Infant cramps (colic)

About infant cramps

When and how?

Infant cramps usually appear during the first three to four months. They manifest themselves as sudden episodes of painful crying which usually occur at least three days a week, last for a week or more, and usually disappear after the age of three months. During this period, the child steadily gains weight and develops normally. In addition to crying, the child turns pale or red in the face and makes painful grimaces; the stomach is tense and bloated, the child draws the legs in, lifts the head and clenches the fists. Symptoms are more frequent in late afternoon or evening, during or after the feeding. An estimated 10 to 30% of infants suffer from cramps. The pain generally occurs in the third week, culminating in the sixth. Usually, the cramps spontaneously disappear by the end of the third or fourth month.

Why?

The precise causes of colic are not known, but they are certainly numerous. Scientific research has tested several possible hypotheses in this respect: allergy to proteins present in cow’s milk; lactose intolerance which leads to excessive gas (mostly hydrogen) which typically disappears after the third month; development (maturation) of the digestive tract (heightened intestinal activity) and the central nervous system (increased irritability); neuro-hormonal immaturity; maternal emotional tension and stressful family circumstances. Children born prematurely with a birth weight of less than 2,500 grams are three times more likely to get cramps. Factors such as sex, socio-economic status, feeding (mother’s milk or infant formula) and family allergies do not affect the frequency of infant cramps. However, some differences do exist: cramps appear earlier if the child is formula-fed (around the second week compared to the sixth week in breastfed children) and are more frequent among children whose mothers are frightened, suffered from stress during pregnancy and birth, or smoke. Higher levels of intelligence, age and educational qualifications of the mother are also commonly associated with cramps. Moreover, first-born children experience cramps more frequently than their siblings. Considering the large number of possible causes, there is no unique treatment for cramps. However, there are some general rules that should be followed in order to reduce as far as possible the discomfort.

How to help?

Feelings

Why all the fuss about colic?

Did you know that the loudness of crying can exceed 100 dB? How loud is that? Look it up in the table below and compare!

Try to think about the feelings you experience when your baby is crying. Crying is the child’s most powerful signal: it gives the parent the strongest impetus to spring into action in order to relieve the child’s discomfort. Crying can have a paralysing effect on parents who lack sufficient emotional stability. They begin to panic, behave irrationally, and are unable to create a feeling of security and comfort, thus failing the parenting test at the very first step. In fact, their behaviour creates additional unease in the child and increases the spiral of fear. Often, only one parent is frightened, so his/her partner calms him/her down, thus indirectly also calming the child.

Long-lasting cramps expose the mother to chronic stress and can lead to depression, diminishing feelings of self-worth and lack of confidence in her ability to be a good parent. The importance of the support the mother receives from her surrounding and paediatrician should therefore be emphasised. Numerous studies have shown that this type of support also has the best effect on reducing cramps. Further, it is important to create a soothing atmosphere during the child’s sleeping time (dimmed light, silence, or soft and calm music) and to respect his/her sleeping pattern. This also means avoiding situations that would create changes in the usual sleeping schedule.

In the event of frequent, strong cramps, the stool can become softer and green because of the increase in intestinal activity. Frequent pain, interrupted sleep and lack of sleep make the child irritable, which, in turn, accelerates the intestinal activity, making the cramps even more prominent. The restlessness present in the child’s surroundings (anxious parents, attempts to overcome the sound of crying in order to calm the child, shaking or frequently turning the child over) does not have a soothing effect and merely accelerates the intestinal activity (and, consequently, the cramps) even further. The child’s environment needs to be soothing: noise and bright lights should be avoided, and the mother’s voice and movements should be soft. Although it is sometimes difficult to keep calm when your child is crying inconsolably, this is the most effective way to help reduce his/her discomfort.

Parents should take turns caring for the baby: when one parent feels physically and emotionally exhausted, s/he should rest while someone else (perhaps another member of the household) takes care of the child. Avoid turning one parent into the child’s “prisoner”. This role typically befalls the mother, who should be given time to attend to her own needs, get out of the house and change her daily routine.

Movement and vibration can sometimes have a positive effect: you can try to ease the pain by rocking the child in a cradle, holding him/her as you rock in a rocking chair or on a Pilates ball, or taking him/her for a ride in the stroller (or car). Gently massaging the infant’s entire body has proven equally effective.

Breastfeeding and cramps

Ensure peace for the breast-fed child and make sure s/he has hold of the entire nipple, along with the areola. With frequent and short breastfeeding sessions, the child usually sucks the “first milk” from the breast, which is rich in carbohydrates. Carbohydrates create more gas in the small intestine and are digested faster than the “second milk” which contains more fat. It is therefore recommended that the child should be fed from a single breast until s/he feels full (e.g. becomes relaxed and falls asleep) and releases the breast him/herself. Prevent “playing” with the breast by squeezing the milk out and stimulating swallowing. If the child is still hungry, offer him/her the other breast as well. Sometimes, changes in the breastfeeding position (lying, sitting, standing) can decrease the frequency of cramps.

Women with an excessive milk ejection reflex – manifested as an overly rapid flow of excessive amounts of milk which triggers coughing, choking and unease in the infant – are advised to begin breastfeeding before the infant becomes overly agitated with hunger, as sudden and energised grabbing of the nipple can trigger a strong milk ejection reflex. In cases like this, breastfeeding in a lying position may help, as gravity reduces the milk flow. If nothing else helps, try extracting a small amount of milk prior to breastfeeding or repeatedly offering the same breast (make sure you extract milk from the other breast to avoid a feeling of overflow).

