The word “colic” is really a catchall term for any condition that causes inconsolable crying and screaming in infants. Colicky babies are in pain. Often, their tummies are hard and distended. They arch their backs, ball their fists, flail their arms and legs, and generally have a hard time with everything from nursing to sleeping. Most babies will calm down when put to the breast and fall asleep shortly after feeding, but not a colicky baby. A colicky baby is more likely to suck vigorously for just a few minutes and then pull away screaming and struggling.

What Causes Colic?

Because there is no single condition described by the word “colic,” there really is no single cause. Immature digestive and nervous systems are often thought to be at the root of colic simply because babies seem to miraculously grow out of it by four months of age, a time when those systems have become significantly more developed. For some babies, many different factors can come into play.

Is there a way to differentiate between colic and fussiness?

Standard fussiness seems to follow predictable patterns. Crying often peaks with babies in their second week of life; they cry more frequently and with more intensity because of environmental overstimulation and growth spurts. But a colicky baby is one that follows the rule of three: She cries continuously for three or more hours, three or more times each week, for three or more weeks.

One common cause of colic is food allergy. Tiny particles of food, called allergens, find their way from your body into your breastmilk. Some of these allergens simply irritate your baby's intestinal lining. Others leak through that lining and enter your baby's bloodstream, causing her immune system to respond. The typical symptoms of a food allergy in infants are rashes, gas, discolored and mucousy stools, vomiting, a stuffy nose, a red ring around the anus, or a refusal to nurse.

Another cause of colic is gastroesophageal reflux, or GER. Basically, GER is a condition in which immature development of a muscular valve at the intersection of the stomach and the esophagus lets stomach acid enter your child's esophagus. The acid causes a painful sensation like heartburn. Babies who spit up a lot and fail to gain weight are often diagnosed with GER. This is a serious condition and must be monitored by your health care provider. Fortunately, breastfed babies are three times less likely to have GER than formula-fed babies.

The other typical causes of colic have to do with the way your baby nurses. Too much milk being let down too quickly causes a baby to take big gulps of air, leading to an upset stomach. Air can also be swallowed if your baby's mouth doesn't form a tight seal around the breast. Some of the latest research on colic and nursing has shown that some babies might become colicky when they switch from breast to breast too soon and fill up on lactose-rich foremilk. This excess lactose can ferment in your baby's body, causing gas, bloating, and explosive, greenish stools. This doesn't mean your baby is lactose-intolerant; it just means she's getting too much foremilk.

What Can I Do?

The first thing to do if your baby shows symptoms of colic is to eliminate all the normal causes of fussiness. Respond quickly to her cries. Offer the breast. Provide any physical security she might need.

If your baby can't be consoled, make an appointment with your pediatrician. Doctors typically use a diagnosis of colic when a baby seems healthy and is gaining weight but can't be consoled. Insist that your child's health care provider make a reasonable effort to find the problem.

A diagnosis of GER gives you a chance to reduce both the frequency and the severity of colic attacks, and continuing to breastfeed is the best way to go about this. Your milk digests more rapidly than formula in your baby's stomach, so there's less chance for stomach contents to back up into the esophagus. Doctors recommend that feedings be frequent and small. Propping up the head of the crib is also helpful in keeping stomach acid down.

The same day you see the doctor, see your lactation specialist. She'll need to observe a normal breastfeeding session so she can check the seal between baby's mouth and your breast, the amount of time your baby spends on each breast, and whether letdown is overwhelming your baby.

If your baby is swallowing air, there are solutions. Check your nursing posture and the feeding position of your baby, and make her open her mouth wide before you let her take the breast.

“When our daughter had colic and wouldn't stop crying, we would play some reggae music and bounce to the beat with her in our arms. We figured the rhythm mimicked a heartbeat, which was soothing to her. Even now, our Reggae Meaggae loves Bob Marley.”—Suzie

If you suspect your baby isn't nursing long enough on each breast to get hindmilk, remember to let her nurse as long as she wants before switching sides. Don't feel that you need to move her to the second breast after some predetermined amount of time. Clocks can't tell you when to switch sides. Both your breasts and your baby will quickly adjust to this change in the feeding pattern.

If your baby seems to quit nursing before your letdown occurs, try breast compression to get her interested again. Breast compression is very much like manual milk expression (see Chapter 11), except that you do it while your baby still has your breast in her mouth. You can also try:

• Sound. The sound of a vacuum cleaner has been known to soothe many a colicky baby. You can also try different types of music.

• Movement. Rocking, bouncing, gentle vibrations. Even dancing, baby swings, and bouncy chairs are good options.

• Warm bath

• Swaddling

• Slings

• Infant massage

Most importantly, continue nursing. Your milk is giving your baby everything she needs to get through this difficult time. As a nursing mother, it might comfort you to know that you can offer your baby a few moments of relief at your breast. If at some point you feel that you just can't do it anymore, express your milk and bottle feed it to your baby.