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Baby colic
Baby colic
Baby colic
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Colic
Other namesInfantile colic
A crying newborn
SpecialtyPediatrics
SymptomsCrying for more than three hours a day, for more than three days a week, for three weeks[1]
ComplicationsFrustration for the parents, depression following delivery, child abuse[1]
Usual onsetSix weeks of age[1]
DurationTypically goes away by six months of age[1]
CausesUnknown[1]
Diagnostic methodBased on symptoms after ruling out other possible causes[1]
Differential diagnosisCorneal abrasion, hair tourniquet, hernia, testicular torsion[2]
TreatmentConservative treatment, extra support for the parents[1][3]
PrognosisNo long term problems[4]
Frequency~25% of babies[1]

Baby colic, also known as infantile colic, is defined as episodes of crying for more than three hours a day, for more than three days a week, for three weeks in an otherwise healthy child.[1] Often crying occurs in the evening.[1] It typically does not result in long-term problems.[4] The crying can result in frustration of the parents, depression following delivery, excess visits to the doctor, and child abuse.[1]

The cause of colic is unknown.[1] Some believe it is due to gastrointestinal discomfort like intestinal cramping.[5] Diagnosis requires ruling out other possible causes.[1] Concerning findings include a fever, poor activity, or a swollen abdomen.[1] Fewer than 5% of infants with excess crying have an underlying organic disease.[1]

Treatment is generally conservative, with little to no role for either medications or alternative therapies.[3] Extra support for the parents may be useful.[1] Tentative evidence supports certain probiotics for the baby and a low-allergen diet by the mother in those who are breastfed.[1] Hydrolyzed formula may be useful in those who are bottlefed.[1]

Colic affects 10–40% of babies.[1] Equally common in bottle and breast-fed infants, it begins during the second week of life, peaks at 6 weeks, and resolves between 12 and 16 weeks.[6] It rarely lasts up to one year of age.[7] It occurs at the same rate in boys and in girls.[1] The first detailed medical description of the problem was published in 1954.[8]

Signs and symptoms

[edit]

Colic is defined as episodes of crying for more than three hours a day, for more than three days a week for at least a three-week duration in an otherwise healthy child.[9] It is most common around six weeks of age and gets better by six months of age.[9] By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks.[9] With colic, periods of crying most commonly happen in the evening and for no obvious reason.[1] Associated symptoms may include legs pulled up to the stomach, a flushed face, clenched hands, and a wrinkled brow.[9] The cry is often high pitched (piercing).[9]

Effect on the family

[edit]

An infant with colic may affect family stability and be a cause of short-term anxiety or depression in the parent(s).[9] It may also contribute to exhaustion and stress in the parent(s).[10]

Persistent infant crying has been associated with severe marital discord, postpartum depression, early termination of breastfeeding, frequent visits to doctors, a quadrupling of laboratory tests, and prescription of medication for acid reflux.[citation needed] Babies with colic may be exposed to abuse, especially shaken baby syndrome.[9]

Parent training programs for managing infantile colic may result in a reduction in crying time.[11]

Causes

[edit]

The cause of colic is generally unknown. Fewer than 5% of infants who cry excessively turn out to have an underlying organic disease, such as constipation, gastroesophageal reflux disease, lactose intolerance, anal fissures, subdural hematomas, or infantile migraine.[9] Babies fed cow's milk have been shown to develop antibody responses to the bovine protein, and some studies have shown an association between consumption of cow's milk and infant colic.[12][13] Studies performed showed conflicting evidence about the role of cow's milk allergy.[9] While previously believed to be related to gas pains, this does not appear to be the case.[9] Another theory holds that colic is related to hyperperistalsis of the digestive tube (increased level of activity of contraction and relaxation). The evidence that the use of anticholinergic agents improve colic symptoms supports this hypothesis.[9]

Psychological and social factors have been proposed as a cause, but there is no evidence. Studies performed do not support the theory that maternal (or paternal) personality or anxiety causes colic, nor that it is a consequence of a difficult temperament of the baby, but families with colicky children may eventually develop anxiety, fatigue and problems with family functioning as a result.[9] There is some evidence that cigarette smoke may increase the risk.[1] It seems unrelated to breast or bottle feeding with rates similar in both groups.[14] Reflux does not appear to be related to colic.[15]

Diagnosis

[edit]

Colic is diagnosed after other potential causes of crying are excluded.[9] This can typically be done via a history and physical exam, and in most cases tests such as X-rays or blood tests are not needed.[9] Babies who cry may simply be hungry, uncomfortable, or ill.[16] Less than 10% of babies who would meet the definition of colic based on the amount they cry have an identifiable underlying disease.[17]

Cause for concern include: an elevated temperature, a history of breathing problems or a child who is not appropriately gaining weight.[9]

Indications that further investigations may be needed include:[18]

