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Medical Hypotheses 75 (2010) 528529

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Medical Hypotheses
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Infantile colic: Is a pain syndrome

Gardar Gudmundsson
Private Praxis, Kjalarland 30, Neurosurgeon, Reykjavik, Iceland

a r t i c l e

i n f o

Article history:
Received 21 May 2010
Accepted 7 July 2010

s u m m a r y
The hypothesis states that infantile colic is a pain syndrome and the excessive crying leads to aerophagia
and abdominal discomfort. The pain comes from sucking the bottle or the nipple. Feeding for the infant is
a heavy workload for the masticatory muscles.
The tiny digastricus muscle moves the hyoid bone, takes part in opening the mouth and retrusion of the
mandible and assists in mowing the tongue upward, forward and backwards. In the adult population pain
from this muscle is well documented. The hypothesis explains the crying as being due to muscular pain at
rst, later on pain from the origins and insertions of the muscle. Then with increased muscular strength
and development the pain fades away.
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Infantile colic was rst described in 1894 and still today we
have no agreement on the exact cause. The rule of three from
1954 is generally accepted as a denition of infantile colic: crying
more than 3 h per day, for more than 3 days per week, and for more
than 3 weeks in an infant that is well-fed and otherwise healthy
[1]. The exact etiology of infantile colic is not well understood
and may of course be multifactorial. The gastrointestinal tract
has been suspected by many as harboring the cause and every parent of a colic infant focuses on the distended abdomen and the
obvious abdominal discomfort the infant is showing and many
therapeutic remedies target this.
Other causes as food allergy, atulence, intestinal hormone
abnormalities, parental factors and dysregulation of the nervous
system have been suggested [2].
In a much cited article by Lucassen et al. Effectiveness of treatments for infantile colic: systemic review from 1998, the authors
conclude that: Infantile colic should preferably be treated by
advising carers to reduce stimulation and with 1 week trial of
hypoallergenic formula milk [3]. Claiming that the care and stimulation of the infant may work to increase the symptoms but not
excluding the possibility that the milk or milk substitute can make
a difference.
With a self-limiting condition many types of therapies will
seem effective in single cases but in spite of all efforts, no accepted
form for therapy exists.
Although self-limiting and benign, infantile colic puts a heavy
strain on many parents and may in some instances be the underlying cause of abuse. Lee et al. published in 2007 ndings that provided convergent indirect evidence that crying, especially in the

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rst 4 months of age, was an important stimulus for shaken baby

syndrome [4].
This hypothesis is not the rst suggestion that infantile colic
may be a pain syndrome. In an article from 1989 by Geertsma
and Hyams, called: Colica pain syndrome of infancy? this idea is
put forward. They state that: a closer look at the methodology of
colic studies along with our preliminary results suggest there may
be at least two different patterns of disturbing infant crying. It is
possible that one is associated with true pain and the other not [5].
In: Infant colic and feeding difculties the authors nd that the
colic group displayed more difculties with feeding than other infants. There was: disorganized feeding behaviours, less rhythmic
nutritive and non-nutritive sucking, more discomfort following
feedings, and lower responsiveness during feeding interactions.
They also point out that: infants with colic are noted to show
higher pitched, more turbulent cries following a feeding as indicated by cry acoustics [6].
This could be symptoms of a pain syndrome. Feeding for the infant is directly painful and excessive crying is the obvious result
from this.

The hypothesis
Feeding is a strenuous effort for the newborn infant. One can
say that this is the only hard work they have to perform in the infant period.
Sucking the bottle or the nipple is a well coordinated muscular
activity and many muscles are involved. It is not easy to show exactly in which muscle there is most fatigue during feeding, but one
muscle: the digastricus, is a very thin muscle with a demanding job
and is the focus of my intention.
The digastricus muscle is a small muscle located under the under side of the jaw. It consists of two bellies united by a single ten-

