Colic: Excessive Crying in Babies

What colic looks like

A colicky baby:

• cries intensely, often screaming, for long periods, most often between late afternoon and midnight
• is hard or impossible to comfort
• may go red in the face, clench fists, draw up the legs and arch the back
• may pass gas, which often follows crying rather than causes it
• feeds well, gains weight normally and is content between episodes

All babies cry, and the amount rises in the early weeks, peaking around 6 to 8 weeks before falling. Colic is the high end of this normal crying curve.

What causes colic

No single cause has been proven. Likely contributors include:

• Normal developmental crying: some babies are more sensitive and take longer to learn to settle.
• Immature digestion and gut bacteria: the gut is still adjusting to feeding.
• Swallowed air during feeding or crying.
• Overstimulation: noise, light and handling build up through the day.
• Feeding issues: overfeeding, underfeeding or a fast milk flow.
• Cow's milk protein allergy: in a small minority, especially with eczema, vomiting, diarrhea, blood or mucus in the stool, or a strong family history of allergy.
• Exposure to tobacco smoke is linked to more crying.

Reflux (spitting up) is common in all babies and is usually not the cause of colic. Most babies do not need reflux medicine.

Is it colic or something else?

A doctor should check a crying baby to rule out illness. Conditions that can cause inconsolable crying include:

How colic is diagnosed

Colic is diagnosed when a baby under 5 months has recurrent, prolonged crying with no sign of illness and normal growth. The doctor will ask about the crying pattern, feeding, stools, vomiting and how you are coping, then examine the baby fully, undressed, and check weight. Tests are not usually needed if the baby is thriving and the examination is normal.

How to soothe a colicky baby

No method works for every baby, so try one at a time and give each a few minutes.

Calming techniques

• Hold and rock your baby, or walk with them in a carrier or sling.
• Swaddle snugly with arms in, hips loose. Stop swaddling once the baby can roll.
• White noise: a fan, vacuum sound or shushing close to the ear.
• Motion: a stroller ride or car ride.
• Reduce stimulation: a dim, quiet room in the evening.
• Warm bath or gentle tummy massage, moving clockwise.
• Pacifier if your baby takes one.

Feeding tips

• Hold your baby upright during feeds and burp regularly.
• For bottle feeding, use a slow-flow nipple and keep the nipple full of milk to reduce swallowed air.
• If breastfeeding, let your baby finish the first breast before offering the second.
• Do not switch formulas repeatedly without advice. If cow's milk protein allergy is suspected, your doctor may suggest a 2 to 4 week trial of an extensively hydrolyzed formula, or removing dairy from a breastfeeding parent's diet.

What does not have good evidence

Simethicone drops, gripe water, lactase drops, chiropractic manipulation and herbal teas have little or no proven benefit. Some studies suggest the probiotic Lactobacillus reuteri may reduce crying in breastfed babies, but results are mixed. Never give honey to a baby under 12 months.

Looking after yourself

Colic is exhausting and can make parents feel helpless. Prolonged crying is a known trigger for abusive head trauma (shaken baby syndrome). If you feel frustrated or angry:

• put your baby on their back in a safe crib and leave the room for 10 to 15 minutes
• take turns with a partner, relative or friend
• talk to your doctor or a helpline about how you are feeling

Persistent low mood, anxiety or hopelessness may be postpartum depression, which is common and treatable.

Frequently asked questions

What are the signs of colic in a baby?

Signs include intense crying for more than 3 hours a day, often in the evening, that is hard to soothe, with a red face, clenched fists, drawn-up legs or an arched back. Between episodes the baby feeds well, grows normally and seems content.

When does colic stop?

Colic usually starts around 2 to 3 weeks of age, peaks at about 6 weeks, and improves by 3 to 4 months. Most babies have outgrown it by 4 to 5 months. Crying that continues beyond this or starts later should be checked by a doctor.

What causes colic in babies?

The exact cause is unknown. It is thought to reflect a combination of an immature digestive and nervous system, a baby's temperament, swallowed air and overstimulation. In a small number of babies, cow's milk protein allergy contributes, especially when there is eczema, vomiting or blood in the stool.

Does gas cause colic?

Gas is often blamed, but babies swallow air when they cry, so gas may be a result rather than the cause. Simethicone gas drops have not been shown to reduce colic. Burping during feeds and slow-flow bottles reduce swallowed air.

When should I worry about my baby's crying?

Get urgent help if your baby has a fever (38 °C or 100.4 °F or higher under 3 months), vomits green fluid, has blood in the stool, is floppy, very sleepy or breathing fast, has a weak or high-pitched cry, or is feeding poorly. Trust your instincts if your baby seems ill.