  • Vomiting (vomit that is green or yellow, bloody or occurring more than five times a day)
  • Change in stool (constipation or diarrhea, especially with blood or mucus)
  • Abnormal temperature (a rectal temperature less than 97.0 °F (36.1 °C) or over 100.4 °F (38.0 °C)
  • Irritability (crying all day with few calm periods in between)
  • Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over six hours)
  • Poor weight gain (gaining less than 15 grams a day)

Problems to consider when the above are present include:[18]

  • Infections (e.g. ear infection, urine infection, meningitis, appendicitis)
  • Intestinal pain (e.g. food allergy, acid reflux, constipation, intestinal blockage)
  • Trouble breathing (e.g. from a cold, excessive dust, congenital nasal blockage, oversized tongue)
  • Increased brain pressure (e.g. hematoma, hydrocephalus)
  • Skin pain (e.g. a loose diaper pin, irritated rash, a hair wrapped around a toe)
  • Mouth pain (e.g. yeast infection)
  • Kidney pain (e.g. blockage of the urinary system)
  • Eye pain (e.g. scratched cornea, glaucoma)
  • Overdose (e.g. excessive Vitamin D, excessive sodium)
  • Others (e.g. migraine headache, heart failure, hyperthyroidism)

Persistently fussy babies with poor weight gain, vomiting more than five times a day, or other significant feeding problems should be evaluated for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).[19]

Treatment

[edit]

Management of colic is generally conservative and involves the reassurance of parents.[9] Calming measures may be used and include soothing motions, limiting stimulation, pacifier use, and carrying the baby around in a carrier,[9] although it is not entirely clear if these actions have any effect beyond placebo.[9][20] Swaddling does not appear to help.[1]

Medication

[edit]

No medications have been found to be both safe and effective.[9] Simethicone is safe but ineffective, while dicyclomine works but is unsafe.[9] Evidence does not support the use of cimetropium bromide,[20] and there is little evidence for alternative medications or techniques.[21] While medications to treat reflux are common, there is no evidence that they are useful.[15] Doses of Lactase taken orally along with milk may help.[22]

Diet

[edit]

Dietary changes by infants are generally not needed.[9] In mothers who are breastfeeding, a hypoallergenic diet by the mother—not eating milk and dairy products, eggs, wheat, and nuts—may improve matters,[9][10][23] while elimination of only cow's milk does not seem to produce any improvement.[23] In formula-fed infants, switching to a soy-based or hydrolyzed protein formula may help.[10] Evidence of benefit is greater for hydrolyzed protein formula with the benefit from soy based formula being disputed.[24][25] Both these formulas have greater cost and may not be as palatable.[25] Supplementation with fiber has not been shown to have any benefit.[10] A 2018 Cochrane review of 15 randomized controlled trials involving 1,121 infants was unable to recommend any dietary interventions.[26] A 2019 review determined that probiotics were no more effective than placebo although a reduction in crying time was measured.[27]

Complementary and alternative medicine

[edit]

No clear beneficial effect from spinal manipulation[28][29] or massage has been shown.[9] Further, as there is no evidence of safety for cervical manipulation for baby colic, it is not advised.[30] There is a case of a three-month-old dying following manipulation of the neck area.[30]

Little clinical evidence supports the efficacy of "gripe water" and caution in use is needed, especially in formulations that include alcohol or sugar.[9] Evidence does not support lactase supplementation.[20] The use of probiotics, specifically Lactobacillus reuteri, decreases crying time at three weeks by 46 minutes in breastfeed babies but has unclear effects in those who are formula fed.[31] Fennel also appears effective.[32][33]

Prognosis

[edit]

Infants who are colicky do just as well as their non colicky peers with respect to temperament at one year of age.[9]

Epidemiology

[edit]

Colic affects 10–40% of children,[1] occurring at the same rate in boys and in girls.[14]

History

[edit]

The word "colic" is derived from the ancient Greek word for intestine (sharing the same root as the word "colon").[34]

It has been an age-old practice to drug crying infants. During the second century AD, the Greek physician Galen prescribed opium to calm fussy babies, and during the Middle Ages in Europe, mothers and wet nurses smeared their nipples with opium lotions before each feeding. Alcohol was also commonly given to infants.[35]

