Colic

Colic is a condition that is characterized by excessive, often inconsolable crying in babies, typically seen in the first few weeks to months of life (Zeevenhoven et al, 2017; Sung, 2018).

Infantile colic is a common condition and the reason for around 20% of pediatrician visits during the first weeks of life (Banks et al., 2022).

A common definition used to describe colic is, when an otherwise healthy baby cries for more than 3 hours per day, more than 3 days in a week (Zeevenhoven et al., 2017; Zeifman & St James-Roberts, 2017) and for more than 3 weeks (Roberts et al 2004).

Colic usually starts a few weeks after birth and by three months the majority of infants with colic will have resolved their condition (Savino et al 2014).

Colic & CMPA

What causes colic in infants?

Experts believe that the causes of excessive infant crying or infantile colic can be multifactorial. One hypothesis is that it is due to the immature development of the digestive and/or nervous system (Zeevenhoven et al., 2017; Hjern et al., 2020).

There is also some evidence linking colic with gut inflammation. In a study by Rhoads et al (2019) they reported that colic in infants was strongly linked to gut inflammation and dysbiosis, with fewer bifidobacteria (Rhoads et al 2019).

It can also be caused by illnesses, such as reflux or by parental stress, as well as CMPA. However, an underlying illness is rarely the cause of inconsolable crying/infantile colic alone (only seen in less than 5% of babies) (Zeevenhoven et al., 2017; Roberts et al 2004).

Crying is considered a normal, accepted part of a child’s development and should be clearly distinguished from inconsolable crying or infantile colic.

Could it be a symptom of Cow’s Milk Protein Allergy?

Colic in infants has also been shown to be linked to the ingestion of cow’s milk protein (Jakobsson & Lindenbergl 1979). Colic can be both a suggestive symptom of CMPA in formula-fed (Savilathi et al 1981; Iacono eet al 1991; Lothe et al 1982; Lothe et al 1989) as well as breastfed infants (Jakobsson & Lindenberg 1979; Jakobsson et al 1983).

However, when considering the diagnosis of CMPA, it’s important to consider that the majority of infants with CMPA have at least two symptoms affecting at least two different organ systems (Lifschitz C. and Szajewska H 2015; Host & Halken 1990; Host et al 1994).

Therefore, it is important to consider the individual child as well as the magnitude of their symptoms. This can be achieved using an awareness tool such as the Cow’s Milk Related Symptom Score (CoMiSS®) which will help you determine if CMPA might be indicated (Vandenplas et al 2015;Vandenplas et al 2022).