by the time they are three to four months old. It’s down to around 1% of babies after four months. Also let them know that, as far as any studies have shown, there is no long-term harm. Then move on to thinking about the parents themselves. How are they coping, how are they managing their emotions? What can you do to help them get through this? I think these are the three targets: to inform, to reassure and to cope.’ 


Coping with Crying

Professor Ian St James-Roberts has looked at the current research on the effect of crying on babies and summarises advice for parents. These points are not controlled crying techniques, but to be used when a baby’s excessive crying becomes overwhelming. 

  • It’s normal to feel upset and angry because of the crying. It’s what you do that matters.
  • Put the baby down in a safe place (such as a cot).
  • Leave the room and focus on doing something else. Do whatever helps you calm down.
  • By all means ask someone to keep an eye on your baby, but a crying baby will not be harmed by being left alone in a safe place for five or 10 minutes. 
  • Try not to focus on negative thoughts.
    Think positively: the crying is not your fault; your baby is well. Your baby must be in vigorous health to be able to cry so much! How much worse if your baby was ill and quiet. This crying is temporary and you can find ways to get through it.  
  • Do not go back to your baby until you feel in control.

Cry-sis, 2017

Image credit | Science Photo Libary


Resources

  • Cry-sis provides a range of resources for parents, plus a hotline open seven days a week from 9am to 10pm for those who need more immediate help. Call 08451 228 669 or visit cry-sis.org.uk
  • The Baby Centre website provides a useful overview of colic plus a video on how to massage a baby’s tummy at babycentre.co.uk/a77/colic
  • A US website, Purple Crying, has lots of information and advice for parents on how to cope with colic at purplecrying.info
  • The Australian Cry Baby programme also offers many tips and techniques for dealing with baby crying and sleep issues, but parents will need to register at bit.ly/ACBP_crying

References

Cry-sis. (2017) Allowing babies to cry and coping with ‘unsoothable’ crying. See: https://docs.wixstatic.com/ugd/6d9714_8806e7b9c514415398057843dc6b6103.pdf (accessed 29 April 2019).

Johnson JD, Cocker K, Chang E. (2015) Infantile colic: recognition and treatment. American Family Physician 92(7): 577-82.

NHS. (2018) Colic. See: https://www.nhs.uk/conditions/colic (accessed 16 April 2019).

Sung V, D’Amico F, Cabana MD, Chau K, Koren G, Savino F, Szajewska H, Deshpande G, Dupont C, Indrio F, Mentula S, Partty A, Tancredi D. (2018) Lactobacillus reuteri to treat infant colic: a meta-analysis. Pediatrics 141(1): e20171811.

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