Infant Colic: Symptoms, Causes & Soothing Techniques

What Is Infant Colic?

Infant colic is defined as episodes of intense, inconsolable crying in an otherwise healthy baby, lasting at least 3 hours a day, occurring at least 3 days a week, for at least 3 weeks. It typically begins around 2 weeks of age, peaks at 6-8 weeks, and resolves by 3-4 months in most infants.

Infant colic is one of the most challenging experiences new parents face. The term "colic" comes from the Greek word "kolikos," meaning "suffering in the colon," though modern research suggests the condition involves much more than digestive discomfort alone. Despite being common and well-recognized, colic remains somewhat mysterious to medical science, with no single definitive cause identified.

The condition affects babies regardless of whether they are breastfed or formula-fed, and it occurs across all cultures and socioeconomic groups. Importantly, colicky babies are otherwise healthy, they feed well, gain weight appropriately, and develop normally. The intense crying episodes, while extremely distressing for parents and caregivers, do not cause any harm to the baby and leave no lasting effects once the colic resolves.

Medical professionals have traditionally used the "Rule of Threes" to diagnose colic: crying for more than 3 hours per day, for more than 3 days per week, for at least 3 weeks. However, newer diagnostic criteria (Rome IV) focus more on prolonged periods of crying, fussing, or irritability that occur without obvious cause and cannot be prevented or resolved by caregivers. This updated definition acknowledges that the specific time criteria may be less important than the pattern and intensity of the crying.

How common is infant colic?

Research estimates that infant colic affects between 10% and 40% of babies worldwide, with most studies suggesting a prevalence of around 20-25%. This wide range reflects differences in diagnostic criteria and cultural factors in reporting. What's clear is that colic is extremely common, you are far from alone if your baby has this condition.

Interestingly, colic appears to affect firstborn and later-born children equally, and there is no consistent difference between male and female infants. While some studies have suggested slightly higher rates in babies born to mothers who smoked during pregnancy, the evidence is not conclusive enough to establish smoking as a definitive cause.

What Are the Symptoms of Infant Colic?

The hallmark symptom of infant colic is intense, high-pitched crying that occurs at predictable times (usually late afternoon or evening), accompanied by physical signs such as clenched fists, drawn-up legs, arched back, and a red face from crying effort. The crying is difficult or impossible to soothe using normal comforting techniques.

Recognizing colic involves understanding a pattern of crying that differs significantly from normal infant fussiness. While all babies cry, colicky crying has distinct characteristics that set it apart. The episodes are typically more intense, last longer, and occur with notable regularity, often starting around the same time each day.

Parents often describe the colicky cry as different from other cries, it may be higher-pitched, more urgent-sounding, or have a quality that seems to indicate pain or distress. However, despite thorough medical examination, no underlying illness or injury is found to explain the crying.

Crying patterns

The crying episodes in colic have several characteristic features that help distinguish them from normal infant fussiness:

• Predictable timing: Episodes often begin in the late afternoon or evening, though they can occur at any time
• Prolonged duration: Crying continues for extended periods, often 1-3 hours or longer
• Inconsolable nature: The baby cannot be calmed by feeding, holding, rocking, or other typical soothing methods
• Sudden onset: The crying often begins abruptly, sometimes while the baby appears content
• Intensity: The cry is typically loud, high-pitched, and sounds urgent or distressed

Physical signs during colic episodes

During a colic episode, babies often display physical signs that can appear concerning to parents but are actually typical of the condition:

• Clenched fists: Hands are tightly closed, suggesting tension
• Drawn-up legs: Knees pulled toward the abdomen, sometimes extending straight out
• Arched back: The baby may arch their back stiffly
• Abdominal tension: The belly may feel hard or distended
• Red or flushed face: From the effort of crying
• Difficult to pass gas: Some babies seem to have trouble passing gas during episodes

What Causes Infant Colic?

The exact cause of infant colic remains unknown, but research suggests multiple contributing factors including an immature digestive system, gut microbiome development, sensory overstimulation, and possibly food sensitivities. Rather than a single cause, colic likely results from a combination of developmental and environmental factors.

Despite decades of research, scientists have not identified a single cause for infant colic. This has led to the understanding that colic is likely multifactorial, arising from a combination of various developmental, physiological, and possibly environmental factors. Understanding these potential contributors can help parents make sense of their baby's condition and guide management strategies.

Modern research views colic less as a disease and more as a variant of normal infant development. Some experts suggest that the intense crying represents the extreme end of normal crying behavior, influenced by temperament, nervous system maturation, and a baby's ability to regulate their responses to stimuli.

