How to Help Parents Cope with Colic

Colic is probably one of the mostfeared 5-letter words known tonew parents. It can best bedefined by inconsolable crying episodesin a healthy and well-fed infant, using the"rule of 3"—crying for more than 3 hoursa day, for more than 3 days a week, andfor longer than 3 weeks.^1,2

Typical symptoms include high-pitchedscreams, furrowed brow, flushed face,and clenched fists.² Symptoms tend tobe worse in the late afternoon andevening hours. Fortunately, colic is a selflimitingabdominal condition which usuallybegins at 2 weeks of age and is oftengone by the time the infant is 3 monthsold. The cause is still unknown, and itaffects an estimated 5% to 28% ofinfants.¹

If patients describe these types ofsymptoms in their infants, it is importantthat they be referred to their pediatricianto rule out any underlying medical causessuch as reflux or infection. Most times,however, frequent fussiness is due tocolic, with only 5% of excessive crying ininfants being attributed to actual underlyingillness.²

What Treatment Options AreAvailable?

Pharmacologic Treatments

No prescription drugs are available inthe United States that have been foundto be safe and effective for the treatmentof infantile colic. OTC simethicone dropsused to treat gas have not been provedeffective in colic treatment, althoughthey do not pose any risk to the infantwhen used at the appropriate dose.^2-7

Herbals

Some studies have found that herbalteas containing chamomile, vervain,licorice, fennel, and lemon balm providesome benefit to colicky babies.^2,4,7,8Herbal teas should be used only underthe advice of a pediatrician. No standardizationrequirements exist forherbal products, and if given too frequently,teas could interfere with adequatemilk consumption.

Gripe water, an herbal remedy marketedon the Internet as a "natural"remedy for colic, is generally not recommendedfor use in colicky infantsbecause it has the potential to containharmful ingredients such as alcohol.^2,5

Nonpharmacologic Treatments

The mainstay of colic treatment isthe use of different calming and soothingtechniques. Although many are notyet scientifically proved to reduce cryingtime in colicky infants, many parentshave found the following strategiesto be helpful for fussy babies:⁹

• White noise—fans, dishwashers,and running-water sounds all helpsimulate the womb environment.
• Vibrations—many parents reportthat nothing puts their baby tosleep faster than a ride in the car.
• Colic holds—the most commonhold is usually the football hold.The parent places the infant bellydown over the parent's forearm.This puts pressure on the baby'sabdomen, which is often tense incolicky infants.
• Reduced stimulation—some studieshave demonstrated that areduction in holding and carryingtimes may actually help reducefussiness in colicky infants.^3,4,8

Other time-tested soothers includestroller rides, warm baths, and slowdancing.

Is Colic Affected by Diet?

The role of diet in infants with colichas been a controversial issue. To date,much of the research has suggested a1-week trial of a hypoallergenic formulausing whey or casein hydrolysate inbottle-fed babies.^2,7,8 In breast-feedingmothers, a hypoallergenic diet in whichdairy, egg, wheat, soy, fish, and nutproducts are eliminated also may bebeneficial.¹⁰ Colic has not been found tobe related to whether infants arebreast-or formula-fed.

What Are the Psychological andSocial Impacts of Colic?

The psychosocial impact of colic onfamilies, especially the primary caregiver,is huge. A study published in ClinicalPediatrics evaluated maternal fantasiesof aggression and infanticide in motherswith colicky infants.³ The mothers wereall married and were the primary caregiversfor their babies. The findings wereastounding. First, they found that motherscoping with colic often felt depressed,anxious, agitated, and angry, which wasmost likely precipitated by the lack ofsleep and extreme fatigue. They alsofound that 70% of the participants hadexplicit aggressive thoughts and fantasiestoward their babies, while 26% hadthoughts of infanticide. One mother hadthoughts of throwing her baby out thewindow, and another fantasized aboutsmothering her infant with a pillow.

This study provided a much neededwake-up call to health care practitionerswho often focus on the health of theinfant and fail to ask about the well-beingof the mother.¹¹ Child abuse is often triggeredby intractable crying similar to thatseen in colicky infants.³ It is thereforeessential to address the health and wellbeingof the mother and father and toprovide them with the necessary supportwhen needed.

Other feelings experienced by mothersin the study included inadequacy, incompetence,and isolation. They often fearedcriticism from others and would refrainfrom public outings. This behavior leadsto isolation and the lack of a much neededsupport system.

Marriages were also stressed whendealing with colicky infants, with 91% ofthe study participants reporting problems.Arguments over what to do whenthe baby cries were commonplace, andthe mothers often felt resentmenttowards their spouse when the spousewas able to leave and "escape" to work.

What Can Pharmacists Do to Help?

Pharmacists play a unique role in theassistance of families coping with colic.They are easily accessible to parents andmay often be the first health care practitionerto turn to for advice on an inconsolableinfant. The following are someimportant counseling points:

• Advise parents that colic is not curable,but inform them of some popularsoothing techniques that mayhelp
• Make them aware of the fact thatcolic occurs in both breast-fed andformula-fed babies, and the cause isunknown
• Reassure them that colic is temporaryand is usually gone by the timethe infant is 3 months old
• Ask open-ended questions related tohow the parents are coping
• Warn them about possibly dangerouson-line colic products such asgripe water
• Always refer them to their pediatricianif their infant has not been formallydiagnosed with colic to makesure there is no underlying illness
• The most important advice you cantell parents is to take a break whenthey are about to lose their cool. TheAmerican Academy of Pediatricsuses the phrase "Take a Break-Don'tShake!"¹² It advises parents to take adeep breath, count to 10, and take abreak and let the baby cry alone.They also suggest calling a friend orrelative. If the parents are not surewhy their baby is crying, they shouldalways be advised to contact theirpediatrician. If the parents feel theyare going to hurt their child or themselves,have them call their doctor or911 immediately.

Although no known cure or treatmentexists for infants with colic, pharmacistscan do their part to assist families that aretrying their best to get through such a difficulttime in their lives. Pharmacists cannot only offer valuable medical advice,but also provide some much neededwords of encouragement to parents.

For additional information, visitwww.themedicinemom.com.

Dr. Kompare is a civilian outpatientpharmacist for McDonald ArmyCommunity Hospital, Ft. Eustis, Va.

For a list of references, send a stamped,self-addressed envelope to: ReferencesDepartment, Attn. A. Rybovic, PharmacyTimes, Ascend Media Healthcare, 103 CollegeRoad East, Princeton, NJ 08540; or send ane-mail request to: arybovic@ascendmedia.com.