References

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Baby colic

View on Grokipedia
from Grokipedia
Infantile colic, commonly referred to as baby , is a benign yet distressing condition characterized by prolonged, episodes in otherwise healthy and well-fed infants, typically lasting more than three hours per day, more than three days per week, and for more than three weeks, often peaking around six weeks of age and resolving by three to four months. This syndrome affects an estimated 10% to 40% of worldwide, with no significant differences based on gender, feeding method (breast or formula), or , though it appears more prevalent in children and in families from industrialized nations. Episodes of are often intense and unpredictable, frequently occurring in the late afternoon or evening, accompanied by physical signs such as a flushed face, clenched fists, arched back, drawn-up legs, and , though the shows no signs of illness like fever or . The exact cause remains unknown and is likely multifactorial, with proposed contributors including gastrointestinal immaturity leading to gas or motility issues, gut microbiome (such as reduced beneficial bacteria like and ), food sensitivities (e.g., to cow's proteins in breastfed or formula-fed ), maternal smoking during , and even factors like parental stress. Diagnosis is primarily clinical, relying on a thorough history and to rule out underlying medical conditions such as infections, , or allergies, using criteria like Wessel's "rule of threes" or the Rome IV guidelines, which emphasize the absence of organic disease. focuses on supportive care for both and parents, including non-pharmacological soothing techniques such as , rocking, white noise, or skin-to-skin contact, alongside dietary modifications like formulas or maternal elimination diets excluding potential allergens such as dairy if . Emerging evidence supports the use of , particularly Lactobacillus reuteri DSM 17938, which can reduce crying time by up to 56 minutes per day in breastfed s, though medications like simethicone or antacids are generally ineffective. While itself poses no long-term health risks to the infant, it can lead to significant parental exhaustion, increased risk of , and strained family dynamics, underscoring the importance of early education and support resources.

Signs and Symptoms

Crying Patterns

Baby colic is characterized by excessive crying in an otherwise healthy , with the most widely used diagnostic criterion being Wessel's "rule of threes," which defines colic as or fussing lasting more than three hours per day, occurring on more than three days per week, and persisting for more than in infants younger than four months of age. This rule, originally proposed in 1954, helps clinicians distinguish colic from typical infant fussiness by establishing thresholds for duration, frequency, and persistence. Crying episodes in colic typically peak in intensity and duration between and of age, with the highest occurrence often noted around , and they frequently happen in the late afternoon or early evening. These patterns align with the natural trajectory of infant crying, but in colic, the episodes are markedly prolonged and recurrent, resolving abruptly by three to four months in most cases. The associated with is typically inconsolable, high-pitched, and intense, often resembling screams rather than typical whimpers, and may be accompanied by visible signs of distress such as facial flushing, clenched fists, and drawing the legs up toward the abdomen. Unlike normal infant , which serves communicative purposes like hunger or discomfort and usually responds to soothing, is more urgent and persistent, resisting common interventions and occurring without an apparent trigger. This distinction is evident in the acoustic profile, where cries exhibit higher variability in pitch and more turbulent sounds compared to routine pre-feeding cries.

Physical Signs

Infants experiencing often exhibit several observable physical signs during episodes of distress, which can help caregivers recognize the condition. Common indicators include , where the belly appears swollen or tense due to swallowed air from , and excessive gas or resulting from . , characterized by stiffening of the limbs such as clenched fists or drawing up of the legs, is frequently observed as the infant tenses in response to discomfort. Additional physical cues include facial grimacing, often accompanied by a reddened face or circumoral , and arching of the back, which may indicate . During these episodes, infants may display rapid breathing or hiccupping alongside their cries, further emphasizing the intensity of the discomfort. Importantly, is distinguished from other conditions by the absence of systemic signs such as fever, , or failure to gain ; affected infants typically feed well and show normal growth patterns. Stool patterns in colicky infants can vary, with some experiencing more frequent bowel movements—up to four times per day initially—or infrequent ones, alongside reports of explosive, green, or foul-smelling stools in qualitative observations.

Family Impact

Infant colic imposes significant emotional and psychological burdens on parents, primarily through disrupted patterns and the relentless demands of soothing a baby, leading to heightened anxiety and . Mothers of infants with colic often experience elevated levels of parenting stress, with studies indicating that up to 45% report moderate to severe depressive symptoms during the colic period. This exhaustion can exacerbate the risk of , as evidenced by higher Postnatal Depression Scale scores among these mothers compared to those with non-colicky infants (mean EPDS 10.2 vs. 6.3). The condition also strains family relationships, contributing to marital conflict and challenges in parent- bonding. Parents frequently describe feelings of toward their , with some expressing due to the unequal burden of care, which can create distance between partners: "It was just about the baby so we lived past each other." This relational tension may manifest as arguments over responsibilities, with mothers feeling isolated while fathers continue external activities, potentially delaying formation. Insecure maternal attachment styles are more prevalent in families affected by colic (62.5% vs. 31.1%). Economically, colic disrupts household functioning by necessitating additional childcare or causing parents to miss work, contributing to broader costs associated with functional gastrointestinal disorders in infancy. In the UK, the annual economic burden from infant crying issues, including colic, reaches £65 million, encompassing healthcare visits, lost productivity, and support services. Families may incur further expenses for alternative caregiving to allow rest, amplifying financial stress during this period. Long-term, while most effects are transient, colic can alter and dynamics, with initial feelings of inadequacy leading to overcompensatory attention toward the post-resolution. Parents often report regained confidence and strengthened bonds after four years, though some experience lingering dissatisfaction with family life or loss of trust in services. relationships may suffer temporarily from reduced parental attention, causing resentment or disrupted routines, but these typically heal as the regains equilibrium. In rare cases, severe strain contributes to marital dissolution.

