Colic- Part 2
By Diji Vaughan, MD
November 11, 2012
Category: Newborn


We will follow through on addressing other therapeutic options for infantile colic in addition to the comfort measures discussed last week.

There is enough evidence in the medical literature suggesting that newborn infants go through a brief period of intestinal enzyme insufficiency simultaneously at the same time colic symptoms peak and wane. The specific enzyme tested for in these studies is called lactase. This enzyme plays a key role in the breakdown and digestion process of milk sugar otherwise known as lactose. A transient deficiency affecting lactase leads to poor milk digestion and lots of gas and other by products are produced. The gas produced contributes to abdominal discomfort and spasm we believe plays a key role in the progression of symptoms leading to infantile colic.

Medications aimed at attenuating this progression of symptoms have always being met with variable amounts of success. There isn’t any one therapeutic option that consistently gives symptomatic relief. A careful evaluation by your physician is always necessary since there are conditions that may mimic infantile colic and yet be very different and distinct disease processes.

Anti-gas over the counter drops often contain a drug known as simethicone. This medication has been described as an “anti-foaming” agent. The medication makes it less likely for the smaller gas bubbles from the maldigestion process described above to coalesce and form even bigger bubbles which end up making it more difficult for the infant to pass the gas as flatus. When simethicone was subjected to a high pedigree of scientific scrutiny known as randomized controlled trial, there was no scientific proof of its usefulness for infantile colic. Our experience has shown a variable response and because its not absorbed or pose toxicity concerns when used as recommended, it continues to be a favorite for colicky infants among parents.

There are other over the counter medications formulated to contain preparations of the lactase enzyme whose transient deficiency is believed to be central to the evolution of colicky symptoms. Lactase is an enzyme and can easily be denatured when exposed inappropriately to the elements. There are scientific studies with a small number of participants showing satisfactory response rates after 3 days of use in more than 20% of enrollees. We would advise readers to discuss with their physician before administering all medications.

Changing the infant formula to products that do not contain lactose sugar in the milk may sometimes be necessary as determined by your physician. These products contain a different form of sugar from corn-syrup. It is noteworthy that human milk contains lactose sugar and these products often contain other partially digested forms of milk protein as well.

The symptoms of infantile colic described in these series eventually resolve between the 3rd and 4th month of life when the partial lactase deficiency resolves and the infant gut usually resumes the production of adequate lactase. Preparing parents for the possibility of colicky symptoms that can affect as many as 20% of newborns  during preventive health visits by far seems to be the best weapon against colic, after all to be forewarned is to be forearmed.