What is colic

Colic is the medical term for excessive, frequent crying in a baby who appears to be otherwise healthy and well fed. Colic is very common, affecting about 1 – 2 in 5 babies (10% to 40% of infants worldwide) ¹⁾. However it is still poorly understood.

In most cases, the intense crying occurs in the late afternoon or evening and usually lasts for several hours.

You may also notice that your baby’s face becomes flushed, and they may clench their fists, draw their knees up to their tummy, or arch their back.

If your baby has colic, they may appear to be in distress. However, the crying outbursts are not harmful and your baby will continue to feed and gain weight normally. There is no clear evidence that colic has any long-term effects on a baby’s health.

• Colic is defined as crying for more than 3 hours a day, for more than 3 days a week, for at least 3 weeks ²⁾. But doctors may diagnose a baby as having colic before that point.
• Most of this crying and fussing seems to happen in the late afternoon and evening, although this can change from day to day.
• Colic is not dangerous, although it can be frightening, frustrating and upsetting for parents.
• Colic usually doesn’t point to any health problems and eventually goes away on its own.
• The incidence of infantile colic is equal between sexes, and there is no correlation with type of feeding (breast vs. bottle), gestational age, or socioeconomic status.
• Colic causes considerable stress for parents and for their health care providers ³⁾. Indeed, in the first 3 months of a baby’s life, crying is the No. 1 reason for pediatric visits ⁴⁾. Parents often perceive—incorrectly—that the inconsolable crying is either a sign of serious illness or a result of poor parenting skills ⁵⁾.

Crying is normal in babies. At six to eight weeks, babies normally cry for two to three hours a day. But babies with colic will cry inconsolably for more than three hours at a time on at least three days each week, and this cycle tends to last for more than three weeks.

When does colic start?

Colic usually begins within the first few weeks of life – colic usually starts between the 3rd and 6th week after birth and peaks at around six to eight weeks ⁶⁾.

How long does colic last?

Colic often stops by the time the baby is four months old and by six months at the latest.

If the baby is still crying excessively after that, another health problem may be to blame.

Here are some key facts about colic baby:

• Colicky babies have a healthy sucking reflex and a good appetite and are otherwise healthy and growing well. Call your doctor if your baby isn’t feeding well, isn’t gaining weight, or doesn’t have a strong sucking reflex.
• Colicky babies may spit up from time to time just as non-colicky babies do. But if your baby is actually vomiting and/or losing weight, see your doctor. (Vomiting is a forceful throwing up of stomach contents through the mouth, whereas spitting up is an easy flow of stomach contents out of the mouth.) Vomiting repeatedly is not a sign of colic.
• Colicky babies typically have normal stools (poop). If your baby has diarrhea or blood in the stool, see your doctor.

Colic complications

Colic does not cause short-term or long-term medical problems for a child.

Colic is stressful for parents. Research has shown an association between colic and the following problems with parent well-being:

• Increased risk of postpartum depression in mothers ⁷⁾
• Early cessation of breast-feeding
• Feelings of guilt, exhaustion, helplessness or anger.

Shaken baby syndrome

The stress of calming a crying baby has sometimes prompted parents to shake or otherwise harm their child ⁸⁾. Shaking a baby can cause serious damage to the brain and death. The risk of these uncontrolled reactions is greater if parents don’t have information about soothing a crying child, education about colic and the support needed for caring for an infant with colic.

What causes colic

Doctors aren’t sure what causes colic, but a number of theories have been suggested — proposed causes include alterations in fecal microflora, intolerance to cow’s milk protein or lactose, gastrointestinal immaturity or inflammation, increased serotonin secretion, poor feeding technique, and maternal smoking or nicotine replacement therapy. Cow’s milk intolerance has been suggested as a possible culprit, but doctors now believe that this is rarely the case. Breastfed babies get colic too; in these cases, dietary changes by the mother may help the colic to ease. Some breastfeeding women find that getting rid of caffeine in their diet helps, while others see improvements when they eliminate dairy, soy, egg, or wheat products.

Some colicky babies also have gas, but it’s not clear if the gas causes colic or if the babies develop gas as a result of swallowing too much air while crying.

Some theories suggest that colic happens when food moves too quickly through a baby’s digestive system or is incompletely digested. Other theories are that colic is due to a baby’s temperament, that some babies just take a little bit longer to get adjusted to the world, or that some have undiagnosed gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD). Gastroesophageal reflux is a condition where stomach acid moves back out of the stomach and into the oesophagus (food pipe). Other research suggests that colic may be an early form of migraine headache. However, there is currently little solid evidence to support these theories.

