> There have been a number of posts lately discussing the alleged
> association between gas, colic, crying and now gripe water.
> There are several reasons why parents (and grandparents) through the
> centuries have thought that infant crying is caused by intestinal pain
> (the word colic even comes from the ancient Greek word meaning
> "intestine".) These babies contort their little faces and cry with a
> sound like they are in pain, they often begin to wail during a meal or
> shortly afterwards, they have noisy tummies, sometimes seem better
> after they pass gas or a BM, double their knees up, and they may
> improve with tummy pressure...
> BUT...there are many convincing reason's why, in the vast majority of
> crying babies, the fussing has little or nothing to do with tummy
> pain:
> 1) the normal pattern of excessive newborn crying is that it starts
> around 2 weeks of age, peaks at 6 weeks and ends around 12 weeks...yet
> gas, feeding and pooping start within days of birth and last well past
> 12 weeks of age.
> 2) premies are as likely to develop colic as full term babies,
> however, they don't start their crying until they reach about 2 weeks
> past their due date. So, a baby who is born 2 months premature won't
> start to have colic until about 10 weeks postnatally...yet they
> certainly are feeding, pooping and passing gas every day of those 10
> weeks...why don't they get colic at an earlier age?
> 3) if babies cry from tummy pain from eating, why is the peak of
> crying so often in the late afternoon-early evening (witching hour)
> and so rarely with feeds in the middle of the night?
> 4) an xray study by Ronald Illingsworth (The UK equivalent of Dr.
> Spock) took radiographs of babies at the start of a crying episode and
> again an hour later after the babies had finally fallen into a
> peaceful sleep...which xray showed more intestinal gas? When the baby
> was shrieking or after she had fallen asleep? Illingsworth showed
> that although babies had much more intestinal gas after an hour of
> crying...they were calm! They had bellies filled with swallowed air,
> but were quite content. (Illingsworth R, The 3-months colic, Arch Dis
> Child 29:165, 1954)
> 5) 2 good double blind studies show that simethicone drops are no more
> effective at decreasing colicky crying than distilled water.
> Danielsson B, Hwang CP, Treatment of infantile colic with surface
> active substance (simethicone), ACTA Ped Scan 74:446-450, 1985
> Metcalf T et al, Simethicone in the treatment of infantile colic,
> Pediatrics, 94:29-34, 1994
> 6) fussy babies often calm with vacuum noises and in slings and
> swings...yet none of these stops severe abdominal pain. Crying babies
> often get better in car rides...and get worse when you stop at a red
> light...how would this effect stomach pain?
> 7) certain cultures have no colic...those parents can soothe their
> baby's crying in under a minute...yet they have gas, poop.
> Additionally, many parents in our culture are mistakenly made to worry
> that feeding their babies too frequently, or too much, will give them
> stomach pain, but in some cultures with no colic babies are usually
> fed 50-100 times a day!! Yet they have no GI upset whatsoever!
> 8) Studies show that only about 10% of all colicky babies have a true
> milk allergy....and since colic occurs in 10-15% of all babies than
> means only 1-1.5% of all babies have a true milk allergy. Lucassen
> P, Assendelft W, et al., Effectiveness of treatments for infantile
> colic: systematic review, BMJ 316: 1563-69, 1998 Forsythe BW, Colic
> and the effect of changing formulas, J Pediatrics 115:521-526, 1989
> Jakobsson I, Lindberg T Cow's milk proteins cause infantile colic in
> breast-fed infants: a double-blind crossover study. Pediatrics. 1983;
> 71:268-271
> 9) Studies show that acid reflux is very, very rarely the cause of
> persistent crying in babies. In fact all babies have reflux (spitting
> up) but babies with medically significant relux have poor weight gain
> and occasionally pneumonia, but very rarely persistent crying. (and
> when they do hae crying it peaks when the reflux peaks - at 4 months
> of age - most colic is long gone by then).Heine R et al, The role of
> gastro-oesophageal reflux in infant irritability, Arch Dis Ch 73:
> 121-5, 1995 Tolia V: Newer developments in gastroesophageal reflux.
> Presented to American Academy of Pediatrics National Conference,
> Boston, Mass., October 21, 2002 de Boissieu D, Dupont C, Barbet JP,
> et al: Distinct features of upper gastrointestinal endoscopy in the
> newborn. J Ped Gastroint Nut 1994;18:334 Moore DJ, Tao BS, Lines DR,
> et al: Double-blind placebo-controlled trial of omeprazole in
> irritable infants with gastroesophageal reflux. J Pediatr 2003;143:219
> Sutphen J: Is it colic or is it gastroesophageal reflux? J Pediatr
> Gastroenterol Nutr 2001;33:110 Poole S, The infant with acute,
> unexplained, excessive crying, Pediatrics 88:450-455, 1991
>
Here's what is the big fooler that confuses most "baby-watchers" - the
gastrocolic reflex. This is a reflex that all babies are born with
(and we all have). When the stomach fills with food, it sends a
message to the lower intestine to "empty out the poop". That is why
babies poop during or shortly after a nursing. Most babies don't even
know when this reflex is happening inside them, but many
super-sensitive babies struggle and fuss when they have this intestinal
"sensation"...but these "sensations" are just the normal,, non-painful
peristaltic actions of the gut, These babies are simply "overreacting"
to this strange sensation they way they may start to cry when startled
by a loud telephone ring. This is what most people confuse for
intestinal pain. It occurs during or shortly after eating and causes
babies to double up (this is the normal reaction all babies have to
distress...they flex into the fetal position...this is not a sign of
stomach pain...they simply still have excessive flexor tone from
spending months in this position in the womb).
The main reason new babies cry and struggle is that they are not ready
for all the stimulation of our world (and stark and abrupt removal of
the wonderful rhythmic stimulation they experienced inside teh womb -
that kept their calming reflex activated). All of this is why fussy
babies calm with skin-to-skin, suckling (even when they are not hungry)
and the 5 S's. These all give babies a highly nurturing and much
needed "4th trimester" .
Harvey Karp, MD
UCLA School of Medicine
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