What you need to know:
- Condition that afflicts 20 to 30 per cent of newborns has no cure
- Many theories about the cause
- Support for new parents and caregivers is key
There is nothing more intimidating than the inconsolable wail of a newborn. A little person leaving everyone frazzled and on edge.
Infantile colic is the number one cause of hospital outpatient visits at this tender age. It is a leading cause of maternal anxiety and depression, especially for first time moms with little experience caring for newborns. Fathers are not left out either.
Antoinette* was doing great on her first postpartum visit. Both mother and baby looked calm throughout the visit and the new parents felt confident and reassured about their new roles.
At the six-week postpartum visit, I could barely recognise the people before me. Antoinette had lost seven kilogrammes, with hollow sunken eyes. Frank*, her husband, was not faring any better. He was fatigued, with a dishevelled appearance for a man who always looked neat and well kempt.
Curl up into a ball
For the past month, life with a newborn had become an absolute nightmare. Baby Nigel* barely slept at night. He would cry incessantly for hours despite there being no apparent reason. On Nigel’s third week of life, the couple drove to hospital in the wee hours of the morning on three different occasions. It was not possible to convince them that Nigel was not suffering from a life-threatening condition.
Nigel would start fussing from 9pm and by 11pm, it was a full-throttle wail for no less than four hours. Nothing would sooth him. He had intervals of wriggling around in the arms, curling up into a ball and screaming in a high-pitched voice.
By 4am, he would literally pass out from exhaustion and sleep fitfully with episodic whining in his dreams. He would be up by around 7am to breastfeed, poop and immediately after his bath, he would sink into a deep sleep that would go uninterrupted for up to five hours.
The young couple was distressed. They had seen their paediatrician, who had concluded Nigel was physically alright and his was just an extreme case of colic.
This made it worse for the couple because, in essence, there was nothing they could do to help Nigel until he was ready to outgrow this stage of life. Antoinette was shocked when the doctor said the colic could last until Nigel was about four months old.
Infantile colic is a diagnosis made after all possible causes of the incessant crying and abdominal discomfort have been eliminated. This includes gastro-esophageal reflux, milk protein allergy, hernia, lactose intolerance, infection, intussusception (a form of intestinal obstruction that commonly occurs in the infant age group) and injury.
In the absence of any of the above conditions, a baby is diagnosed with infantile colic if he/she cries incessantly for no less than three hours a day, for at least three days a week, persisting for at least three weeks (the rule of threes). Despite the crying, these babies will demonstrate good weight gain and normal achievement of developmental milestones.
Many theories have been considered but none has been scientifically proven to explain the cause of infantile colic. This is the reason a condition that afflicts 20 to 30 per cent of newborns has no cure. My favourite one is with regard to normal intestinal bacterial colonisation.
The normal human digestive tract is far from sterile, and is full of various types of bacteria that live peacefully. These bacteria are beneficial to us.
Risk of depression
While in the womb, babies are essentially sterile. At birth, they come into contact with environmental bacteria and begin to accumulate their own gut bacteria. It takes at least three years for the gut colonisation to settle down and be able to compare with that of adults.
Imagine what happens to a baby during this period of gut bacteria colonisation. The bacteria are all over the place trying to settle down, strike a healthy balance and start playing their role. Meanwhile, the baby is drinking milk, which they digest partially and it passes down to the colon where the bacteria have to complete the digestion of components that were incompletely broken down. Bacterial digestion of undigested sugars is by fermentation, a process that releases plenty of gas.
The baby’s immature gut is still struggling with peristalsis. It takes a while for the intestines to efficiently push things along, including this excess gas building up. Accumulated gas in the intestines will cause them to balloon and this is quite uncomfortable, even for an adult. This will trigger intestinal spasms in an effort to expel the gas, which are extremely painful.
Overall, infantile colic is not just a problem for the baby, but a family problem. As we seek solutions for the little one, we must never underestimate the importance of supporting the new parents and primary caregivers of the baby. Otherwise, anxiety and fatigue will lead to depression and eventually put the baby at risk of harm such as shaken baby syndrome.