Colic Therapy – Could EC Help to Treat Your Baby‘s Colic?

I clearly remember my son David’s excessive crying periods, which seemed to come out of the blue and made me feel helpless. Those were very stressful situations for all family members.

I particularly remember one afternoon when I became physically too weak to carry David. I had to lay him on the bed while he was still screaming uncontrollably and seemed to be in great pain. I’d tried everything I knew to ease his pain (moving his legs, giving him herbal tea, applying warmth and massaging his tummy), and was carrying and jiggling him while walking in circles for mile after mile in our apartment. Nothing helped. Luckily his dad came home just in time to take over. After another twenty minutes of my husband carrying and trying to calm him, David finally fell asleep on his Dad’s lap – and my husband was so exhausted that he fell asleep too. In a sitting position, with earplugs still in his ears.

We had just gone through another one of David’s episodes of colic.

Fact-Box: What is Colic? What are the symptoms? Medical science defines infant colic as excessive crying in early infancy. It has negative effects on the whole family and puts parents and caregivers under a lot of stress, which may result in an abusive response and a higher risk of shaken baby syndrome and parental postpartum depression. Less than 5% of colic episodes are related to a bodily dysfunction or disease. Up to 40% of infants are reported to have colic. The symptoms are inconsolable crying, screaming, legs drawn up against the belly, furrowed brow, swollen belly and arched back, difficulty pooing, crying after a feed and passing gas. Baby seems to be in great pain. [2]

As soon as David had a little more control of his head movements and could support his head on his own, I felt confident enough to give Elimination Communication (EC) a go. It immediately improved his physical wellbeing.

Could Elimination Communication help to treat your baby’s colic?

The answer is: Yes. Elimination Communication, which involves responding to baby’s needs and providing a secure and comfortable position for them to fully relieve themselves, is a scientifically approved and effective way of treating and reducing infant colic.

What is Elimination Communication?

Not everyone has the same picture in their mind when they hear or read about Elimination Communication, sometimes also called Natural Infant Hygiene. Here it refers to recognizing baby’s need to poop or wee by reading the little one’s body language and their verbal cues or by means of the caregiver’s intuition. The caregiver then brings the baby to a suitable place, uncovers the bottom and holds the little one in a comfortable and secure position so that they can effortlessly and fully relieve themselves.

All the negative comments I had read and doubtful questions I had heard from my own family and friends were brushed aside in an instant when my little boy gave me his cues and literally blew out “big business” over the bathtub for the first time. He had the biggest smile on his little face and was unspeakably happy. And so was I.

Here is a picture of David aged 3 months – he continued to be incredibly happy when I picked up on his cues:

In our Western society infant crying is regarded as normal. It is usually viewed as something that “can’t be changed” and has to be endured. Since the information you find on the web is not always the most reliable, and the opinions on Elimination Communication cover a wide range, I was curious about what the scientific research says on the topic of infant colic, colic therapy in general, and Elimination Communication.

Fact Box: What is considered normal in modern Western society? I was surprised to read that ignoring little one’s cues and the use of diapers combined with a presumed readiness for toilet training at about age 2 were initiated by the medical community. This was due to a paper published in Pediatrics in 1962 [7]. Another paper [8] published in the same year stated that infant crying is normal. This is now known as the “rule of 3s”: an otherwise healthy infant cries for more than 3 hours per day on more than 3 days a week for more than 3 weeks. These two publications were adopted by the medical community and lay the foundation of our present-day thinking that a crying infant and diapers until about the age of 2 are very normal.

Is there a different approach?

Since then many other papers have been published, studies conducted, and books written stating that crying indicates that an infant is experiencing pain and stress. Evidence shows that the little one needs help coping, and that their hygiene requirements must not be ignored.[9], [10], [11], [12]. Jordan agrees with this. [2]

Fact Box: Where is EC practiced? Jordan’s research showed that EC is widely practiced in developing countries and traditional cultures, but also in many industrial countries in the West, though mostly on a limited basis. Interestingly, she found that in the Western settings it was mainly highly educated parents who chose to practice Elimination Communication with their infants. [2]

What does science say about what causes infant colic?

The causes of infantile colic are unknown, but are likely to be dependent on a number of factors. These factors can be gastrointestinal (related to the stomach or the intestines), hormonal, neurodevelopmental (relates to the development of the nervous system), and psychosocial (a combination of social factors and the individual thought and behavior of a person). [1]

Which colic therapy methods exist and are scientifically proven?

