Colic is probably one of the most feared 5-letter words known to new parents. It can best be defined by inconsolable crying episodes in a healthy and well-fed infant, using the "rule of 3"—crying for more than 3 hours a day, for more than 3 days a week, and for longer than 3 weeks.^1,2

Typical symptoms include high-pitched screams, furrowed brow, flushed face, and clenched fists.² Symptoms tend to be worse in the late afternoon and evening hours. Fortunately, colic is a selflimiting abdominal condition which usually begins at 2 weeks of age and is often gone by the time the infant is 3 months old. The cause is still unknown, and it affects an estimated 5% to 28% of infants.¹

If patients describe these types of symptoms in their infants, it is important that they be referred to their pediatrician to rule out any underlying medical causes such as reflux or infection. Most times, however, frequent fussiness is due to colic, with only 5% of excessive crying in infants being attributed to actual underlying illness.²

What Treatment Options Are Available?

Pharmacologic Treatments

No prescription drugs are available in the United States that have been found to be safe and effective for the treatment of infantile colic. OTC simethicone drops used to treat gas have not been proved effective in colic treatment, although they do not pose any risk to the infant when used at the appropriate dose.^2-7

Herbals

Some studies have found that herbal teas containing chamomile, vervain, licorice, fennel, and lemon balm provide some benefit to colicky babies.^2,4,7,8 Herbal teas should be used only under the advice of a pediatrician. No standardization requirements exist for herbal products, and if given too frequently, teas could interfere with adequate milk consumption.

Gripe water, an herbal remedy marketed on the Internet as a "natural" remedy for colic, is generally not recommended for use in colicky infants because it has the potential to contain harmful ingredients such as alcohol.^2,5

Nonpharmacologic Treatments

The mainstay of colic treatment is the use of different calming and soothing techniques. Although many are not yet scientifically proved to reduce crying time in colicky infants, many parents have found the following strategies to be helpful for fussy babies:⁹

• White noise—fans, dishwashers, and running-water sounds all help simulate the womb environment.
• Vibrations—many parents report that nothing puts their baby to sleep faster than a ride in the car.
• Colic holds—the most common hold is usually the football hold. The parent places the infant belly down over the parent's forearm. This puts pressure on the baby's abdomen, which is often tense in colicky infants.
• Reduced stimulation—some studies have demonstrated that a reduction in holding and carrying times may actually help reduce fussiness in colicky infants.^3,4,8

Other time-tested soothers include stroller rides, warm baths, and slow dancing.

Is Colic Affected by Diet?

The role of diet in infants with colic has been a controversial issue. To date, much of the research has suggested a 1-week trial of a hypoallergenic formula using whey or casein hydrolysate in bottle-fed babies.^2,7,8 In breast-feeding mothers, a hypoallergenic diet in which dairy, egg, wheat, soy, fish, and nut products are eliminated also may be beneficial.¹⁰ Colic has not been found to be related to whether infants are breast-or formula-fed.

What Are the Psychological and Social Impacts of Colic?

The psychosocial impact of colic on families, especially the primary caregiver, is huge. A study published in Clinical Pediatrics evaluated maternal fantasies of aggression and infanticide in mothers with colicky infants.³ The mothers were all married and were the primary caregivers for their babies. The findings were astounding. First, they found that mothers coping with colic often felt depressed, anxious, agitated, and angry, which was most likely precipitated by the lack of sleep and extreme fatigue. They also found that 70% of the participants had explicit aggressive thoughts and fantasies toward their babies, while 26% had thoughts of infanticide. One mother had thoughts of throwing her baby out the window, and another fantasized about smothering her infant with a pillow.

This study provided a much needed wake-up call to health care practitioners who often focus on the health of the infant and fail to ask about the well-being of the mother.¹¹ Child abuse is often triggered by intractable crying similar to that seen in colicky infants.³ It is therefore essential to address the health and wellbeing of the mother and father and to provide them with the necessary support when needed.

Other feelings experienced by mothers in the study included inadequacy, incompetence, and isolation. They often feared criticism from others and would refrain from public outings. This behavior leads to isolation and the lack of a much needed support system.

Marriages were also stressed when dealing with colicky infants, with 91% of the study participants reporting problems. Arguments over what to do when the baby cries were commonplace, and the mothers often felt resentment towards their spouse when the spouse was able to leave and "escape" to work.

What Can Pharmacists Do to Help?

Pharmacists play a unique role in the assistance of families coping with colic. They are easily accessible to parents and may often be the first health care practitioner to turn to for advice on an inconsolable infant. The following are some important counseling points:

• Advise parents that colic is not curable, but inform them of some popular soothing techniques that may help
• Make them aware of the fact that colic occurs in both breast-fed and formula-fed babies, and the cause is unknown
• Reassure them that colic is temporary and is usually gone by the time the infant is 3 months old
• Ask open-ended questions related to how the parents are coping
• Warn them about possibly dangerous on-line colic products such as gripe water
• Always refer them to their pediatrician if their infant has not been formally diagnosed with colic to make sure there is no underlying illness
• The most important advice you can tell parents is to take a break when they are about to lose their cool. The American Academy of Pediatrics uses the phrase "Take a Break-Don't Shake!"¹² It advises parents to take a deep breath, count to 10, and take a break and let the baby cry alone. They also suggest calling a friend or relative. If the parents are not sure why their baby is crying, they should always be advised to contact their pediatrician. If the parents feel they are going to hurt their child or themselves, have them call their doctor or 911 immediately.

Although no known cure or treatment exists for infants with colic, pharmacists can do their part to assist families that are trying their best to get through such a difficult time in their lives. Pharmacists can not only offer valuable medical advice, but also provide some much needed words of encouragement to parents.

For additional information, visit www.themedicinemom.com.

Dr. Kompare is a civilian outpatient pharmacist for McDonald Army Community Hospital, Ft. Eustis, Va.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Rybovic, Pharmacy Times, Ascend Media Healthcare, 103 College Road East, Princeton, NJ 08540; or send an e-mail request to: arybovic@ascendmedia.com.