Insufficient speed of the milk flow causes the child to swallow large quantities of air, which also leads to infant cramps. In cases like this, compressing the breast during feeding sessions (squeezing out the milk to increase the flow) is recommended. If nothing else helps, try offering breast milk through a bottle (a preferred alternative to using infant formula).

Formula-fed infants

In the case of bottle feeding, the nipple has to have a good valve and its opening has to be large enough for the baby to draw the content without much exertion, but not so large as to enable excessive flow resulting in a mouth full of milk that is simultaneously being spilled along the nipple. At the half-way point in the meal, it is good to lift the baby on your shoulder and stretch him/her into a fully upright position (if the child remains in a reclining position, it will be more difficult for him/her to release the excess air). This will create more room in the stomach, so the feeding can continue. Repeat the action after the baby has finished the meal (with added gentle tapping on the back) to alleviate air elimination. However, numerous tiny air bubbles still remain in the milk in the stomach, so the baby should be placed in an elevated position (45 degrees) in the baby chair or on a hard pillow for another 45 minutes in order for these bubbles to float to the top of the stomach, which will lead to air elimination. Slightly raise the mattress below the infant’s head (cca. 10 cm) to prevent excessive regurgitation. Namely, the air in the intestines increases the overall pressure within the stomach; in the case of physical exertion (caused by cramps), the pressure is further increased to such a degree that food no longer remains in the stomach but is raised towards the mouth. Acid contents of the stomach additionally stimulate the oesophagus, which may cause pain.

A paediatrician should exclude illness as a possible cause of infant colic. Allergic colitis is extremely rare among infants, so there is no need to change the mother’s or infant’s diet as soon as the cramps occur. Leave all decisions regarding possible changes in diet to the paediatrician!

Some infant formulae are intended to reduce the frequency and intensity of infant colic; however, before deciding on using them, please consult your paediatrician.

Medication?

Air in the intestines can be “fragmented” so as to facilitate its elimination. This is achieved by administrating simethicone (in Croatia, SAB Simplex drops) with every meal. This preparation is not resorbed, which means it is not passed from the intestines into the organism. It prevents the formation of large bubbles of gas which the intestines then try to pass (this causes pain), creating instead (much like a detergent) numerous tiny bubbles that can be passed more easily. It should be noted that research has yet to provide evidence of the indisputable usefulness of this preparation.

Probiotics are also beneficial in reducing the intensity and frequency of cramps.

The use of some “traditional” remedies such as caraway tea is not recommended as these can actually create additional gas. Other types of tea are not recommended either, especially not as remedies for breast-fed children.

If none of the recommendations listed above leads to observable improvement, consult your doctor to eliminate other possible causes of stomach pain and obtain additional treatments such as spasmolytics (antispasmodic drugs used to relieve intestinal cramps).

Touch

Close contact between the skin of the child and the mother has an extremely positive effect on reducing cramps. There are two practical positions that ensure both close contact and the elevated position of the child’s upper body. The first position has the child wearing only a diaper and resting on the mother’s chest. The head rest for the mother is significantly elevated and her pyjama tops are buttoned around the baby so that only the head remains outside (the kangaroo system).

Fathers can do this, too – studies have shown that infants are even calmer when resting against a hairy chest!

The second position has the mother sitting and resting her feet against another chair or a low table, with both her upper legs elevated at an angle of 45°. The child is placed on the upper legs, facing the mother. This position ensures ample body contact between mother and child, while at the same time enabling good face-to-face contact.

Laying the baby on his/her stomach or carrying the child who is lying on his/her stomach also facilitates air elimination.

In critical moments of inconsolable crying, the child’s legs, bent at the knees, can be pushed towards his/her stomach. At the same time, a thermometer is inserted into the colon in order to open its “valve” and stimulate defecation. Regardless of whether this results in the evacuation of the stool or air (typically a “frothy” stool – stool mixed with air), the procedure will create relief.

Massage and exercises

1. Place your hands on the stomach, calm down and try to relax regardless of the child’s restlessness and crying. Try to calm your own breathing: breathe in deeply through the nose and breathe out gently through the mouth, while creating an “S” sound. Repeat five to six times in a row.
2. The stomach can be massaged by bringing the fingers of your hand together and running your palms across the stomach. Move your hands from the upper part of the stomach towards the lower. When one palm reaches the bottom part, begin massaging the top part with the other hand. Change hands while massaging: first use one hand, then the other. Do six exchanges in one massage cycle.
3. Hold the child’s lower legs. Bend his/her legs towards the stomach and keep them in this position for half a minute.
4. Gradually reduce the pressure, stretch the legs, and allow the child to rest and relax.
5. Place one hand (the left one if you are right-handed) on the bellybutton. Use your right hand to create gentle pressure and move the hands clockwise, from left to right. When your hands become aligned with each other, raise the right hand away from the stomach and continue with a new cycle of movements. Keep the other hand on the bellybutton. This direction is recommended for massaging as it is the direction of our digestive system. Make six circles in a row.
6. Repeat exercise 3.
7. Repeat exercise 4.

Repeat exercises 1 to 7, three times in succession.

In order for this treatment to be useful, massages and exercises should be done every day for two weeks. Some children will find it more useful than others, but it is worth trying!

Since October 2006, workshops in which experts give advice regarding infant cramps have been organised in Zagreb. After familiarising parents with the nature of the problem, a senior physiotherapist uses practical activities to teach parents proper techniques for holding, massaging and exercising with their infant. Attendance is free. To register or obtain additional information, please call 098 403 808.