Causes

Etiological Theories

The of baby colic remains multifactorial and incompletely understood, with no single cause identified despite extensive research; proposed mechanisms span physiological, neurological, and environmental domains. Gastrointestinal theories posit that arises from an immature digestive system in early infancy, leading to symptoms such as gas accumulation, intestinal spasms, and potential transient due to underdeveloped enzyme activity. Overfeeding, underfeeding, or inadequate burping may exacerbate and gut distension, while elevated motilin hormone levels suggest hypermotility from imbalance. These factors are supported by observations of increased breath in a subset of colicky infants, indicating carbohydrate malabsorption, though evidence is inconsistent across studies. Neurological immaturity theories emphasize the underdeveloped central and autonomic s in young infants, which may impair self-regulation of , sleep-wake cycles, and response to soothing stimuli, resulting in prolonged episodes. This "fourth trimester" concept views colic as an extension of conditions, where hypersensitivity to external stimuli overwhelms the infant's immature and vestibular regulation. Longitudinal data link early colic to later neurodevelopmental outcomes, such as increased risk in , suggesting a heritable component in nervous system maturation. Recent research highlights gut microbiota dysbiosis as a key contributor, where altered fecal flora disrupts intestinal homeostasis and may influence brain-gut axis signaling, exacerbating crying. A 2025 NIH-funded KOALA birth cohort study of over 1,000 infants found higher abundance of Ruminococcus gnavus group at one month associated with increased colic symptoms at 4-7 months, independent of feeding mode, supporting microbiota's role in symptom persistence. Similarly, a 2025 longitudinal analysis revealed reduced beneficial acidifying bacteria (e.g., Bifidobacterium, Lactobacillus) and elevated proteolytic species (e.g., Escherichia coli, Klebsiella) in colicky infants, correlating with intermediate dysbiosis levels and elevated fecal calprotectin indicating gut inflammation. Earlier seminal work confirmed sevenfold higher calprotectin and reduced Actinobacteria in affected infants, linking dysbiosis to behavioral symptoms via potential neuroinflammatory pathways. Allergic or responses, particularly to cow's proteins transmitted through maternal diet in breastfed infants, are implicated in a subset of cases, potentially triggering gut and discomfort mimicking . Clinical challenges arise when IgE-mediated cow's manifests solely as excessive crying, as seen in case studies where reintroduction of dairy post-elimination provoked and confirmed via positive challenges, underscoring the need for targeted evaluation. Systematic reviews note that hypoallergenic formulas reduce crying duration in responsive infants, though the overall association remains equivocal without universal causality.

Risk Factors

Several infant-related factors have been associated with an increased likelihood of developing . First-born status, or maternal nulliparity, is linked to higher risk of . Maternal factors during contribute to elevated risk. Smoking during increases the likelihood, with infants of mothers who smoked 15 or more cigarettes daily facing a twofold higher risk. Young maternal age is another predisposing element, as identified in cohort studies examining parental influences. Additionally, high maternal intake, such as from or consumption, has been associated with increased in breastfed infants. Environmental influences include family history of or allergies, which raises risk; maternal atopic disorders are linked to higher . Certain factors may offer protection against . Breastfeeding serves as the primary protective element, reducing incidence in multiple cohort analyses. Responsive , in contrast to attitudes fearing spoiling, are associated with lower risk by promoting better regulation.

Diagnosis

Clinical Assessment

The clinical assessment of infant colic begins with a detailed parental to characterize the infant's patterns and overall . Caregivers are asked about the duration, timing, and triggers of episodes, including whether the crying occurs in the late afternoon or evening, lasts for prolonged periods, and responds poorly to standard soothing techniques such as feeding, rocking, or holding. Additional history includes feeding methods ( or ), stooling and voiding patterns, routines, and any associated symptoms like gas or regurgitation, helping to quantify excessive that meets diagnostic thresholds. A thorough follows to evaluate the infant's general and identify any abnormalities. Key components include measuring growth parameters such as weight, length, and head circumference to ensure appropriate development, auscultating the for bowel sounds and palpating for tenderness or distension, and assessing neurological status through checks for bulging, tone, and reflexes. The examiner observes the infant's demeanor during the visit, noting responses to handling and any visible signs of discomfort, while also screening for hydration status and signs of or trauma. Validated tools assist in objectively quantifying symptoms during assessment. The Infant Colic Scale, a parental , evaluates intensity, duration, and fussiness to support , with versions validated in multiple languages for clinical use. Other instruments, such as the Crying Pattern and parental diaries of cry and fuss behavior, track daily patterns over time to confirm persistent excessive . These tools, often referenced alongside brief criteria like Wessel's rule of three ( for three or more hours per day, on three or more days per week, for three or more weeks), aid in establishing the functional nature of colic without underlying pathology. Throughout the evaluation, clinicians monitor for red flags that may warrant further investigation, including poor , , fever, or , which could indicate non-colic etiologies. If present, these prompt immediate referral or additional testing, but in typical cases, colic is diagnosed clinically based on the absence of such concerns and normal examination findings.

