5 Possible Hidden Medical Causes of Colic

In general, a medical cause is likely if the so-called colic isn’t getting better by four months and your intuition tells you that your baby is in pain. Suspect a medical cause for colic if baby is:

• Getting worse or not gradually getting better
• Awakening frequently with painful cries
• Unable to be consoled
• Not thriving: poor weight gain, frequent respiratory or intestinal illnesses

Among the possible underlying causes for colic are:

1. Gastroesophageal reflux (GER), a newcomer to the hidden causes of colicky and nightwaking behavior, occurs when the muscular tissue at the junction of the esophagus and the stomach doesn’t function like a one-way valve and allows irritating stomach acids to be regurgitated into the esophagus, causing pain similar to what adults call heartburn. Clues that your baby suffers from reflux are many, but not necessarily all, of the following:

• Wails and shrieks in pain, causing you to feel that he’s not just crying but truly hurting
• Spits up after feedings
• Experiences painful bursts of nightwaking
• Most painful cries occur after eating
• Draws up his legs, knees to his chest, and arches his back as if writhing in pain
• Has frequent, unexplained colds, wheezing, and chest infections
• Often seems happier when he’s upright rather than lying flat.

Your doctor may suspect GER based on the information from your colic diary and the way you describe baby’s crying episodes. GER can be confirmed by placing a tiny tube into the baby’s esophagus and leaving it in place for 12 to 24 hours while continuously recording the amount of stomach acids regurgitated into the esophagus. About one-third of infants have some degree of reflux, so simply measuring the stomach acids doesn’t prove that GER is why baby is hurting. For this reason, a parent or trained observer records the timing of baby’s colicky episodes. If these coincide with the time the baby refluxes, the hidden cause of colic has been found.

If your doctor suspects severe GER, the doctor may suggest an esophagoscopy: placing a thin flexible tube into baby’s esophagus under anesthesia to see if there is any damage to the lining of the esophagus from the regurgitation of stomach acids. Your doctor may choose to begin treatment without subjecting baby to these studies and instead do a less invasive test, called an upper G.I. series, where baby swallows some formula- like fluid to be sure there isn’t a blockage in the intestines causing the reflux.

Your doctor may prescribe medications that lessen the amount of stomach acid produced and accelerate the emptying of the stomach which, along with the comforting measures listed later, will diminish the reflux and alleviate the baby’s discomfort. Holding your baby upright for twenty to thirty minutes after a feeding, in addition to feeding him smaller amounts more frequently, will often reduce reflux as well. (See Treating GER)

2. Food sensitivities. Do gassy foods ingested by a breastfeeding mother cause gassy babies? Nursing mothers have long noticed a correlation between what they eat and how colicky their baby gets, and they have compiled their own fussy foods list. Suspects include: dairy products, caffeine-containing foods and beverages (soft drinks, chocolate, coffee, tea, and certain cold remedies), cruciferous vegetables (cabbage, green peppers, broccoli, cauliflower, brussel sprouts, and onions), spicy foods (such as garlic or curry), wheat, and corn. (See Elimination Diet).

3. The colic-cow’s milk connection. New research supports what old wives tales have long suspected: some breastfed babies become colicky if their mothers drink cow’s milk. That’s because potentially allergenic protein called beta-lactoglobulin in cow’s milk is transferred to baby through the breastmilk. This allergen upsets the intestines as if the baby had directly ingested the cow’s milk.

4. Transient Lactase Deficiency. TLD is a recently-recognized contributor to colic. Research has shown that 38% infant colic cases can be attributed to a temporary insufficiency of lactase enzyme, an intestinal enzyme that digests the lactose sugar in milk (breast milk or cow’s milk formula). The undigested sugar will ferment and create lactic acid and hydrogen gas, which can contribute to colicky symptoms. Such infants will usually begin producing more lactase enzyme by four months of age, but the intervening months can be very uncomfortable. This can be improved by adding lactase digestive enzyme drops to an infant’s formula or breast milk. I have seen these drops work well in many of my little colicky patients. Click here for more information on treating TLD.
5. Formula allergies. Babies fed a cow’s-milk-based formula may become colicky if they’re allergic to the protein or can’t tolerate the lactose in cow’s milk. If a formula allergy is suspected, a hypoallergenic formula (Alimentum, Nutramigen, or Pregestamil) or a lactose-free formula may be recommended by your doctor. The American Academy of Pediatrics Committee on Nutrition does not recommend changing to soy formula, since studies have shown that colicky infants do not improve when switching from cow’s milk to soy formulas.

Suspect sensitivity to formula or to something in your breastmilk if any of the following ring true:

• Baby’s pain escalates within an hour after feeding.
• Baby seems gassy or bloated, rather than contented, after feeding.
• Baby spits up profusely soon after feeding.
• Baby begins to nurse or bottlefeed, but keeps pulling off, crying as if he’s in pain. (The irritated gut starts churning during a feeding, which can make feeding time torturous for the allergic, yet hungry, baby and frustrating for mothers.)
• Baby has constipation or diarrhea.
• Baby’s bowel movements are extremely watery, mucousy, or explosive.
• Baby shows the “target-sign”: a red, circular rash around the anus, caused by the skin reacting to irritants in his feces.

If you’re nursing, make a diary of possible “fuss foods.” {C}List the foods you’ve eaten most frequently in the past week, especially those you tend to eat a lot of. From your diary, see if you can correlate a cause-and-effect relationship between what you eat and how much pain your baby is in. Be objective. In your desperation to comfort your baby, it’s easy to pin the wrap on food sensitivity. You’re willing to try anything, and your desire for a solution can cloud your objectivity. In my experience, if a food allergy is behind a baby’s colic, he’ll also show other signs of allergy (for example, rashes, diarrhea, runny nose, or wheezing). Eliminate the most suspicious fuss foods from your diet for at least a week, and then add them back into your diet one by one and see if your baby’s symptoms return.

Our daughter-in-law, Diane, shared her experience as a colic detective:”At three weeks of age Lea started to cry all day long. She would awaken in the morning fussing, and by late afternoon it would turn into uncontrollable screaming fits. There was no way to calm her down. After a few sucks at my breast, she would throw her head back, arch her back, and start screaming. Within three days of eliminating all dairy products from my diet, her colic greatly improved. I’m glad we didn’t just accept that she was ‘colicky’ and that ‘some babies just cry all the time’.”

Other hidden medical causes of colicky behavior that your doctor will look for are: ear infections, urinary tract infections, constipation, and a cause that receives little attention – a tight rectal opening, which prevents easy passage of bowel movements. A clue that this may be the problem is that baby grimaces, gets red in the face, draws her legs up to her distended abdomen before having a bowel movement, cries while moving her bowels, and seems greatly relieved after passing a large stool. Your doctor may perform a finger dilation of baby’s rectum, enabling baby to pass stools more easily.

Traditionally, colic has been “treated” by laying a reassuring hand on the tummy of the baby and the shoulders of the parents and temporizing, “Oh, he’ll grow out of it!” Most approaches to colic are aimed more at helping parents cope than at relieving baby’s pain. By maintaining the mindset “the hurting baby” rather than “the colicky baby” you and your doctor form a partnership to find the cause and the remedy for your baby’s pain.