Colic occurs equally in boys and girls, and in babies who are breastfed or bottle-fed. Colic is thought to be more common in babies whose mothers are smokers or who smoked while they were pregnant but the evidence is not conclusive.

Possible contributing factors that have been explored include:

• Digestive system that isn’t fully developed
• Imbalance of healthy bacteria in the digestive tract
• Food allergies or intolerances
• Overfeeding, underfeeding or infrequent burping
• Early form of childhood migraine
• Family stress or anxiety

Risk factors for colic in babies

Risk factors for colic are not well-understood. Research has not shown differences in risk when the following factors were considered:

• Sex of the child
• Preterm and full-term pregnancies
• Formula-fed and breast-fed babies

Infants born to mothers who smoked during pregnancy or after delivery have an increased risk of developing colic.

Colic signs and symptoms

Fussing and crying are normal for infants, especially during the first three months. And the range for what is normal crying is difficult to pin down. In general, colic is defined as crying for three or more hours a day, three or more days a week, for three or more weeks.

Features of colic may include the following:

• Intense crying that may seem more like screaming or an expression of pain
• Crying for no apparent reason, unlike crying to express hunger or the need for a diaper change
• Extreme fussiness even after crying has diminished
• Predictable timing, with episodes often occurring in the evening
• Facial discoloring, such as reddening of the face or paler skin around the mouth
• Bodily tension, such as pulled up or stiffened legs, stiffened arms, clenched fists, arched back, or tense abdomen

Sometimes there is relief in symptoms after the infant passes gas or has a bowel movement. Gas is likely the result of swallowed air during prolonged crying.

Colic in babies diagnosis

There are no tests to diagnose colic. Colic can usually be diagnosed based on the pattern and amount of crying, and the fact that the baby is otherwise thriving – they are gaining weight normally and eating well. If parents are concerned about their baby’s crying, their doctor may examine the baby and check for problems with their digestive system or signs of other medical conditions.

Your baby’s doctor will do a complete physical exam to identify any possible causes for your baby’s distress.

The exam will include:

• Measuring your baby’s height, weight and head circumference
• Listening to the heart, lungs and abdominal sounds
• Examining the limbs, fingers, toes, eyes, ears and genitals
• Assessing reaction to touch or movement
• Looking for signs of rash, inflammation, or other signs of infection or allergies

Table 1. Conditions to Consider in the Evaluation of Unexplained Crying in Infants

How to soothe colic baby

There is no ‘best’ way to comfort your baby or reduce the symptoms of colic. Different babies respond to different methods, so you may have to see what works best for you.

There is no single treatment that has been proven to make colic go away. Many parents have tried things like over-the-counter gas relieving medicine, but these medicines haven’t been shown to improve colic. Other people have tried probiotics (things that help to maintain the balance of ‘good’ bacteria in the digestive system). While some studies have shown that certain probiotics may improve colic, others have shown no improvements. Experts currently don’t recommend probiotics for treating colic.

The probiotic Lactobacillus reuteri (strain DSM 17938) reduced colic symptoms in four out of five clinical trials ¹⁰⁾, ¹¹⁾, ¹²⁾, ¹³⁾. No adverse effects were reported. Two recent meta-analyses and one systematic review found that administration of five drops of Lactobacillus reuteri per day significantly decreased colic in infants who are breastfed (average of 61 minutes less crying time per day at 21 days) ¹⁴⁾, ¹⁵⁾, ¹⁶⁾. One trial found a significant increase in crying or fussing in bottle-fed infants who received Lactobacillus reuteri ¹⁷⁾. Based on these results, Lactobacillus reuteri DSM 17938 may be considered as a treatment option for breastfed infants, but cannot be recommended for formula-fed infants.

Experts have also looked at the effects of changing diets or restricting certain foods, but currently there no specific dietary recommendations for treating colic. Switching from breastfeeding to formula does not help colic. Using a special teat on feeding bottles has not been shown to help colic.

Colic usually gets better on its own in a few months. But there are ways to make life easier for both you and your colicky baby.

First, if your baby is not hungry, don’t try to continue the feeding. Instead, try to console your little one — you won’t be “spoiling” the baby with your attention.