Differential Diagnosis

The differential diagnosis of infantile colic involves ruling out organic conditions that may present with excessive crying in otherwise healthy infants, as colic itself is a without identifiable underlying . Conditions mimicking colic typically exhibit additional red-flag symptoms or abnormal findings on clinical examination, laboratory tests, or , which are absent in true colic. Gastroesophageal reflux disease (GERD) is differentiated from colic by symptoms such as frequent regurgitation, post-feeding worsening of crying, and potential apneic or cyanotic episodes, often confirmed through history and, if needed, pH monitoring. In contrast, colic lacks these gastrointestinal reflux indicators and shows no response to anti-reflux measures. Infections, such as urinary tract infections, , or , are identified by accompanying fever, , or systemic signs, with diagnosis supported by cultures or as indicated. Allergies, particularly cow's milk protein intolerance, present with stool changes like occult blood or , eczema, or , and are confirmed via elimination trials of offending formulas or maternal diet adjustments. Other mimicking conditions include intussusception, characterized by acute , vomiting, and currant jelly stools, diagnosed through abdominal or . Neurological issues, such as increased intracranial pressure from or infantile , feature abnormal neurologic exams like bulging fontanelles or altered mental status, requiring like CT scans for differentiation. Unlike these, infantile colic demonstrates no organic abnormalities on routine labs, stool studies, or in thriving infants.

Management

There is no single "best" colic medicine for babies, as colic typically resolves on its own by 3-4 months of age and has no proven cure. Authoritative sources, including the Canadian Paediatric Society, recommend soothing techniques (e.g., rocking, swaddling, white noise, motion) as the primary approach. Evidence for medications and supplements is limited, and parents should consult a pediatrician before using any product, as many over-the-counter remedies lack strong evidence and some can be harmful.

Supportive Techniques

Supportive techniques for managing baby colic focus on non-invasive methods to activate the infant's calming and provide immediate comfort during episodes of excessive . These strategies, grounded in behavioral and sensory interventions, aim to mimic the intrauterine environment and help regulate the baby's without altering diet or using medications. Evidence from clinical reviews indicates that such techniques can reduce crying duration by up to 50% in affected infants when applied consistently. One widely adopted approach is the "five S's" method developed by pediatrician Dr. Harvey Karp, which combines five sensory elements to soothe colicky babies by recreating womb-like conditions. The first S, , involves securely wrapping the in a to limit startle reflexes and promote a sense of security, with studies showing it reduces crying in fussy newborns. The second S, side or positioning, entails holding the baby on their side or tummy while awake and supervised to ease gas and discomfort, though this position is never used for sleep due to safety risks. Shushing, the third S, uses continuous white noise at 60-70 decibels to drown out startling sounds, mimicking the constant whooshing of blood flow in the womb and calming arousal in over 85% of cases. Swinging, the fourth S, applies gentle rhythmic motion such as rocking or swaying at a rate of 45-65 beats per minute to simulate the mother's walking gait during , effectively lowering and fussiness. Finally, sucking provides non-nutritive comfort through a or finger, engaging the baby's innate rooting reflex to release and reduce distress in colicky episodes. This method, validated in neonatal protocols, has demonstrated efficacy in reducing crying bouts when all five elements are used together. Environmental adjustments complement these techniques by creating a soothing atmosphere to minimize overstimulation. machines or apps emitting steady, low-frequency sounds have been shown in randomized trials to decrease duration more effectively than motion alone, with colicky infants sleeping up to 1.5 hours longer per session compared to controls. Gentle rocking or swinging in a carrier or replicates vestibular stimulation from the womb, reducing irritability in 60-70% of cases, while warm baths at body temperature (around 37°C) can relax abdominal muscles and alleviate gas-related discomfort, leading to calmer post-bath periods of 30-45 minutes. These interventions are most effective when combined and applied during peak times, typically evenings. Parental education plays a crucial role in empowering caregivers to implement these techniques effectively and respond to the infant's cues. Programs emphasizing responsive holding—such as cradling the baby upright against the chest or using a football hold to support the head and reduce reflux-like symptoms—have been associated with decreased parental anxiety and improved infant soothing success rates of 75-90%. Training in responsive feeding cues, like pausing to burp and observing signals without overfeeding, helps prevent of symptoms while fostering . Systematic reviews of interventions confirm that structured on these behavioral strategies not only shortens crying episodes but also mitigates stress by building confidence. Recent evidence highlights , or skin-to-skin contact, as a particularly effective supportive technique for . In a 2025 randomized controlled trial, colicky infants receiving kangaroo care for 15-20 minutes twice daily experienced reductions in colic symptom scores, alongside improvements in crying and sleep duration, attributed to stabilized and oxytocin release promoting relaxation. The study found kangaroo care reduced colic symptom scores by a of 8 points. This method, involving the parent holding the undressed baby against bare skin, is recommended for regular sessions to optimize benefits.

