What To Do If Your Child Has Colic

Colic is attacks of abdominal pain, caused by muscle spasms in the intestines. Colic is common in infants.

Milk and soy allergies are particularly common in infants and young children. These allergies sometimes do not involve hives and asthma, but rather lead to colic, and perhaps blood in the stool or poor growth. Infants and children are thought to be particularly susceptible to this allergic syndrome because of the immaturity of their immune and digestive systems. Milk or soy allergies in infants can develop within days to months of birth. Sometimes there is a family history of allergies or feeding problems. The clinical picture is one of a very unhappy colicky child who may not sleep well at night. The doctor diagnoses food allergy partly by changing the child's diet. Rarely, food challenge is used.

If the baby is on cow's milk, the doctor may suggest a change to soy formula or exclusive breast milk, if possible. If soy formula causes an allergic reaction, the baby may be placed on an elemental formula. These formulas are processed proteins (basically sugars and amino acids). There are few if any allergens within these materials. The doctor will sometimes prescribe corticosteroids to treat infants with severe food allergies. Fortunately, time usually heals this particular gastrointestinal disease. It tends to resolve within the first few years of life.

Exclusive breast feeding (excluding all other foods) of infants for the first 6 to 12 months of life is often suggested to avoid milk or soy allergies from developing within that time frame. Such breast feeding often allows parents to avoid infant-feeding problems, especially if the parents are allergic (and the infant therefore is likely to be allergic). There are some children who are so sensitive to a certain food, however, that if the food is eaten by the mother, sufficient quantities enter the breast milk to cause a food reaction in the child. Mothers sometimes must themselves avoid eating those foods to which the baby is allergic.

There is no conclusive evidence that breast feeding prevents the development of allergies later in life. It does, however, delay the onset of food allergies by delaying the infant's exposure to those foods that can prompt allergies, and it may avoid altogether those feeding problems seen in infants. By delaying the introduction of solid foods until the infant is 6 months old or older, parents can also prolong the child's allergy-free period.

Most infants consume fruit juices by 6 months of age. However, fruit juices containing sorbitol may be associated with carbohydrate malabsorption without clinical symptoms. Increased physical activity and metabolic rate may be associated with carbohydrate malabsorption.

Fruit juices are an integral part of an infant's diet because of taste availability, low price, and positive exposure as a healthy snack food. This has resulted in a multimillion dollar market for fruit juices packaged exclusively for infant consumption. Intake usually starts when supplemental foods are introduced to the infant at 4 to 6 months of age. According to a survey conducted by juice manufacturers, more than 90% of all infants consume some type of fruit juice by 1 year of age.

The chemical makeup of such a popular food and its absorption from the infant's gut have been the interest of several investigators. For example, juices containing sorbitol and high fructose-to-glucose ratios, such as apple or pear juice, exhibit incomplete carbohydrate absorption in children from 6 months to 5 years of age. In another study, children younger than 6 years incompletely absorbed oral fructose when it was administered alone (0.7 to 2.0 g/kg); if given with equimolar amounts of glucose, its absorption was enhanced. These findings have resulted in an advisory from the American Academy of Pediatrics Committee on Nutrition for moderation in the amount of sorbitol-containing fruit juices fed to children.

The malabsorption of carbohydrates produces excess hydrogen gas. This has been suggested as a cause of minor irritability or colic. Increased physical activity and metabolic rate are the result of carbohydrate malabsorption after the consumption of sorbitol-containing fruit juices. We used a recently developed infant respiratory chamber to simultaneously evaluate carbohydrate absorption from fruit juice consumption in relation to physical activity and metabolic rate. These tests were performed under double-blinded conditions on infants who had ingested either pear or white grape juice.

  • From the Research Institute, Miami Children's Hospital, Miami, Fla. Corresponding author: Russell Rising, MS, PhD, Research Institute, Miami Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155.

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