You can also:

• Walk with your baby or sit in a rocking chair, trying various positions.
• Keep calm and talk gently to your baby.
• Check your baby doesn’t need a nappy change.
• Holding your baby during a crying episode can sometimes help, as can wrapping them snugly in a blanket or baby sling.
• Develop a regular daily pattern of feeds and sleeps.
• Don’t overstimulate your baby
• Try to soothe your baby before they become too worked up
• Try not to startle your baby, eg with quick movements
• Check formula is being made up correctly, if you’re using it
• Try burping your baby more often during feedings.
• Place your baby across your lap on his or her belly and rub your baby’s back.
• Put your baby in a swing or vibrating seat. The motion may have a soothing effect.
• Put your baby in an infant car seat in the back of the car and go for a ride. The vibration and movement of the car are often calming.
• Play music — some babies respond to sound as well as movement.
• Place your baby in the same room as a running clothes dryer, white noise machine, or vacuum — some infants find the constant low noise soothing.
• Some babies need decreased stimulation. Babies 2 months and younger may do well swaddled in a darkened room.

Caring for a colicky baby can be extremely frustrating, so be sure to take care of yourself, too. Don’t blame yourself or your baby for the constant crying — colic is nobody’s fault. Try to relax, and remember that your baby will eventually outgrow this phase.

In the meantime, if you need a break from your baby’s crying, take one. Friends and relatives are often happy to watch your baby when you need some time to yourself. If no one is immediately available, it’s OK to put the baby down in the crib and take a break before making another attempt at soothing your little one. If at any time you feel like you might hurt yourself or the baby, put the baby down in the crib and call for help immediately. Never shake a baby.

If your baby has a temperature of 100.4 °F (38 °C) or higher, is crying for more than 2 hours at a time, is inconsolable, isn’t feeding well, has diarrhea or persistent vomiting, or is less awake or alert than usual, see your doctor right away. Also see your doctor if you’re unsure whether your baby’s crying is colic or a symptom of another illness.

Trial changes in diet

If soothing or feeding practices aren’t reducing crying or irritability, your doctor may recommend a short-term trial of dietary changes. If your baby has a food allergy, however, there would likely be other signs and symptoms, such as a rash, wheezing, vomiting or diarrhea. Dietary changes may include:

• Formula changes. If you feed your infant formula, your doctor may suggest a one-week trial of an extensive hydrolysate formula (Similac Alimentum, Nutramigen, Pregestimil, others) that has proteins broken down into smaller sizes.
• Maternal diet. If you’re breast-feeding, you may try a diet without common food allergens, such as dairy, eggs, nuts and wheat. You may also try eliminating potentially irritating foods, such as cabbage, onions or caffeinated beverages.

The prevalence of colic is similar between breastfed and bottle-fed infants; therefore, breastfeeding mothers should be encouraged to continue ¹⁸⁾. A randomized controlled trial showed significant reductions in colic symptoms among breastfed infants whose mothers followed a low-allergen diet ¹⁹⁾. Infants whose mothers excluded cow’s milk, eggs, peanuts, tree nuts, wheat, soy, and fish from their diet cried for 137 minutes less per day, compared with 51 minutes less per day in the control group. A systematic review of six studies supported the effectiveness of low-allergen diets in reducing colic ²⁰⁾. These diets may be an option for some breastfeeding mothers, but should be accompanied by dietary counseling to ensure adequate nutrition. Return to a normal diet can be considered after the infant reaches three to six months of age.

Parents of formula-fed infants with colic often consider switching formulas. A systematic review of 13 studies found a statistically significant decrease in crying time among infants who switched to partially, extensively, or completely hydrolyzed formulas (Table 2) ²¹⁾. These studies suggest that a two-week trial of a different formula may be considered for infants with colic. To make the change more palatable, parents can transition to hydrolyzed formula by mixing the new formula with regular formula incrementally over four days, until only hydrolyzed formula is being given. These formulas are expensive, however, and may not be covered by assistance programs (e.g., Women, Infants, and Children). If the new formula is successful in reducing colic symptoms, regular formula may be restarted after three to six months of age.

Four studies that evaluated the use of soy formula for the treatment of colic provided insufficient evidence to make clinical recommendations ²²⁾. The American Academy of Pediatrics recommends against the routine use of soy formula in the management of infantile colic, because soy can be an allergen ²³⁾.