Dietary Interventions

Dietary interventions for colic primarily target potential food sensitivities or allergies that may exacerbate symptoms, often linked to theories of cow's milk protein intolerance. For breastfeeding mothers, eliminating common allergens from the diet is a frequently recommended approach to reduce colic symptoms in infants. Common allergens to consider avoiding include dairy products (cow's milk), eggs, peanuts, tree nuts, wheat, soy, and fish. Caffeine and spicy foods are also sometimes suggested for elimination, while gassy vegetables (e.g., broccoli, cabbage) are occasionally implicated as potential triggers, though these have weaker supporting evidence. Dairy elimination, in particular, addresses potential transmission of cow's milk proteins through that may trigger gastrointestinal discomfort. Clinical trials have demonstrated that a low-allergen maternal diet can lead to a significant reduction in crying and fussing duration in some affected breastfed infants, though results vary by individual and evidence is not universal. One reporting a 25% decrease in distressed behavior over 48 hours compared to controls (95% CI, 0.18–0.56). Another study found that exclusion of multiple allergens resulted in up to a 39% reduction in infant distress for those on the intervention diet versus 16% in the control group. It is essential to consult a pediatrician or lactation specialist before eliminating foods to ensure nutritional balance for the mother. In formula-fed infants, switching to or extensively hydrolyzed formulas is advised when standard cow's milk-based formulas are suspected to contribute to . These formulas break down proteins to minimize allergic reactions, and evidence from systematic reviews indicates potential benefits in symptom relief, though results vary across studies. For severe cases, amino acid-based formulas, which provide elemental nutrition without intact proteins, have shown short-term efficacy; a 2025 prospective study reported significant reductions in symptom severity and frequency in affected infants after switching to such formulas.

Pharmacological Options

Pharmacological interventions for infant colic are generally not recommended as first-line treatments due to the condition's unclear , limited efficacy of available medications, and potential risks, with guidelines emphasizing supportive care instead. There is no proven pharmacological cure for colic, and evidence for medications remains limited. The and other authoritative bodies advise against routine use of drugs, prioritizing non-pharmacological approaches to avoid unnecessary risks in young infants. Simethicone, an over-the-counter anti-foaming agent available as drops (e.g., Ovol drops in Canada), is commonly used by parents to alleviate gas-related discomfort in colicky infants, but clinical evidence shows it is no more effective than in reducing crying time or symptoms, though it may provide relief from gas. A randomized, double-blind, -controlled trial involving 83 infants found that simethicone (20 mg four times daily for one week) led to perceived improvements similar to , with no significant difference in crying duration or frequency. Systematic reviews, including a Cochrane of multiple studies, confirm the lack of benefit, attributing any minor effects to natural symptom resolution rather than the drug's action on intestinal gas. Despite its ineffectiveness for colic overall, simethicone is considered low-risk with minimal side effects, such as occasional loose stools, making it a harmless option if parents prefer to try it under medical guidance. Antispasmodics, such as (also known as ), have been explored historically for their potential to relax gastrointestinal smooth muscles and reduce abdominal cramping, but their use is now strongly discouraged in infants due to serious adverse effects. Early studies in the and suggested some reduction in crying episodes, but subsequent reports documented risks including apnea, respiratory distress, seizures, and syncope, leading to in children under six months by manufacturers and regulatory bodies. The and other guidelines explicitly advise against dicyclomine, citing these potentially life-threatening side effects as outweighing any unproven benefits. For pain relief, oral sucrose solution has been investigated primarily for procedural analgesia in neonates rather than as a routine treatment, though limited evidence suggests possible short-term soothing effects. A small randomized of 30 infants showed that 2 mL of 12% administered twice daily reduced symptoms compared to , potentially by activating endogenous pathways to provide mild analgesia. However, broader guidelines from the recommend (typically 24% solution at 0.1-0.5 mL/kg) only for acute painful procedures like heel sticks, not for ongoing management, due to insufficient evidence for daily use and concerns over repeated exposure in preterm or vulnerable infants. Side effects are rare but can include gagging or decreased if overused. Overall, major guidelines from organizations like the and the National Institute for Health and Care Excellence (NICE) underscore that should be avoided routinely for infant colic, as no medication has demonstrated consistent efficacy without risks, and symptoms typically resolve spontaneously by 3-4 months of age. Clinicians may consider targeted use only after ruling out underlying conditions, with close monitoring for adverse reactions and consultation with a pediatrician.

