Colic

Normal infant behaviour

All babies cry, but a baby may have colic if they cry more than 3 hours a day, 3 days a week for at least 1 week but are otherwise healthy.

Typical onset is in the first weeks of life, with resolution usually around 3-4 months, 6 months in some cases but is more prevalent in the first 6 weeks of life.

What is colic?

Infant colic is defined by the following clinical diagnostic criteria:

• The infant is less than 5 months of age when the symptoms start and stop.
• There are recurrent and prolonged periods of infant crying, fussing, or irritability reported by caregivers that occur without obvious cause and cannot be prevented or resolved by caregivers.
• There is no evidence of faltering growth, fever, or illness.

Additional signs may include:

• Crying most often occurs in the late afternoon or evening.
• Drawing the knees up to the abdomen or arching the back when crying.
• Clenching of the fists.

What causes colic?

Often the cause of colic is never uncovered and may be related to the baby’s own personality or temperament. Some babies are more sensitive than others and need more comforting. It’s not unusual for a baby to cluster feed in the evening both for comfort and to increase milk production, and crying which is labelled as “colic” may simply mean that the baby needs to nurse again.

For other babies, the discomfort can be traced to overabundant supply of milk, overactive letdown, reflux or occasionally allergies.

Colic-type symptoms can appear if a baby is having problems latching onto the breast. A shallow latch can lead to babies taking in a lot of air which then causes discomfort.

Treatment

Colic is usually self-limiting.

In the meantime, parents should try a range of options:

• Continue responsive feeding – breast and bottle (only stage one formula needed, check appropriate teat flow and size, advise against ‘perfect prep’ machines due to risk of infections and check safe preparation of feeds)
• Consider a breastfeeding assessment (possible powerful milk ejection)
• Parents can look at baby massage/various winding techniques (several classes available locally)
• Try baby wearing and motion to keep baby upright after feeds and close to their parent
• Warm bathing or co-bathing

NICE CKS states that the following should NOT be recommended due to insufficient evidence:

• Simeticone (eg. infacol) or lactase (eg. colief) drops
• Changes to maternal diet (if breastfeeding) or changing formula preparation (if formula feeding)
• Probiotics
• Herbal supplements
• Spinal manipulation or cranial osteopathy

Specialist paediatric referral or advice should be sought if:

• Parents/carers feel unable to cope despite reassurance and advice in primary care.
• There is suspected faltering growth, or symptoms are severe, worsening, or persist beyond 5 months of age.
• There is a suspected underlying cause for symptoms which cannot be managed in primary care.

Useful resources for parents: 

I think my baby's got colic - La Leche League GB

ICON Cope – resource for parents with crying babies