There is a wide range of colic therapy methods available, although not every method is scientifically proven and/or backed up by intensive research [1]. The methods can be categorized as follows:

• Conventional Approaches
• Acupuncture
• Chiropractic Therapy
• Complementary Medicine
• Medication

The conventional approaches include changing feeding techniques, swaddling, removing or giving environmental stimulation (e.g. white noise), switching formula, gripe water, and skin-to-skin contact. These have not been scientifically studied but are considered rational and anecdotally beneficial, meaning they have been practiced for many decades and found helpful by caregivers.

The category of complementary medicine includes common herbs like fennel, chamomile, lemon balm and other herbal combinations. Herbal remedies are generally not recommended as first-line treatments, meaning that they should not be used by themselves, but should be complemented by other treatment methods. Reasons for this include unproven safety and the fact that these remedies are not always able to produce the desired or intended results (treating the colic) in infants. There is also a risk of unknown biological effects and dosing responses (overreactions).

With respect to medication, a large variety is available for colicky babies, including over-the-counter medication that relieves gasiness and bloating, or regulates stomach acid. A wide variety of studies regarding probiotics have been carried out.

Which other therapeutic methods help with infant colic?

Not many good and reliable studies on therapeutic methods have been conducted. [2] According to a study from 1962, additional carrying does not reduce crying in colicky infants [6]. More recent research does not agree with those results.

I personally as a mom could not imagine taking these statements as an excuse to not pick up and carry my crying baby. I think it just comes naturally, even if that one study showed that it doesn’t help in the case of colic.

Other complementary therapies such as probiotics, herbal teas, fennel seed, colimil, infant massage, targeted reflexology, chiropractic manipulation, and cranial osteopathy have “substantial limitations”. However, improvements in colic could be seen when breastfeeding moms went on a hypoallergenic diet and formulas with hydrolyzed whey or casein were used. [2]

I was surprised to not find Elimination Communication on the list of researched colic therapies from the year 2018 [1], because I personally have had such a great experience with it in drastically relieving David’s colic. Another great “side effect” was that it greatly improved our relationship with each other. I was therefore interested whether it can still be considered a scientifically proven method for treating colic in infants.

Is Elimination Communication regarded as colic therapy treatment in infants according to scientific research?

Yes, according to two publications from the years 2014 and 2017, Elimination Communication and responding to baby’s need to relieve themselves reduce excessive infant crying that is unrelated to a physical dysfunction or disease. They are therefore considered an effective way to reduce health problems such as colic and result in further positive benefits for the caregivers and infants. They also lead to a lower risk of abusive responses and shaken baby syndrome as well as postpartum parental depression. [2], [3]

The internet has made a flood of information available. However, if you’re bouncing a screaming baby on your hips in the middle of the night, decisions have to be made quickly, with search engines like Google and the first few results shown being the primary source of information. A word of caution: One study shows that parents may access incomplete or inaccurate information about colic treatments on the Internet and may be persuaded to purchase products that capitalize on their anxiety and uncertainty about infant crying. [4]

So, if the information you collect is not provided by a health information site that has the primary goal of providing medical and health information (most .org, .edu and .gov sites with the HON-logo on them), it may still provide good and valuable information, but should be carefully evaluated. By the way, that also includes this site, so feel free to be critical ; ).

Which EC cues does an infant give?

There is a wide range of cues, which include certain types of crying, squirming, straining, wriggling, grimacing, fussing, vocalizing, looking intently at the caregiver, a red face, passing gas, and grunting. Many of these signs are also considered the initial symptoms of colic. Studies showed that these cues are hard to miss and were picked up on by 90% of caregivers.

Fact-Box: Scientific context of baby’s stools and colic Jordan [2] found in her research that her colleagues do not agree on the connection between stool frequency and colic. Where some papers stated that fewer poops per day lead to colic, others stated that infants with colicky symptom had a higher frequency of stools. Despite this disagreement, all papers concede that a bloated belly is uncomfortable and painful for the little one and leads to crying.

In this video I was feeding David (14 months) when he started to behave differently and I thought that he might need to relieve himself. Did I get the cues right? Would you have picked up on them? I was present-minded enough to take the camera with me, so let’s find out together…

Which positions are beneficial for babies to relieve themselves?

Lying vs. Sitting vs. Squatting

Medical studies on healthy grown-ups showed that a lying position is the hardest for excreting stool, to the extent that not every grown-up was able to relieve him- or herself. The Western method of sitting on a toilet is better than the lying position, but still makes it harder to empty the bowels than the use of a traditional squatting toilet. A study compared the amount of time and effort it takes to relieve yourself on a traditional squatting toilet with that on a Western sitting toilet.

