DrQitta

Colic is a condition where there are repeated bouts of excessive crying in a baby who is otherwise healthy. The definition doctors use is: a baby crying for more than three hours a day, for more than three days a week, for at least three weeks. Colic is common and distressing. It usually goes away by the age of 3-4 months. Ways that may help to ease colic in some cases, and some tips on how to cope, are given below.

A typical baby with colic
Colic is common and can affect up to three out of ten babies. A healthy newborn baby may have periods of crying. For no apparent reason he or she cries as if in pain. The usual methods of comforting do not work very well. He or she does not want to feed, and may pull up their knees. Sometimes the baby's abdomen (tummy) appears to rumble. The cry may sound different and more piercing than normal. He or she may appear to be settling when suddenly another bout of crying occurs. This may go on and off for several hours until he or she settles and falls asleep.

The rest of the time he or she is fine. However, the bouts of colic occur regularly, most commonly every evening, but can occur at any time. Bouts of colic gradually become less frequent, and have gone in most babies by the age of 3-4 months.

Variations on a theme
In some babies, a period of restlessness in the evening may be all that you notice. In some babies with severe colic, the crying may go on for many hours throughout the day (and/or night). However, babies with colic are fine between bouts of colic. They feed well, grow well, and do not show any other signs of illness.

What causes colic?
Despite a huge amount of research on this condition, the actual cause is still not clear. The term colic is used as it is thought the baby has pain in the abdomen. Research suggests this may be related to a change in the level of hormones that control the movement of gut muscles. Another theory is that babies with colic may have an abnormal balance of bacteria in their gut, which gradually corrects itself over a few weeks. Some (but certainly not the majority) of babies with colic have an intolerance to cow's milk.
Smoking during pregnancy and also taking nicotine replacement treatment during your pregnancy does increase the risk of your baby developing baby colic. Being in a smoky atmosphere (passive smoking) also increases the risk.
Some parents feel that they have done something wrong in some way. This is not the case.

How is it diagnosed?
Colic is diagnosed by excluding other causes of persistent crying. Babies with colic are otherwise well and continue to put on weight normally. In the majority of babies who cry a lot, no illness can be found and colic is often the cause of this. Remember, a baby with colic will have spells when they are perfectly fine in between bouts of crying. Conditions sometimes mistaken for colic include:

If you are unsure as to the cause of a distressed or crying baby, then see a doctor.
Helping colicky babies and their parents
There is no treatment that cures colic. Every parent has their own way of coping and may find different things helpful. Try not to despair. You have to remember that there is nothing that you have done to cause the colic. Also, that colic usually goes away by 3-4 months of age, often much sooner.
One or more of the following may help.
Check for causes of discomfort
Make sure the baby is not cold, is not hungry, and is changed often enough.

Reducing anxiety
Even newborn babies may sense anxiety. This can make things worse. Try to create a relaxed atmosphere. If possible, have a rest and meal before the colic begins (usually in the evening). The more rested and relaxed you are, the better you will be able to cope.
Colic happens more frequently when the mother has postnatal depression or feels very down after the baby was born. If this is the case, see your doctor for some help.

Soothing
It is natural to try to soothe a crying baby. Holding a baby through the crying episode may help to soothe. However, a colicky baby may simply not be comforted or soothed. At such times it is acceptable to leave a baby to cry for short periods if you are satisfied that he or she is not hungry, too cold, too hot, wet, or unwell. Remember - never shake a baby. If you need a break from the crying, or if you feel at the end of your tether, gently place the baby in his or her cot and leave the room for around 10 minutes. You could then do something which will help you - perhaps have a cup of tea, a snack or phone a friend.

Time out
Friends or other family members may be willing to help. However, try to avoid several people fussing at once, as this may cause anxiety. It may be sensible to leave the coping to one person at a time. Take it in turns if you have help. If possible, it is good to have time out and leave someone else to look after your baby for a few hours.
If you have a partner, it can be worth taking it in turns to do the 'night shift'. Many mums, even with partners, always try to do the nights themselves. This can be exhausting. It may be sensible to take it in turns to get a good night's sleep. If you are breast-feeding, you may be able to express enough milk in the day for a feed to be given in the night by your partner.