Table 2. Select Hydrolyzed Infant Formulas

Medications

• Simethicone. Although simethicone drops are readily available and often used to treat colic, a systematic review of three randomized controlled trials found that they are no better than placebo ²⁵⁾.
• Dicyclomine. Although a systematic review of three randomized controlled trials found that dicyclomine was significantly better than placebo for the treatment of colic, it is contraindicated in infants younger than six months because of adverse effects such as drowsiness, constipation, diarrhea, and apnea ²⁶⁾.
• Proton Pump Inhibitors. A four-week randomized controlled trial of 30 infants with colic symptoms and gastroesophageal reflux or esophagitis found that omeprazole (Prilosec) was no better than placebo at reducing crying or fussing time ²⁷⁾.

Coping with colic

Looking after a baby with colic can be very difficult for parents, particularly first-time parents.

It’s important to remember that colic:

• Is not the parents’ fault
• Doesn’t mean a baby is unwell or in pain
• Is temporary: it will go away eventually. Colic episodes often improve after age 3 to 4 months.
• Take a break. Take turns with your spouse or partner, or ask a friend to take over for a while. Give yourself an opportunity to get out of the house if possible.
• Use the crib for short breaks. It’s OK to put your baby in the crib for a while during a crying episode if you need to collect yourself or calm your own nerves.
• Express your feelings. It’s normal for parents in this situation to feel helpless, depressed, guilty or angry. Share your feelings with family members, friends and your child’s doctor.
• Don’t judge yourself. Don’t measure your success as a parent by how much your baby cries. Colic isn’t a result of poor parenting, and inconsolable crying isn’t a sign of your baby rejecting you.
• Take care of your health. Eat healthy foods. Make time for exercise, such as a brisk daily walk. If you can, sleep when the baby sleeps — even during the day. Avoid alcohol and other drugs.

It’s important that parents take care of themselves as well. Parents should try to take a break and ask someone else to take over for a little while, even just for an hour or 2.

Remember that caring for a baby with colic is not a one-person job. A doctor or child health nurse can provide support and will have some ideas that may help to soothe an unsettled baby.

It may be helpful to:

• Check with the doctor to make sure the baby is otherwise well
• Make sure the baby is not hungry or needs a nappy change
• Develop a regular daily pattern for feeding, sleeping and playing
• Develop a routine for settling the baby for naps and sleep
• Avoid excessive stimulation before sleep
• Avoid excessive quiet – most babies find a low level of background noise soothing, e.g. gentle music
• Darken the bedroom for daytime naps
• Try soothing techniques such as baby massage, gentle rocking or gentle patting
• Respond to the baby before they become too worked up
• Avoid startling the baby, e.g. with quick movements
• Handle the baby gently and speak quietly to them
• Carry the baby in a front pack or sling when they are unsettled
• If using formula, check that it is being made up correctly
• Ask for and accept offers of help
• Talk to a health professional if you need support or are feeling that you can’t cope.

Alternative medicine

Several small studies have shown some benefits or mixed results for alternative treatments. There’s not enough evidence, however, to judge the potential benefit over the risks. Alternative remedies under investigation include:

• Herbal teas
• Herbal remedies, such as fennel oil
• Sugar water
• Gripe water, a mix of water and herbs
• Massage therapy
• Chiropractic manipulation
• Acupuncture

Herbal supplements, including Mentha piperita (peppermint) and various herbal teas (including fennel, chamomile, vervain, lemon balm, and licorice), have decreased crying time in some studies ²⁸⁾. Despite these findings, a systematic review concluded that further research is required before recommending these treatments ²⁹⁾.

“Gripe water,” which consists of dill seed oil, bicarbonate, and hydrogenated glucose, has also been used for the treatment of colic. However, there are no trials demonstrating its effectiveness, and it may cause harm.

Physical therapies for colic include chiropractic and osteopathic manipulation, massage, and acupuncture. A Cochrane review found insufficient evidence to support chiropractic or osteopathic manipulation, because many studies were small, nonblinded, and had a high likelihood of bias ³⁰⁾. Trials of acupuncture and infant massage have had conflicting results, and further studies are needed to determine their benefits and harms ³¹⁾.

Known risks include the following issues:

• Regular use of herbal teas or other liquid preparations may lead to decreased milk intake or a drop in sodium levels in an infant’s blood.
• The lack of product regulation may result in contamination, unlabeled ingredients or inconsistent dosages in herbal remedies.
• Some homeopathic remedies contain low amounts of potentially toxic substances.

Talk to your doctor before using an alternative medicine to treat your infant for colic.