In case you’re interested: it takes half the time and a third less effort in the squatting position… : )

So, the squatting position wins. Why? It’s because of our anatomy:

It was found that the pelvic floor muscle, which controls the anus, is very relaxed in this position, it’s an easy position for “pushing”, and several other muscles (I’ll spare you the medical terms here) are more relaxed as well. The end part of the rectum and the anus are in a straight line, which makes it easier to completely empty the bowls. Also, hip flexion (not pushing the knees together) proved to be beneficial for aligning the inner organs.

Since babies are not able to put themselves into the squatting position, it’s vital for the caregiver to securely place the little one in it and hold them like that.

About the information provided (and not provided) in this article

I have attempted to give you a well summarized and rounded insight into the topic of infant colic. Yet this is still just an article and not a medical book.

The main thing I truly want to stress here is that, although thoroughly researched, it cannot substitute your intuition as a mother or caregiver, and it also cannot substitute a checkup of your little one by primary care providers or your pediatrician. I strongly recommend visiting your doctor when your beloved little one shows signs of the first bout of colic in order to rule out an organ-related disease or dysfunction.

Fact-Box: When does colic happen? Crying patterns that are associated with colic start at the age of about 2 weeks* and reach their peak at about 2 months. They intensify in the late afternoon and the evening. [2] Other papers suggest that the peak occurs at about 3 months of age and that by about age 6 months no infants suffered from colic anymore. [4], [5] Therefore, take courage – time is on your side! David had his first episode of colic 3 days after birth. I vividly remember walking up and down late at night in the tiny private room we had in the hospital.

I also highly advise doing anything that helps you to stay calm. This may include earplugs, putting the little one down for a few minutes and taking a deep breath in another room, washing your face with cold water, or calling up a friend or relative to ask for support.

I also advise choosing a kind of treatment that you as a family feel comfortable with and that is approved by a pediatrician you trust. A study clearly shows that infants who received treatment (in this case it was chiropractic treatment) had way fewer temper tantrums, fell asleep more quickly and stayed asleep longer than children who had not had treatment during their colicky months. [5]

My last and final thoughts for you also mean the most to me:

There is NO shame in admitting that those most disturbing and nerve-wracking cries of your baby totally drain your energy level and push you to your physical and psychological limit.

Seeking help when you need it will mean that you’ll never have to feel devastated and guilty because you lost control and behaved abusively (e.g. by shaking your little one), causing injury or even death. You also must not suffer through these periods all by yourself; asking for help will take a lot of weight off your shoulders. Try out the various options until you find one that works for your little one. Taking care of and raising children is one of the most challenging things you’ll do in your life – but developing and maintaining an intimate and loving relationship with your beloved little one is also the most beautiful reward you can imagine.

Remember: This too will pass.

References:

[1] Mai, T. et al.: New Insights into an Old Problem. Elsevier Inc. (2018)

[2] Jordan, G.: Elimination Commiunication as Colic Therapy, Medical Hypotheses 83 (2014)

[3] Dombroski, K.: Learning to be affected: Maternal connection, intuition and “Elimination Communication” Emotion, Space and Society (2017)

[4] Bailey, S.D. et al.: Information on Infantile Colic on the World Wide Web. Elsevier Inc. (2012)

[5] Miller J. et al.: Long-Term Effects of Infant Colic: A Survey Comparison of Chiropractic Treatment and Nontreatment Groups. Journal of Manipulative and Physiological Therapeutics (October). (2009)

[6] Barr, R.G. et al.: Carrying as Colic “Therapy”: A Randomized Controlled Trial. Pediatrics 87 (1991)

[7] Brazelton, T.B.: A child-oriented approach to toilet training. Pediatrics 29 (1962)

[8] Brazelton, T.B.: Crying in infancy. Pediatrics 29 (1962)

[9] Ruolotto, S. et al.: Assisted infant toilet training: is it time for a critical revision? La pediatria medica e chirurgica 30 (2008)

[10] Bauer, I.: Diaper free: the gentle wisdom of natural wisdom of infant hygiene. Natural Wisdom Press 272 (2001)

[11] DeVries, M.W., et al.: Cultural relativity of toilet training readiness: a perspective from East Africa. Pediatrics 60 (1977) [12] Rugolotto, S. A surging new interest on toilet training stared during the first months of age in Western countries. Tech Coloproctol 2 (2007) ffff