Complementary Therapies

Complementary therapies for baby colic encompass a range of non-pharmacological, alternative interventions aimed at alleviating symptoms such as excessive crying and fussiness, often drawing from holistic or traditional practices. These approaches, including , manual manipulations, techniques, and others like or herbal remedies, have garnered interest due to the limited efficacy of conventional treatments, though varies in and consistency. Recent systematic reviews and trials highlight potential benefits in select subgroups, particularly breastfed infants, but emphasize the need for caution regarding , consultation with a pediatrician before use, and the absence of robust, large-scale data. Probiotics, particularly strains like Lactobacillus reuteri DSM 17938, have been investigated for their role in modulating to reduce symptoms. Some studies support certain probiotics, including Lactobacillus reuteri and specific Bifidobacterium strains (e.g., in products like Culturelle Baby Calm + Colic), for reducing crying time, particularly in breastfed infants. A 2023 meta-analysis of randomized controlled trials found that overall decreased daily crying time by an average of 51 minutes, with L. reuteri showing a 65-minute reduction; this effect was more pronounced in exclusively breastfed infants, achieving up to 74 minutes of reduced crying. However, evidence remains mixed, as some reviews indicate inconsistent benefits for formula-fed or non-breastfed infants, and long-term impacts on gut health are unclear. Parents should consult a pediatrician before administering probiotics, as benefits are strain-specific and safety must be ensured. Manual therapies, such as spinal manipulation and osteopathic manipulative treatment, involve gentle adjustments to address potential musculoskeletal or visceral tensions contributing to colic discomfort. A 2022 Cochrane review of six trials involving 325 infants reported that these interventions reduced average daily by 72 minutes compared to usual care, with effects persisting in low-bias studies at around 74 minutes. A 2025 scoping review of seven randomized controlled trials corroborated modest to substantial reductions in crying (ranging from 36 minutes to nearly 7 hours daily) and improvements in duration (1.1 to 2.8 hours), though methodological heterogeneity precluded ; no serious adverse events were noted, but monitoring was inconsistent. Emerging research supports infant combined with (skin-to-skin contact) for symptom relief, with some exploration of soothing auditory elements like white noise or ocean sounds to mimic womb environments. A 2025 randomized controlled trial of 90 infants demonstrated that colic-specific reduced colic severity scores by 14 points and increased sleep duration more effectively than alone (which scored an 8-point reduction), while both outperformed controls in decreasing crying episodes. Limited 2024-2025 studies on white noise, including ocean-like sounds, suggest potential for reducing fussiness during procedures or sleep onset, though direct trials for colic are sparse and primarily anecdotal, warranting further validation. Acupuncture and herbal teas represent lower-evidence options with notable safety concerns. A 2018 systematic review and of three blinded trials (307 infants) found no clinically meaningful reduction in crying time from percutaneous needle (less than 12 minutes at treatment end), and it increased procedural crying; thus, it is not recommended for routine use. Herbal teas, such as those containing or , showed low-to-moderate evidence of reducing crying by about 60 minutes in a 2016 Cochrane review of four trials, but risks include reduced milk intake, electrolyte imbalances like , and potential allergic reactions in infants, leading experts to advise against unsupervised use.

Prognosis

Resolution Timeline

Baby colic typically begins in the second or third week of life, with symptoms manifesting as prolonged periods of excessive in otherwise healthy infants. The condition follows a characteristic pattern, starting with increasing crying episodes that intensify over the initial weeks. Crying intensity and frequency peak around 6 weeks of age, often reaching several hours per day on more than three days per week. From this point, symptoms gradually decrease in both duration and severity over the following weeks, with a noticeable reduction after 8-9 weeks. In most cases, resolves spontaneously by 3 to 4 months of age, with approximately 90% of affected infants experiencing full remission within this timeframe. Supportive care techniques, such as soothing measures, can help manage symptoms during this period but do not alter the overall timeline. Persistence of symptoms beyond 4 months is atypical and warrants further medical evaluation to rule out underlying conditions.

Long-Term Outcomes

Research indicates no direct causal link between infant colic and long-term cognitive or physical developmental delays in children. However, some longitudinal studies suggest a possible association with increased risk of childhood , with children who experienced colic showing higher odds of developing migraine without aura later in life. Similarly, colic in infancy has been linked to a modestly elevated risk of allergic conditions such as and in childhood. In uncomplicated cases, there is a lack of supporting permanent to the infant's overall or development. Regarding family health, parental mental health can be affected beyond the colic period, with some studies reporting higher levels of parenting stress and internalizing behavioral concerns in families up to several years later, potentially contributing to persistent anxiety. Qualitative research highlights that while most parents perceive resolution without lasting personal distress, a subset describes ongoing strains in dynamics and emotional stemming from the colic experience. On a positive note, navigating may foster enhanced parental resilience through developed coping strategies and strengthened problem-solving skills during and after the episodes. Overall, the majority of evidence points to favorable long-term trajectories for both infants and families once the acute phase subsides.

Epidemiology

Prevalence Rates

Baby affects approximately 10% to 40% of infants worldwide, with the condition typically manifesting in the first few months of life. Estimates tend to be higher in Western countries, reaching up to 28% in the and 34% in during peak periods around 3-4 weeks of age. Prevalence rates vary significantly depending on the diagnostic criteria used, as broader definitions capture more cases of excessive while stricter ones, such as the modified Wessel criteria, yield lower figures of 5% to 19%. For instance, prospective studies applying rigorous thresholds report incidences at the lower end of this spectrum. Meta-analyses of studies spanning decades show no significant changes in colic prevalence or fussing/ durations over time, indicating stable patterns across generations. Reported rates are often lower in non-Western cultures, such as 2% in , potentially due to underreporting influenced by differing caregiving norms and perceptions of .

