Coliques, pleurs excessifs et comment les calmer

A quel moment peut-on parler de colique du nourrisson ?

Les coliques du nourrisson se caractérisent principalement par des pleurs inconsolables qui commencent et s’achèvent sans avertissements, mais plusieurs définitions existent1,2. Le principal type de colique appelée « colique de Wessel » se caractérise par la règle des trois : l’enfant pleure plus de trois heures par jour, pendant plus de trois jours par semaine, pendant plus de trois semaines3,4. Les autres définitions incluent d’autres symptômes comme des pleurs haut perchés, de l’hypertonie (poings fermés, jambes fléchies, grimaces, abdomen distendu), des flatulences, de la régurgitation ou de la diarrhée1.

Dépendant de la définition choisie et du type de population observée, le taux de prévalence varie de 2 à 40 % de la population4–7. De plus, il semble que ces coliques du nourrisson portent bien mal leur nom car, d’après plusieurs études, seuls 5 à 10 % de ces pleurs semblent dus à un problème digestif (du style intolérance au lait de vache, etc.)1,2.

Quelles options s’il y a un problème digestif ?

Lorsqu’il y a un problème digestif, il est conseillé de consulter un médecin. Celui-ci pourra prescrire plusieurs types de traitement.

Les traitements liés à un changement de régime alimentaire ont démontré leur efficacité8–13. Pour les mères allaitantes, ils consistent généralement à réduire les allergènes comme le lait de vache, les œufs, les noix, le blé, le soja et le poisson12. Pour les mères non allaitantes, le médecin peut prescrire des probiotiques ou des préparations plus hydrolysées de lait 8–13.

Concernant l’efficacité de traitements alternatifs comme les suppléments naturels ou les infusions de menthe, fenouil, camomille, verveine, mélisse, réglisse, les quelques études s’y étant intéressées suggèrent des effets positifs, mais elles sont encore trop rares pour conclure avec certitude sur leurs effets14–19. De même, les études concernant les traitements physiques du type ostéopathie, acuponcture ou massage (thérapie craniosacrale et réflexologie), suggèrent aussi des effets positifs, mais sont encore trop rares pour conclure de manière certaine quant à leurs avantages ou leurs risques sur le long terme20–24.

Quelles options s’il n’y a pas de problème digestif ?

Lorsque l’intolérance au lactose n’est pas concernée, il semble que ces pleurs excessifs reflètent juste le point extrême d’une variabilité normale. Tout simplement, certains bébés pleurent en moyenne beaucoup plus que les autres29. Chez ces bébés, les chercheurs n’ont constaté aucune différence dans le rythme cardiaque, le tonus vagal et les niveaux de cortisol (hormone qui reflète le niveau de stress)30.

Mais que faire dans ces cas-là pour prévenir et/ou calmer les crises de pleurs ? Plusieurs comportements ont été identifiés.

  • Chanter des comptines semble retarder la crise de pleurs31.
  • Si vous êtes concernés, diminuer la consommation de cigarettes et d’alcool. Certaines études ont montré que des pleurs excessifs sont plus probables chez les bébés exposés à la fumée de cigarette pendant la grossesse ou après la naissance32,33. La fumée augmente les niveaux de motiline, une hormone induisant des contractions intestinales douloureuses33. La fumée est aussi liée à des problèmes de sommeil qui peuvent contribuer à l’irritabilité du bébé34,35. Enfin, d’autres études ont montré que l’exposition à l’alcool pendant la grossesse ou pendant l’allaitement altère aussi le développement du cerveau, augmentant les risques d’irritabilité et d’anxiété36,37.
  • Habituer le bébé au cycle jour-nuit en l’exposant davantage à la lumière naturelle et en évitant les lumières artificielles la nuit. Ceci semble diminuer les problèmes de sommeil38–43, ainsi que ceux de digestion44. (Voir le chapitre dédié au sommeil pour en savoir plus.)
  • D’autres études suggèrent que la promptitude à répondre aux pleurs diminue leur quantité45,46.
  • L’efficacité du portage reste controversée. Il semble que la quantité et la durée des pleurs diminuent globalement47–49; mais ce n’est pas toujours répliqué50 et cela pourrait augmenter les réveils nocturnes48. Aussi, même si prendre un bébé dans les bras a tendance à le calmer, cela recommence souvent quand on le repose51.
  • Des tétées ou des nourrissages plus fréquents réduisent globalement le nombre et la durée des pleurs52–55.
  • Essayer de se calmer et sourire, car le stress semble contagieux même pour les bébés36,56.
  • Enfin, un des facteurs les plus importants reste le soutien parental. La plupart des recherches sur les pleurs ont été faites chez des Occidentaux où les parents, souvent les mères, passent de longues heures seuls avec leurs bébés. Cet isolement peut augmenter l’anxiété chez certains parents, ce qui peut en retour impacter le bébé et favoriser les pleurs excessifs36,57–62. C’est d’ailleurs aussi valable pendant la grossesse63–65. Davantage de soutien pour le parent (conjoint, grands-parents, amis, infirmière à domicile …), de même qu’avoir plusieurs figures d’attachement pour le bébé ont par ailleurs été corrélés à des bienfaits cognitifs et émotionnels évidents pour le bébé66–73. Tous ces facteurs ont été confirmés par des études interculturelles, notamment avec des tribus de chasseurs-cueilleurs dont les bébés pleurent jusqu’à deux fois moins que les bébés occidentaux74–76.

Pourquoi des pleurs excessifs sont-ils si rares chez les chasseurs-cueilleurs ?

Les coliques du nourrisson semblent extrêmement rares chez eux. Reflétant très bien la littérature décrite précédemment, ces cultures se caractérisent par :

  • une absence de lait de vache. Les chasseurs-cueilleurs n’en boivent pas, ce qui peut du coup limiter les coliques chez les 10 % de bébés concernés ;
  • une meilleure habituation du bébé au cycle jour-nuit, en exposant davantage le bébé à la lumière naturelle et en évitant les lumières artificielles la nuit ;
  • une haute réactivité aux complaintes de leurs bébés (92 % de réponses se font dans les 15 secondes qui suivent leur gigotement)75,77,78 ;
  • un portage presque constant de leurs bébés (supérieur à plus de 80 % de la journée, ce qui facilite la haute réactivité aux complaintes, on est d’accord ! )74,75,79 ;
  • des tétées à la demande (jusqu’à quatre fois par heure)74,75,79. Les tétées sont généralement courtes, ce qui pourrait prévenir les régurgitations et aider le bébé à digérer ;
  • enfin, chez les chasseurs-cueilleurs, les parents ne sont pratiquement jamais seuls avec les bébés. Non seulement il y a souvent d’autres personnes autour, mais les adultes ainsi que les jeunes enfants savent en général consoler un bébé qui pleure et peuvent jouer facilement les babysitters75,80,81. Les autres adultes sont généralement extrêmement tolérants face à un bébé qui pleure76. Tout cela pourrait permettre aux parents de faire une ou plusieurs siestes la journée, au cas où le bébé aurait passé une mauvaise nuit.

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Date de dernière mise à jour : 22/10/2020