Help - my newborn baby is crying and I am not sure if this is colic!

Hello from Dr Mark Anthony at Oxford Private Medical Practice.  I am a consultant paediatrician with a particular interest in babies from birth to two years old.  

The rule of threes is useful when considering whether colic is present in a baby - crying for more than 3 hours, for 3 or more days of the week, for more than 3 weeks. The discomfort tends to be worse in the evenings. There is no test for colic and diagnosis is made by exclusion of other causes of discomfort.

Persistent crying in babies is not normal. Most babies are content except for short periods of crying when hungry, needing a nappy change, tired, etc. Inconsolable crying when a baby is fed and clean can be caused by colic but also by hunger, poor feeding technique, gastroesophageal reflux, cow's milk protein intolerance (CMPI), and rarely by constipation or lactose intolerance.

Distinguishing between these causes of excessive crying can be challenging. Babies with colic tend to be thriving and otherwise well; those with reflux usually have vomiting and may have grow failure and stridor (an inspiratory high-pitched noise with breathing); babies whose milk is over-thickened for reflux treatment can get constipated; those with CMPI often have failure to thrive, rash, mucousy or bloody stools and are generally miserable. Many babies with reflux have CMPI underlying the reflux, and CMPI can occur in solely breast fed babies, if mother is exposed to cow's milk products. Babies who are struggling with feeding can be miserable, cry frequently, fail to thrive, and have green 'starvation' stools.

One approach to the 'colicky' or inconsolable baby is to use simple anti-reflux treatment in the first instance and check breast feeding technique. If these measures are unsuccessful, then a trial of maternal avoidance of cow's milk protein (if solely breast feeding) or a change of formula  to hydrolysed milk (such as nutramigen) may help. If this is unsuccessful, then the choice is to move to more sophisticated anti-reflux treatment and/or a trial of elemental formula (such as nutramigen AA or neocate). The only two potentially helpful remedies for true colic are probiotics from birth or a trial of hydrolysed formula. If crying persists when on specialised formula and with maximal anti-reflux treatment then consider just waiting for resolution, if baby is thriving. If there is weight loss then consider investigations for reflux and treatment for lactose intolerance. Lactose intolerance is rarely the cause of the discomfort. In the occasional baby with persistent crying, there has been a traumatic early life experience such as a difficult delivery, and the crying is behavioural.

Many mothers, whose baby is at the mild end of the persistent crying spectrum, find some commercial comfort milks helpful, such as SMA Comfort. This milk is thickened to help reflux, partially digested to reduce CMPI, and partially enzyme treated to reduce the lactose content. A commercially-available comfort milk could be the first line treatment for babies who cry excessively, but consider seeking help if crying persists. Remember, babies should generally be content, not crying most of the time.

I offer a baby check service at the practice and my contact details are found on the website www.oxfordprivategp.com 

With best wishes

Dr Mark Anthony