Demographic Variations

Infant colic exhibits notable variations in prevalence and presentation across different demographic groups, influenced by factors such as , geography, , and . While the condition affects infants of both genders equally, with reported rates of approximately 18% in boys and 18% in girls, it appears more frequently among children. Studies indicate that lower parity, particularly first births, is associated with increased of colic, potentially due to less experienced parental or heightened sensitivity to in new parents. Geographically, prevalence is elevated in and , where rates range from 17% to 34% in the early weeks of life, compared to lower figures in Asian countries such as (around 2-6%) and (6.5%). This disparity may stem from differences in care practices, environmental factors, or diagnostic reporting, with Western countries showing longer average durations—up to 150 minutes per day at 3-4 weeks in —versus shorter durations in (107 minutes at 5-6 weeks). Overall global hovers around 20%, but these regional patterns highlight the role of localized caregiving norms. Cultural contexts further modulate reported colic rates, with lower incidences observed in collectivist societies featuring support and communal child-rearing. In such settings, infants experience more frequent carrying, skin-to-skin contact, and distributed caregiving, which correlate with reduced crying durations and fewer diagnoses compared to individualistic Western cultures where nuclear families predominate. For instance, anthropological observations in non-industrialized or communities report minimal colic-like excessive crying, attributing this to constant physical proximity and responsive soothing from multiple caregivers. Socioeconomic factors also play a role, with higher colic reporting in affluent households and among parents with non-manual occupations or longer . A large-scale study of over 76,000 infants found that more affluent districts and higher parental were significant predictors (P < 0.0001), possibly reflecting greater awareness, access to medical consultation, or sensitivity to distress rather than inherent biological differences. Conversely, limited evidence suggests potential variations between urban and rural settings, with some regional studies noting statistically significant differences in colic experience by residence, though directionality requires further confirmation.

History

Early Descriptions

The term "colic" originates from the word kolikos, referring to pain related to the colon or intestines. The first descriptions of colic in infants are attributed to the Greek physician Hippocrates around 400 BCE, who described it as a painful condition of the bowels. These early accounts attributed such distress to digestive disturbances or excesses in bodily fluids, marking the initial medical recognition of prolonged and abdominal discomfort as a distinct condition. In the 17th and 18th centuries, infant was frequently linked to "bilious" disorders—imbalances of and other humors under prevailing medical theories—or to , which was believed to cause systemic symptoms including , fever, and convulsions. Treatments reflected these views, often involving purging with laxatives or emetics to expel supposed toxins, alongside opium-based remedies to soothe and ; poppy extracts, used for millennia, were commonly administered to infants for excessive fussiness or suspected gastrointestinal issues. By the , remained a primary suspected cause of , with hazardous patent medicines like morphine-laced soothing syrups widely employed, sometimes leading to overdoses amid high rates. Early folklore also misinterpreted colic-like symptoms, attributing persistent infant crying to supernatural interference, such as witchcraft or fairy substitutions known as changelings—fussy, irritable substitutes left by fairies that cried incessantly despite care. These beliefs sometimes implied moral failings in parents, like neglecting rituals or incurring supernatural wrath, leading to harmful interventions in pre-modern societies.

Modern Developments

In 1954, Morris A. Wessel and colleagues formalized the diagnosis of infantile colic through the establishment of specific criteria, known as the "rule of three," which defines the condition as paroxysmal crying lasting more than three hours per day, occurring on more than three days per week, and persisting for more than three weeks in an otherwise healthy under three months of age. This framework shifted colic from a vague descriptor of infant distress to a quantifiable clinical entity, enabling more consistent identification and research into its patterns. From the through the , research transitioned from a predominant emphasis on gastrointestinal causes—such as immature or gas—to multifactorial models that incorporated behavioral, neurodevelopmental, and environmental influences. Studies during this period highlighted associations with factors like parental stress, feeding practices, and , suggesting that episodes often reflected interactions between physiological immaturity and external stressors rather than a singular organic . In the 2020s, advancements have increasingly integrated research, revealing potential links between and colic symptoms, with aberrant microbial signatures observed preceding and during episodes. For instance, a 2025 study supported by the demonstrated that alterations in infant contribute to excessive crying in colic and related conditions like , prompting explorations into interventions. Concurrently, randomized controlled trials have evaluated non-pharmacological interventions, such as osteopathic manipulative , showing that a series of three sessions over two weeks can lead to significant reductions in crying duration and improvements in parental perceptions of infant well-being. Evolving clinical guidelines reflect this progress, with the ' 2019 recommendations prioritizing parental education, reassurance, and supportive strategies over routine medication, underscoring colic's self-limiting nature and the importance of ruling out underlying issues without over-medicalization.

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