Infant Colic

What is infant colic?

Infant colic describes prolonged or recurrent periods of crying, fussiness or irritability in a baby who otherwise appears healthy. During crying episodes, a baby may clench their fists, draw their legs up, become red in the face or be difficult to console.

Colic is common during early infancy. Crying often becomes more noticeable in the late afternoon or evening. It commonly begins during the first few weeks, becomes more troublesome around 4–6 weeks and gradually improves over the following weeks. Most babies are substantially better by 3–4 months.

Why does colic happen?

The exact cause of colic is not known. It is probably multifactorial. Normal development of the baby's nervous system, feeding patterns, gastrointestinal function, sensitivity to stimulation and other factors may contribute.

Colic does not mean that parents are doing something wrong. It is also not simply a problem of "too much gas".

Is colic dangerous?

Typical colic occurs in an otherwise healthy baby who continues to feed, pass urine and grow normally.

However, excessive crying can sometimes be caused by an illness or another medical problem. A baby with new, unusually severe or persistent crying should be assessed if there are other concerning symptoms.

Does colic need medicine?

Usually, no. There is no medicine that reliably cures ordinary infant colic.

Simethicone and other "gas drops" have not demonstrated consistent benefit for infant colic. Gripe water and herbal preparations are also not routinely recommended because evidence of benefit is limited and products may contain different ingredients.

What about probiotics?

Evidence for probiotics is strain-specific rather than applying to probiotics as a whole.

ESPGHAN states that healthcare professionals may consider Lactobacillus reuteri DSM 17938 or Bifidobacterium animalis subsp. lactis BB-12 for some breastfed infants with colic. The recommendation is weak, and there is insufficient evidence to recommend these probiotics routinely for formula-fed infants.

Parents should discuss probiotic use with their pediatrician rather than assuming that any probiotic product will help.

Could cow's milk allergy be causing the crying?

Cow's milk allergy can cause symptoms that overlap with colic, but allergy is rarely the explanation for crying and irritability alone.

Cow's milk allergy becomes more likely when crying is accompanied by symptoms such as blood in the stool, persistent vomiting, diarrhea, significant eczema, feeding difficulties or poor growth.

Do not routinely remove dairy or multiple foods from a breastfeeding parent's diet, or repeatedly change formula, without discussing the situation with a pediatrician.

What parents can do at home

• Check the basics first: hunger, wet or dirty diaper, temperature, tiredness and whether your baby needs to be burped.
• Feed your baby responsively and avoid repeatedly feeding simply to stop crying if your baby has recently had a full feed.
• If bottle-feeding, use an appropriate teat and avoid feeding too quickly.
• Keep your baby appropriately positioned during feeds and allow breaks if they are swallowing a lot of air.
• Burping during or after feeds may help some babies who swallow air.
• Hold your baby upright for a short period after feeding while they are awake.
• Try holding, carrying, gentle rocking, walking or rhythmic movement.
• Reduce bright lights, loud sounds and excessive stimulation during crying episodes.
• Gentle background noise or white noise may help some babies settle.
• A pacifier can be offered if your baby accepts one.
• Gentle tummy massage or bicycle-leg movements may be comforting for some babies when awake and supervised.
• If you swaddle your baby, always place them on their back for sleep and stop swaddling when they show signs of trying to roll.
• Continue breastfeeding normally unless your pediatrician advises otherwise.
• If formula feeding, avoid repeatedly changing formulas without discussing this with your pediatrician.
• Avoid giving gripe water, herbal preparations or medicines without appropriate medical advice.
• Keep a simple record of feeding, sleep and crying patterns if the episodes are frequent. This can be useful during a pediatric assessment.

When you need a break

Caring for a constantly crying baby can be exhausting. If you feel overwhelmed, place your baby safely on their back in an empty crib and step away for a few minutes. Ask your partner, relative or another trusted adult for help.

Never shake, hit or violently handle a baby. Shaking can cause severe brain injury or death.

You should arrange a pediatric assessment if:

• Your baby's crying is persistent, unusually severe or significantly different from their normal behavior.
• Your baby is feeding poorly or refusing feeds.
• Your baby is not gaining weight appropriately.
• Your baby has frequent vomiting or vomiting associated with poor feeding or poor growth.
• Your baby has diarrhea or significant changes in bowel movements.
• You notice blood or significant mucus in the stool.
• Your baby has significant eczema together with gastrointestinal or feeding symptoms.
• Your baby seems unusually sleepy, weak or difficult to wake.
• Your baby appears to be in pain when touched or moved.
• Your baby has significantly fewer wet diapers than usual.
• You are exhausted or struggling to cope with your baby's crying.