Colic

Colic is when a baby cries and fusses more than usual without an obvious cause and may be difficult to console. Colic usually resolves on its own with time. However, steps can be taken to reduce the severity of colic and lessen parental stress.

General information

Colic is common in babies, being estimated to occur in 10 to 40 per cent of infants. It usually starts when a baby is a few weeks old, peaks at about six weeks of age, and usually stops by the time they are three to four months of age.

All babies cry – it is their way of telling caregivers they are hungry, tired, and/or need a nappy change. Colicky crying is more frequent, intense, higher-pitched, and prolonged than normal crying, and has no obvious cause in otherwise healthy and well-fed infants.

While the excessive crying and fussiness will normally resolve after a number of weeks, managing colic adds stress and frustration for parents because the baby's distress is inconsolable and occurs for no apparent reason.

Causes

The cause of colic is unknown, but many factors may play a role, including:

• A digestive system that has not yet fully developed
• Abdominal pain or discomfort due to gas or indigestion
• An imbalance in the digestive tract’s bacterial community (microbiome)
• Gastric reflux (i.e., the bringing up of stomach contents)
• Food allergies (e.g., cows’ milk protein allergy)
• Food intolerances (e.g., milk lactose intolerance)
• Overfeeding, underfeeding, or infrequent burping
• Childhood migraine 
• Parental or family stress or anxiety.

Complications

Although colic does not cause health problems for a baby, it can be a major burden to families. Colic is associated with exhaustion, stress, and depression  in parents and is a risk factor for shaken baby syndrome.

Colic is also a cause of stopping breastfeeding early, disturbed sleep (insomnia), feelings of guilt and helplessness in parents, and family problems.

Signs and symptoms

Although crying is normal for all babies, excessive crying (generally defined as crying for more than three hours a day, three or more days per week, for three or more weeks) is not normal and may indicate colic.

Signs and symptoms of colic in babies include:

• Recurrent and prolonged periods of intense crying or screaming
• Crying for no apparent reason
• Fussiness or irritability even when not crying
• Attempts to soothe or settle the baby have no effect
• Crying occurs more often in the afternoon and evening
• Going red in the face
• Clenched fists, knees tucked up to their tummy, or arching their back
• Rumbling tummy and wind.

Excessive, inconsolable crying may be colic, or it may indicate a health condition that is causing pain or discomfort. The signs and symptoms of colic may lessen after the baby has a bowel movement or passes gas. A lot of air can be swallowed during prolonged and intense crying.

Caregivers should contact their doctor if they are worried about their baby, soothing strategies are not helping, and/or their baby is older than four months and still seems to have symptoms of colic. Further symptoms like fever, lethargy, poor feeding or weight loss, vomiting, diarrhoea, or blood in the stools may indicate a visit to the doctor to assess other possible health conditions.

Parents should also see their doctor if they are finding it hard to cope.

Diagnosis

Your doctor will look at the baby's medical history and conduct a physical examination to check for possible causes of a baby’s crying. Colic can usually be diagnosed based on the pattern, timing, and duration of the baby’s symptoms. Keeping a diary of the infant’s crying and fussy behaviour may be helpful.

Laboratory tests are not usually required but may be done to exclude other health conditions as potential causes of a baby’s distress.

Treatment

There is no specific treatment for colic. Instead, the aim of treatment is to soothe the child as much as possible and to provide support for the parents.

Soothing strategies for a baby with colic include:

• Using a pacifier
• Holding or cuddling the baby
• Holding the baby upright during feeding to stop them swallowing air
• ‘Winding’ or burping the baby after feeds to relieve trapped gas
• Walking around with, or gently rocking, the baby over your shoulder
• Rubbing the baby’s tummy or placing the baby on their tummy for a back rub
• Bathing the baby in a warm bath
• Gentle rhythmic noise and vibration
• Quietly singing, humming, or talking to your baby
• Playing gentle, low-volume audio in the background (e.g,. heartbeats, soothing sounds, white noise)
• Limiting visual stimulation.

Anti-colic drops or supplements should not be used unless advised by a doctor. If a baby is being formula-fed, switching to a hydrolysed formula, in which cow’s milk protein is broken down into smaller pieces to make an allergic reaction less likely, might help. However, doing so should be discussed with a doctor.

Breastfeeding mothers may also want to try removing certain foods from their diet, including:

• Common food allergens such as dairy, eggs, nuts, and wheat
• Potentially irritating foods, such as cabbage, onions, or caffeinated beverages.

Because parents of infants with colic may be sleep deprived and have feelings of frustration and failure because they are unable to console their baby, parental reassurance, empathy, and education (about colic, caring for an infant with colic, and the need for support) is essential in the overall management of infant colic.

It is important that parents take care of themselves. The following self-care strategies may help:

• Take breaks from looking after your baby by taking turns with a spouse or partner or asking a trusted friend or relative to take over for a while
• Put your baby in their cot for a while during a crying episode if you need to collect or calm yourself
• Share your feelings with family members, friends, and/or your doctor
• Do not judge yourself. Colicis not the result of poor parenting, and being unable to console your baby does not mean that they are rejecting you
• Look after your own health – eat healthy foods, schedule time for exercise, and sleep when the baby sleeps, even during the day
• Remind yourself that colic is temporary – colic usually resolves by the time the baby is four months old
• Contact your doctor, Healthline, or local Plunket for support if you are feeling overwhelmed and have no one to turn to.

Further information and support

Healthline

Freephone (24/7): 0800 611 116

Website: www.healthline.govt.nz

Plunket

Freephone (24/7): 0800 933 922

Website: www.plunket.org.nz

E-mail: [email protected]

References

Cleveland Clinic (2019). Colic (Web Page). Cleveland, OH: Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10823-colic [Accessed: 04/04/2022]

Lam T.M.L., Chan P.C., Goh L.H. Approach to infantile colic in primary care. Singapore Med J. 2019;60(1):12–16

Mayo Clinic (2020). Colic (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/colic/symptoms-causes/syc-20371074 [Accessed: 04/04/22]

Prashant, G.D. (2017). Colic (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/330815-overview#a7 [Accessed: 04/04/22]

NHS (2018). Colic (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/conditions/Colic/ [Accessed: 04/04/22]

Zeevenhooven, J., et al. (2018). Infant colic: Mechanisms and management. Nat Rev Gastroenterol Hepatol. 2018;15(8):479–496

Reviewed: April 2023