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DEAR MAYO CLINIC: My six-week-old granddaughter is extremely fussy for much of the day, sometimes crying off and on for four or five hours. I understand it’s probably just colic, but should she be seen by a pediatrician to rule out other problems? Is there anything we can do to help her?
ANSWER: In most cases, colic does not require medical care, nor is it a symptom of a larger medical problem. It usually improves on its own within several months.
All babies cry and get fussy from time to time. But colic is different than normal fussiness. Babies with colic typically cry more than three hours a day, three days a week for three weeks or longer. The crying tends to come around the same time each day. There appears to be no clear reason for the crying. Babies with colic are otherwise healthy and may cry even when well-fed and clean.
Colic crying is intense. It sounds distressed and is often high pitched. The baby’s face may flush. Babies often curl up their legs, clench their fists and have tense abdominal muscles during episodes of colic.
Comfort measures — such as holding, rocking or walking with the baby — usually do not help soothe an infant with colic. But some parents do have success easing colic symptoms by going through a consistent series of interventions. They may include steps such as checking if a diaper needs changing, seeing if the baby is hungry, swaddling, gentle swinging or trying a pacifier.
In most cases of colic, the symptoms get better on their own by about three to five months of age. A medical evaluation usually is not necessary.
However, if colic is causing a significant amount of worry and stress for parents, or if a baby has other symptoms along with colic that may signal another medical problem, then it is wise to make an appointment to see a health care provider. Those symptoms may include poor feeding, slow weight gain, vomiting, diarrhea, constipation, abdominal distension, blood in stools, fever, irritability, lethargy, breathing problems, poor muscle tone or an unusual rash.
While no treatment for colic has been proven to be fully effective, there are a number of options for parents who feel the need to do more than wait for the symptoms to improve. Simethicone, an over-the-counter gas-relief medication, is frequently used. But a randomized, placebo-controlled trial of this medication found no benefits for babies with colic. If a baby is formula-fed, then trying a hypoallergenic formula may be helpful. In breast-fed infants, there is some evidence to support mothers eating a low-allergen diet, starting with avoiding cow’s milk.
Research has also shown that the probiotic Lactobacillus reuteri seems to reduce the amount of time breast-fed babies with colic cry. Be aware, though, that probiotic supplementation should not be given to an infant whose immune system or intestinal system is compromised, nor should it be used for infants who have indwelling central venous catheters, unless it is provided under a physician’s guidance.
Caring for a baby with colic can be exhausting. As a grandparent, you may be able to help by offering to give the parents a break from the colic episodes. Even an hour or two can make a difference. It is important to stay calm as you are caring for a baby with colic. If you get frustrated or upset, it is okay to put a crying baby in his or her crib for a little while, so you can take time to collect yourself. Never shake a baby.
If the baby’s parents have questions or concerns about colic, encourage them to call your granddaughter’s health care provider. He or she may be able to offer some useful tips on how to manage colic, as well as reassurance that colic is temporary and likely to fade over time. — Chris Derauf, M.D., Pediatrics, Mayo Clinic, Rochester, Minn.