crying

CAUSES — There are many theories about the causes of colic, although evidence supporting a single theory is scant. Most infants with colic do not have an underlying medical condition that causes them to cry excessively. Colic probably results from a number of different factors, including gastrointestinal, biologic, and psychosocial factors.

Gastrointestinal factors — Gastrointestinal factors have been proposed as a cause of colic for several reasons: some infants with colic have a tense or bloated abdomen, draw their legs up to the abdomen (as if their abdomen hurts), and stop crying after passing gas or a bowel movement.

Biologic factors

Feeding techniques — Underfeeding, overfeeding, infrequent burping, and swallowing air have all been described as possible causes of colic.

Smoking — Infants of mothers who smoke during pregnancy or after delivery have twice the risk of developing colic.

Psychosocial factors

Temperament — Experts have proposed that infant behavior and development are the result of a child's response (based on their individual characteristics) to their environment. However, there is limited evidence for this theory.

Parental variables — Family stress and tension have been suggested as a cause of colic but studies have shown conflicting results.

OTHER CAUSES OF EXCESSIVE CRYING — There are a number of reasons, other than colic, that an infant may cry excessively; these can range from simple problems such as hunger to more serious problems such as infection. A list of these is included in the table (show table 2).

A parent should first check for manageable causes of crying:

Hunger — Try feeding the baby to see whether hunger is the problem. Although most young infants (younger than 3 months) feed every two to four hours, all babies go through periods when they will want to feed more frequently (usually during growth spurts).
Pain — Check to see if the baby is uncomfortable because of illness or physical injury. Feel the skin to determine if the baby is overheated or too cold. Finally, check to see if the clothing or diaper is too tight or if a hair is wrapped around a finger, toe, or the penis (called a hair tourniquet).
Fatigue or overstimulation — Babies often cry when they become tired or overstimulated from playing or being handled. Swaddling the baby snugly (show figure 1), offering a pacifier, or a change of scene (such as a stroller or car ride) may help the baby to fall asleep.
Food sensitivities — Infants can have an allergy or sensitivity to foods in their mother's diet or a component of their formula. Foods such as milk, eggs, nuts, and wheat in a mother's diet have a direct effect on the composition of her milk; these foods can occasionally cause adverse food reactions and subsequent gastrointestinal reactions such as abdominal pain, cramping, and diarrhea. Formula-fed infants can be sensitive or allergic to a protein in cow's milk-based formulas. Lactose (a type of sugar found in cow's milk) intolerance has little to no effect on the development of colic.
Food sensitivities may be suspected if an infant cries or spits up a large amount within an hour of feeding or if a baby has constipation or diarrhea. Symptoms of cow's milk allergy include eczema, wheezing, diarrhea, or vomiting.

If these causes have been eliminated and the baby continues to cry excessively, parents should speak with their healthcare provider. Most infants who cry excessively do not have a serious underlying medical problem; a healthcare provider can help to make this determination. (See "When to seek help" below).

DIAGNOSIS — The diagnosis of colic is often made after it has run its typical three- to four-month course. Parents who are concerned about their infant's crying should visit a healthcare provider to discuss their concerns and possible management strategies. Other causes of excessive crying must be considered in any infant who is suspected to have colic.

The provider may perform a physical examination, including measurement of the infant's height and weight. These measurements are used to monitor an infant's growth pattern, and may show abnormal changes if there is an underlying medical problem.

Home monitoring — Parents can monitor the characteristics of their infant's crying; it may be helpful to keep a written record of the following information. This information can be shared with a healthcare provider and may help to determine the cause of an infant's crying as well as the best ways to manage it.