Lactose intolerance
Research suggests that some babies with colic may be intolerant to lactose which is a sugar found in milk. This is quite rare. More commonly babies become intolerant after a tummy bug (gastroenteritis). This is usually a short lived phase. Changing from ordinary baby formula milk to a baby formula milk that is free from, or low in, lactose is an option. However, you should check with your doctor or health visitor before trying this. Another method which your doctor or health visitor may suggest is to add lactase drops to the milk, which breaks down lactose. Once things settle down you should try the baby with ordinary formula milk again, as lactose may play a part in keeping the bowel healthy in the long term.
Soy-based formula milks are not recommended and should not be given to babies with colic.

The diet of breast-feeding mothers
If you breast-feed, there's some evidence that it may help if you do not have cows' milk, dairy products, eggs, wheat, nuts and caffeine (which can also be found in some painkillers). Some women find cutting out spices or garlic is also helpful, although there's little scientific support for this. If there's no improvement after you've made changes for a week, go back to your normal diet.

What about medicines?
If simple things don't work, you could try a medicine called simeticone (eg, Infacol®). However, there is no scientific evidence to support its use. Dicycloverine used to be used but is now considered unsafe. Some people find gripe water helpful, but its use is not supported by research.

Popular but non-proven advice
The following tips are often given. However, the advice is based on individual experiences and no research studies have proved that they help. So, they may or may not help.

Noise
Some people say that white noise helps to soothe colicky babies. White noise is background, nonspecific noise such as that made by vacuum cleaners, washing machines, etc. You can even buy CDs of white noise which claim to soothe crying babies. There is a lack of research that proves that this works in most babies, but it may be worth a try.

Rides and carrying
Crying babies may settle on car journeys. It is possibly the white noise of the car engine and the gentle movements of the car that do the trick. Pram rides seem good too - it may be the movement that helps to soothe some babies. Or, simply walking with the baby in a sling or baby carrier may help to soothe.
Complementary and alternative remedies
Many alternative therapies are promoted and advertised for colic. There is no firm evidence that any of these are beneficial.
Note: not all alternative therapies are without risk. For example, some herbal products, such as star anise, have caused serious reactions in some babies, and are not recommended.

Your feelings
Sometimes parents become angry, tearful, or resentful towards a baby with colic. These are normal and common emotions. The crying can seem distressing, intolerable and very frustrating.
If you are finding it hard to cope then do see your health visitor or doctor, or call Cry-sis for advice.

The Gut

This leaflet gives a brief overview of the gut and how the gut works.

What is the gut?

The gut (gastrointestinal tract) is the long tube that starts at the mouth and ends at the anus. Cross-section diagram of the abdomen showing the full gastrointestinal organs

Where is the gut found?

The mouth is the first part of the gastrointestinal tract. When we eat, food passes down the oesophagus (gullet), into the stomach, and then into the small intestine. The small intestine has three sections - the duodenum, jejunum and ileum. The duodenum is the first part of the small intestine and follows on from the stomach. The duodenum curls around the pancreas creating a c-shaped tube. The jejunum and ileum make up the rest of the small intestine and are found coiled in the centre of the abdomen. The small intestine is where food is digested and absorbed into the bloodstream. Following on from the ileum is the first part of the large intestine, called the caecum. Attached to the caecum is the appendix. The large intestine continues upwards from here and is known as the ascending colon. The next part of the gut is called the transverse colon because it crosses the body. It then becomes the descending colon as it heads downwards. The sigmoid colon is the s-shaped final part of the colon which leads on to the rectum. Faeces is stored in the rectum and pushed out through the anus when you go to the toilet. The anus is a muscular opening that is usually closed unless you are passing stool. The large intestine absorbs water, and contains food that has not been digested, such as fibre.

What does the gut do?

The gut processes food - from the time it is first eaten until it is either absorbed by the body or passed out as faeces. The process of digestion begins in the mouth. Here your teeth and enzymes (chemicals made by the body) begin to break down food. Muscular contractions help to move food into the oesophagus and on to the stomach. Chemicals produced by cells in the stomach begin the major work of digestion.

While some foods and liquids are absorbed through the lining of the stomach, the majority are absorbed in the small intestine. Muscles in the wall of the gut mix your food with the enzymes produced by the body. They also move food along towards the end of the gut. Food that can't be digested, waste substances, bacteria and undigested food all get passed out as faeces.

How does it work?

The mouth contains salivary glands which release saliva. When food enters your mouth the amount of saliva increases. Saliva helps to lubricate food and contains enzymes that start chemically digesting your meal. Teeth break down large chunks into smaller bites. This gives a greater surface area for the body's chemicals to work on. Saliva also contains special chemicals that help to stop bacteria from causing infections.