G. Gudmundsson / Medical Hypotheses 75 (2010) 528529

don which is connected to the hyoid bone. The muscle originates

from the posterior belly at the mastoid groove for the digastricus
muscle and inserts by the anterior belly into the lower border of
the mandible. The posterior belly is innervated by the facial nerve
and the anterior belly is innervated by the mylohyoid nerve which
branches from the trigeminal nerve. This muscle assists the mylohyoid and geniohyoid muscles in moving the hyoid bone and the
tongue upward and forward and then upward and backward during the process of swallowing. The digastricus muscle is therefore
taking part in sucking the nipple and then swallowing.
In the adult population this muscle can be the source of a very
painful situation.
Travell and Simons have described clearly the symptoms arising
from trigger points in the digastricus muscle.
The trigger points in the muscle spread pain and soreness to
neighbouring structures. Trigger points from the posterior belly
can radiate up to the sternocleidomastoid muscle, the throat in front
of the muscle and sometimes onto the occiput. Trigger points in the
anterior belly refer pain to the four lower incisor teeth and the alveolar ridge below them. Other symptoms are pain on swallowing.
Therapy is vapocoolant spray and stretch of the muscle and direct lidocain injection if the stretch therapy is insufcient [7].
In my practice as a neurosurgeon I have had some patients with
what can be called the digastricus syndrome. Many of them have
professions or hobbies that make heavy demand on the mouth and
throat. Singers, waiters or other professions with heavy vocal demand are the most common.
My hypothesis is that infantile colic is a pain syndrome, rising
mostly from the digastricus muscle but other muscles of the tongue, oor of mouth and throat can be involved. The infants mostly
at risk are the ones with a muscle system that is not strong enough
to meet the challenges of feeding. Muscle pain results. Gradually
the muscles gain strength, but the origin and insertion may be
painful for a considerable longer period. This is therefore a selflimiting condition.
Interestingly, crying itself may therefore be painful!
Evaluation of the hypothesis


sorts, craniosacral therapy, Bowen Technique and others may

be giving relief for infantile colic. If the treatment involves the
neck and throat area, direct effect might be gained.
5. The consistence or texture of the milk formula: food allergy had
been evaluated as a possible cause of infantile colic. In the
Infantile colic: a review article by Leung et al. from 2002 this
is given some thought. They nd it possible that increased permeability to macromolecules could reect an immature function of the gastrointestinal tract and thereby be a mechanism
for food allergy. They refer to studies where changing from
cows milk to a soy-milk formula or other milk formulas seemed
to reduce crying time in infants, but they do not consider the
consistence or texture of the milk in question, but for an infant
with pain during swallowing this might make a difference [2].
Consequences of the hypothesis
Finding a cure for this self-limiting, benign but at times
exhausting condition will spare the infant for a painful condition
and give tired parents rest.
Treatment might be of 4 types, but rst it must be strongly
emphasized that the vicinity of the carotid artery and the vagus
nerve and other important structure demands expert knowledge
and care during the development of the best form for treatment.
1. Understanding of the condition and gentle massage of the muscles in question might in some cases be adequate treatment.
2. Medical treatment: pain killers or other drugs of the NSAID category may be useful. Topical ointment might help.
3. Manual therapy directed at the muscles and their origins and
4. Direct injections with lidocain into the muscular bellies. This of
course is very difcult and should only be done under ultrasound guidance.
Conict of interest statement
None declared.

1. Feeding for the infant is a demanding muscular effort. It has

been demonstrated that during breastfeeding the infant has to
build up negative pressure up to 98 mm Hg for 75 s prior to
milk ejection. Breastfeeding is on the average 8 min and 6 times
a day. Bottle feeding is of course less demanding [8].
2. Muscular pain comes from the overuse of muscle in the speaking population. The fact that the infant uses crying to communicate its dissatisfaction must not overshadow the fact, that it
can be in real pain.
3. Chiropractors claim to be able to reduce symptoms of colic with
spinal manipulation: In an article from 1999, Jesper et al.
described a clinical trial where a short term spinal manipulation
was signicantly superior to medical treatment with
Dimethicone (Dicyclomine). The spinal manipulation included
motion palpation of the articulations of vertebral column and
pelvis [9].
4. Searching the internet for remedies for infantile colic many
forms of treatment seem to be available. Massage of various

[1] Roberts DM, Ostapchuk M, OBrian JG. Infantile colic. Am Fam Physician
[2] Leung AKC, Lemay JF. Infantile colic: a review. JRSH 2004;124(4):1626.
[3] Lucassen PLBJ, Assendelft WJJ, Gubbels JW, van Eijk JTM, Van Geldrop, Neven
AK. Effectiveness of treatments for infantile colic: systematic review. BMJ
[4] Lee CB, Barr RG, Nicole C, Wicks A. Age-related incidence of publicly reported
shaken baby syndrome: is crying a trigger for shaking? JDBP
[5] Geertsma MA, Hyams JS. Colica pain syndrome of infancy? Pediatr Clin North
Am 1989;36(4):90519.
[6] Miller-Loncar C, Bigsby R, High P, Wallach M, Lester B. Infant colic and feeding
difculties. Arch Dis Child 2004;89:90812.
[7] Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: trigger
point manual. vol.1. Upper Half of the Body. 2nd ed. Williams and Wilkins;
1999. p. 27381.
[8] Ogbuanu IU, Karmaus W, Arshad SH, Kurukulaaratchy RJ, Ewart S. The effect of
breastfeeding duration on lung function at age 10 years: a prospective birth
cohort study. Thorax 2008;101:543. doi: 10.1136/thx.2008.
[9] Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal
manipulation in the treatment of infantile colic: a randomized controlled
clinical trial with a blinded observer. JMPT 1999;22(8):51722.