When a Disease Causes Baby's Colic

Easing Baby Bellies

Reviewed by Gary D. Vogin, MD

Jan. 14, 2002 -- Christie Manners of Duvall, Wash., was worn out by her colicky baby boy, Gabriel. He would cry inconsolably for hour after hour, and no amount of rocking, singing, or walking would calm him. No one was able to sleep -- not the baby; and certainly not mom and dad.

For many parents like the Manners and their afflicted newborn, colic remains a bothersome, mysterious condition that only time and a lot of patience can cure. But sometimes colic isn't a mystery. For some inconsolable infants, gastroesophageal reflux disease (GERD)may be to blame for the screaming, the sleeplessness, and the pain.

What finally did the trick for Gabriel, now 12 weeks old, was Zantac (ranitidine), the same medicine doctors give to grown-ups with acid reflux or ulcers. "Once it kicked in, he was like a different baby," says Manners. "It didn't take away all the colic symptoms -- he was still fussy from 6:15 to 9:15 in the evening -- but he obviously wasn't as uncomfortable and he wasn't screaming in pain anymore."

Little Tummies, Big Discomfort

How do you know if GERD is the source of your baby's woes? When a newborn has GERD, the contents of his stomach backs up into the esophagus, and he may vomit, have breathing problems, and fail to gain weight. An immature digestive system is usually the culprit, so infants tend to grow out of GERDby the time they're 6 months to 1 year old.

Your doctor diagnose GERD with a test that involves placing a string-like tube into the baby's esophagus for 12 to 24 hours to measure the amount of regurgitated stomach acid, says William Sears, MD, co-author of "The Baby Book: Everything You Need to Know About Your Baby -- From Birth to Age Two." But since one-third of infants normally have some degree of reflux, this test doesn't necessarily prove that reflux is the cause of your baby's pain.

So pediatricians may forego the test and suggest treatment for GERD if the timing of colicky episodes coincides with the time when a baby typically refluxes, says Sears. Here are some other symptoms that may indicate GERD:

  • Frequent episodes of spitting up after feeding, which may include forceful regurgitation through the nose
  • Frequent inconsolable bouts of abdominal pain, day and night
  • Painful episodes of night waking
  • Fussiness after eating, drawing legs and knees up to chest
  • Arching or writhing as if in pain
  • Diminished fussiness when carried upright, prone (on stomach), or propped up at a 30-degree angle
  • Frequent unexplained colds, wheezing, and chest infections
  • Episodes of stopping breathing

Treatment, and Time

If a baby's colic symptoms appear to be caused by GERD, your pediatrician may prescribe Zantac or similar medications, such as Tagamet (cimetidine). These drugs, available by prescription in an infant-strength liquid, block the production of the irritating stomach acids that may be regurgitated into the esophagus, thus relieving baby's heartburn-like symptoms.

"In the vast majority of infants, GERD is a benign condition that resolves spontaneously without medication," says Robert Squires, MD, associate professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas and chair of the American Academy of Pediatrics' section on gastroenterology and nutrition.

But histamine blockers, like Zantac and Tagamet, or another class of drugs designed to improve intestinal motility, such as Reglan (metoclopramide), may be helpful, particularly if a child is vomiting blood, has recurrent asthma or pneumonia, or isn't gaining weight properly, says Squires. He discourages the use of antacids like Mylanta or Maalox, which contain aluminum that may be absorbed by bone if used for months or years.

Which medication is most effective depends on the child. Gabriel's symptoms improved temporarily from Zantac but when they returned two weeks later, his pediatrician switched him to Tagamet, which is more effective, says his mother. An advantage to Tagamet, says Manners, is that it kicked in after two days, as opposed to the five days it took to see the effects of Zantac.

Besides doctor-prescribed medications, Sears suggests other remedies for quelling GERD:

  • Prop your baby at a 30-degree angle for 30 minutes after feeding and while sleeping. A special sling manufactured by Tucker Designs in Kenner, La., will hold baby while he lies prone on a propped-up crib mattress.
  • Offer smaller, more frequent feedings.
  • Wear your baby in a sling as much as possible to decrease crying. Babies reflux more while crying.
  • Breast-feed. Studies show that GERD is less common among breast-fed babies.