The amount of saliva released is controlled by your nervous system. A certain amount of saliva is normally continuously released. The sight, smell or thought of food can also stimulate your salivary glands.

To pass food from your mouth to the oesophagus you must be able to swallow. Your tongue helps to push food to the back of the mouth. Then the passages to your lungs close and you stop breathing for a short time. The food passes into your oesophagus. The oesophagus releases mucus to lubricate food. Muscles push your meal downwards towards the stomach.

The stomach is a j-shaped organ found between the oesophagus and duodenum. When empty, it is about the same size as a large sausage. Its main function is to help digest the food you eat. The other main function of the stomach is to store food until the gut is ready to receive it. You can eat a meal faster than your intestines can digest it.

Digestion involves breaking food down into its most basic parts. It can then be absorbed through the wall of the gut into the bloodstream and transported around the body. Just chewing food doesn't release the essential nutrients, so enzymes are needed.

The wall of the stomach has several different layers. The inner layers contain special glands. These glands release enzymes, hormones, acid and other substances. These secretions form gastric juice, the liquid found in the stomach.

Muscle and other tissue form the outer layers. A few minutes after food enters the stomach the muscles within the stomach wall start to contract (tighten). This creates gentle waves in the stomach contents. This helps to mix the food with gastric juice.

Using its muscles, the stomach then pushes small amounts of food (now known as chyme) into the duodenum. The stomach has two sphincters, one at the bottom and one at the top. Sphincters are bands of muscles that form a ring. When they contract the opening, the control closes. This stops chyme going into the duodenum before it is ready.

Digestion of food is controlled by your brain, nervous system and various hormones released in the gut. Even before you begin eating, signals from your brain travel via nerves to your stomach. This causes gastric juice to be released in preparation for food arriving. Once food reaches the stomach, receptors (special cells which detect changes in the body) send their own signals. These signals cause the release of more gastric juice and more muscular contractions.

When food starts to enter the duodenum this sets off different receptors. These receptors send signals that slow down the muscular movements and reduce the amount of gastric juice made by the stomach. This helps to stop the duodenum being overloaded with chyme.

Diagram showing detail around the pancreas

The duodenum, jejunum and ileum make up the small intestine. The first part of the duodenum receives food from the stomach. It also receives bile from the gallbladder via the bile duct, and pancreatic enzymes made by cells in the pancreas via the pancreatic duct. Pancreatic enzymes are needed to break down and digest food. Bile, although not essential, helps in the digestion of fatty foods. Cells and glands in the lining of the the small intestines also produce intestinal juice that helps digestion. Contractions in the wall of the small intestine help to mix food and to move it along.

The small intestine also has special features which help to increase the amount of nutrients absorbed by the body. The inner layer of the small intestine has millions of what are known as villi. These are tiny finger-like structures with small blood vessels inside. They are covered by a thin layer of cells. Because this layer is thin, it allows the nutrients released by digestion to enter the blood. Most of the important nutrients needed by the body are absorbed at different points of the small intestine.

Following on from the ileum is the large intestine. The inside of the large intestine is wider than the small intestine. It does not contain villi, and mainly absorbs water. Bacteria in the large intestine also help with the final stages of digestion. Once chyme has been in the large intestine for 3-10 hours it becomes semi-solid. This is because most of the water has been removed. These remnants are now known as faeces.

Movements of the muscles found in the large intestine help to digest the chyme and move faeces towards the rectum. When faeces are present in the rectum, the walls of the rectum stretch. This stretch activates special receptors. These receptors send signals via nerves to the spinal cord. The spinal cord signals back to the muscles in the rectum, increasing pressure on the first sphincter of the anus. The second, or external sphincter of the anus is under voluntary control. This means you can decide whether you will open your bowels or not. Young children have to learn to control this during toilet training.

Some disorders of the gut

•Acid reflux and oesophagitis

•Anal fissure

•Appendicitis

•Barrett's oesophagus

•Cancer of the bowel

•Cancer of the liver

•Cancer of the oesophagus

•Cancer of the pancreas

•Cancer of the stomach

•Cholecystitis

•Coeliac disease

•Constipation

•Crohn's disease

•Cystic fibrosis

•Diarrhoea

•Diverticula

•Duodenal ulcer

•Dyspepsia

•Gallstones

•Gastroenteritis

•Haemorrhoids (piles)

•Helicobacter pylori and stomach pain

•Hernia

•Hiatus hernia

•Irritable bowel syndrome

• ect..