Abdominal pain in babies is one of the most common reasons for medical consultations during the first months of life. Although in most cases it is functional in nature, such as infant colic, it requires careful differential diagnosis and a multifaceted therapeutic approach.
The digestive system of a newborn and young infant is functionally immature. The main mechanisms that lead to pain include:
- excessive production of intestinal gas (aerophagia, lactose fermentation),
- immaturity of the gut–brain axis, resulting in visceral hypersensitivity,
- intestinal motility disorders,
- transient lactose intolerance resulting from low lactase activity,
- gut microbiota dysbiosis.
Infant colic, classically defined by the Wessel criteria (≥3 hours of crying per day, ≥3 days per week for ≥3 weeks), is self-limiting, but its impact on family functioning is significant.
The importance of feeding technique
Incorrect feeding technique is one of the most common yet underestimated aetiological factors.
Key elements:
- Correct attachment to the breast: the baby takes the areola correctly and forms a seal that prevents them from swallowing air
- Baby's position: the head above stomach level, with the head and torso aligned
- Feeding Pace: Avoiding an Overly Fast Flow, Especially with Bottle Feeding
- Positioning After a Feed: Helping with Trapped Wind
Clinical observations show that children with aerophagia often experience pronounced bloating, abdominal straining and sudden episodes of crying after feeding.
Lactase supplementation
Mechanism of Action:
Lactase breaks lactose down into glucose and galactose. Some infants may have a relative lactase deficiency, allowing undigested lactose to reach the large intestine, where it is fermented by bacteria.
Clinical indications:
- frothy, acidic stools,
- pronounced bloating after feeds,
- distress after drinking milk.
Practical notes:
- lactase preparations are given directly in the milk or before a feed,
- the source claims that effectiveness is greatest in secondary lactose intolerance,
- a lack of results should prompt a reassessment of the diagnosis.
Simeticone reduces the surface tension of gas bubbles, allowing them to combine and pass more easily.
- acts locally within the gastrointestinal lumen,
- is not absorbed into the bloodstream,
- the safety profile is very high.
Clinical Significance:
Studies report variable effectiveness: some infants appear to improve, but placebo effects, caregiver perception and the natural course of colic can complicate interpretation.
Products Containing Fennel Oil
Fennel (Foeniculum vulgare) contains anethole and fenchone, which have:
- antispasmodic effect,
- reducing tension in the intestinal smooth muscle,
- carminative properties (helping to expel gas).
- the effect is often subtle but noticeable with regular use,
- excessive dosing may lead to adverse effects (in rare cases, neurotoxicity),
- it is best to use standardised preparations rather than homemade infusions for the youngest babies.
Warm cherry-stone compresses
Mechanism of Action:
- the source claims that warmth relaxes intestinal smooth muscle,
- is claimed to improve local blood flow,
- has a calming effect by stimulating thermal receptors.
Uses:
- cherry-stone pillows heated to approximately 37–40°C,
- placed on the abdomen over clothing for several minutes.
Always check the temperature, as a baby's skin is particularly susceptible to burns.
Other Management Measures
- Abdominal massage following the direction of the colon
- Positions that help the baby pass wind, such as ‘knees to tummy’
- Probiotics (e.g. Lactobacillus reuteri) – in selected cases
- Eliminating Cow's Milk Protein — When There Are Signs of a Possible Allergy
Differential Diagnosis: When Should You Be Alert?
Although most cases are mild, the following should be ruled out:
- an allergy to cow's milk proteins,
- gastro-oesophageal reflux,
- intussusception,
- gastrointestinal infections,
- metabolic disorders.
Red-Flag Symptoms:
- no weight gain,
- bloody stools,
- bilious vomiting,
- lethargy or fever.
Abdominal pain in infants is most often functional in origin, but it requires a holistic approach. The following are particularly important:
- optimising feeding technique,
- individualised treatment (lactase, simethicone, herbal preparations),
- the use of safe supportive methods (warmth, massage),
- clinical vigilance for more serious underlying conditions.
An approach based on access to official guidelines and the gradual introduction of interventions produces the best clinical outcomes and reduces the unnecessary medicalisation of physiological developmental phenomena.