Digestive system factors

For many years, gastrointestinal discomfort was thought to be the primary cause of colic, hence the name. While this theory has not been definitively proven, several digestive factors may play a role:

• Immature digestive system: A baby's gut continues developing after birth, and the incomplete development of digestive enzymes and motility patterns may cause discomfort
• Swallowed air: Babies who feed rapidly or have difficulty with latch may swallow excess air, leading to gas and abdominal distension
• Gut microbiome: The bacterial population in a baby's intestines is still developing, and imbalances may contribute to digestive discomfort and inflammation
• Lactose processing: Some research suggests temporary difficulty digesting lactose may contribute to symptoms in some infants

Food sensitivities

In some cases, dietary factors may contribute to colic symptoms. This is an area where careful observation and sometimes trial elimination diets (under medical guidance) can be helpful:

For breastfed babies, proteins from the mother's diet can pass into breast milk. Some infants may be sensitive to:

• Cow's milk protein (most common)
• Eggs
• Wheat
• Nuts
• Caffeine

For formula-fed babies, cow's milk protein allergy or intolerance is sometimes identified as a contributing factor. However, it's important to note that most colicky babies do not have food allergies, and switching formulas without medical guidance is not recommended.

Neurological and developmental factors

Emerging research suggests that colic may relate to a baby's developing nervous system and ability to process sensory information:

• Overstimulation: Some babies have difficulty filtering and processing the many sensations they experience throughout the day, leading to evening "meltdowns"
• Serotonin levels: Research has found differences in serotonin metabolism in colicky babies, which may affect gut motility and mood regulation
• Circadian rhythm development: The infant's internal clock is still developing, which may contribute to the evening timing of colic episodes
• Fourth trimester theory: Some experts suggest that human babies are born relatively immature and that the first three months represent a transition period where the baby is still adjusting to life outside the womb

When Should You See a Doctor for Infant Colic?

While colic itself is not dangerous, you should contact a healthcare provider if your baby has fever, vomiting, bloody stools, poor feeding, weight loss, or if the crying pattern suddenly changes. Seek emergency care if your baby has difficulty breathing, becomes unresponsive, or if you're concerned about your ability to cope safely.

Most babies with colic do not require medical treatment, as the condition resolves on its own. However, it's important to have your baby examined to rule out other causes of excessive crying and to receive support and guidance. A healthcare provider can help confirm the diagnosis of colic by excluding other conditions that might cause similar symptoms.

The first step is usually to schedule a routine appointment with your baby's pediatrician or family doctor. They will conduct a physical examination and ask about your baby's feeding patterns, stool characteristics, sleeping habits, and the specific nature of the crying episodes.

Reasons to contact your healthcare provider

• Persistent crying: Your baby cries intensely for many days in a row
• You're exhausted: The stress is affecting your ability to care for yourself or your baby
• You need support: You want guidance on soothing techniques or just reassurance
• Feeding concerns: You suspect a food sensitivity or allergy
• Your baby seems sad all day: The fussiness extends beyond typical colic patterns

How Can You Soothe a Colicky Baby?

Effective soothing techniques include swaddling, white noise (shushing), gentle rhythmic motion (rocking or swinging), offering a pacifier, and holding baby in the colic carry position. The "5 S's" method, swaddle, side position, shush, swing, and suck, developed by pediatrician Dr. Harvey Karp, combines these techniques for maximum calming effect.

While there is no guaranteed cure for colic, many parents find that certain soothing techniques can significantly reduce their baby's distress and shorten crying episodes. The key is to experiment with different methods to discover what works best for your individual baby. What soothes one infant may not work for another, so patience and persistence are essential.

Many effective soothing techniques aim to recreate sensations the baby experienced in the womb, where they felt constant motion, heard rhythmic sounds, and were snugly contained. The transition to the outside world with its bright lights, sudden noises, and open spaces can be overwhelming for some babies, and womb-like sensations can help them feel secure.

The 5 S's method

Developed by pediatrician Dr. Harvey Karp and popularized in his book "The Happiest Baby on the Block," this technique combines five calming reflexes:

1. Swaddle: Wrap your baby snugly in a blanket with arms at their sides. This prevents the startle reflex and recreates the secure feeling of the womb. Use a thin cotton blanket and ensure the swaddle is not too tight around the hips.
2. Side or Stomach position: Hold your swaddled baby on their side or stomach (never place them to sleep in this position). The "colic carry," where baby lies face-down along your forearm with their head supported in your palm, can be particularly effective.
3. Shush: Make a loud "shhhh" sound near your baby's ear, or use a white noise machine. The sound should be as loud as the crying. This mimics the constant whooshing sounds of blood flow that babies hear in the womb.
4. Swing: Provide gentle, rhythmic motion through rocking, swinging, or jiggling. Small, quick movements (supporting the head) are often more effective than large, slow rocks. Baby swings and car rides can also help.
5. Suck: Offer a pacifier, clean finger, or the breast for non-nutritive sucking. Sucking is deeply calming and can trigger the relaxation response.

Additional soothing strategies

• Warm bath: A warm bath, given before the typical fussy period begins, can relax muscles and soothe your baby
• Infant massage: Gentle abdominal massage in a clockwise direction may help with gas and provide calming touch
• Skin-to-skin contact: Holding your baby against your bare chest can be deeply calming for both of you
• Change of scenery: Sometimes a brief walk outside or moving to a different room can interrupt the crying cycle
• Reduced stimulation: Dim lights, quiet environments, and minimal handling during evening hours may prevent overstimulation
• White noise: Continuous sounds like a fan, vacuum cleaner, or specialized white noise machine can mask other sounds and soothe

How Does Feeding Affect Infant Colic?

Feeding techniques can influence colic symptoms. Ensuring proper latch during breastfeeding, using slow-flow nipples for bottles, taking breaks to burp, and avoiding overfeeding can reduce air swallowing and digestive discomfort. In some cases, dietary changes (eliminating dairy from a breastfeeding mother's diet or switching to hydrolyzed formula) may help.

While colic is not caused by feeding problems, the way a baby feeds can influence their comfort level. Babies who swallow excess air during feeds may experience more gas and abdominal discomfort, potentially worsening colic symptoms. Additionally, some babies may have sensitivities to proteins in breast milk or formula that contribute to their distress.

It's important to note that babies can develop colic regardless of whether they are breastfed or formula-fed. Neither feeding method is "better" for preventing colic, and parents should not feel guilty about their feeding choices.

Breastfeeding adjustments

If you're breastfeeding a colicky baby, consider these strategies:

• Check the latch: Ensure your baby takes as much of the areola as possible into their mouth, with lips flanged outward. Poor latch can lead to air swallowing and inefficient feeding.
• Express before feeding: If you have a strong let-down reflex, expressing a small amount of milk before latching can slow the flow and reduce gulping.
• Feed more frequently: Smaller, more frequent feeds may be easier for your baby to digest than larger, less frequent ones.
• Burp during feeds: Pause to burp your baby midway through the feeding, not just at the end.
• Consider your diet: Some breastfed babies may be sensitive to proteins in the mother's diet, particularly cow's milk. If you suspect this, consult your healthcare provider before eliminating foods.

Formula feeding adjustments

For formula-fed babies, these strategies may help:

• Use slow-flow nipples: Ensure the nipple flow matches your baby's age and feeding ability. If milk flows too quickly, babies swallow more air.
• Try anti-colic bottles: Bottles designed to reduce air intake can decrease the amount of gas in your baby's digestive system.
• Keep bottle at correct angle: Tilt the bottle so the nipple is always filled with milk, not air.
• Feed smaller amounts more often: This can reduce the load on your baby's digestive system.
• Don't switch formulas without guidance: Consult your pediatrician before changing formula, as unnecessary switching can cause additional digestive upset.

Burping techniques

Effective burping can help release trapped air and reduce abdominal discomfort:

• Over the shoulder: Hold baby upright with their chin on your shoulder, supporting their bottom. Pat or rub their back gently.
• Sitting position: Sit baby on your lap, support their chin with one hand, and lean them slightly forward while patting their back.
• Face-down on lap: Lay baby across your lap on their stomach, supporting their head, and pat their back.

Do Colic Drops and Remedies Work?

Evidence for colic remedies is mixed. Simethicone drops are safe but show limited effectiveness. Probiotics (particularly Lactobacillus reuteri) may reduce crying in some breastfed infants. Gripe water lacks scientific support, and some products may contain harmful ingredients. No medication is specifically approved for treating colic.

Parents of colicky babies are often eager to try anything that might help, and there is no shortage of products marketed for colic relief. However, the scientific evidence supporting most of these remedies is limited, and some may carry risks. Understanding what research shows can help you make informed decisions.

The most important thing to remember is that colic resolves on its own with time. While waiting, focus on soothing techniques and parental support rather than seeking a pharmaceutical cure that doesn't exist.

Simethicone drops

Simethicone (sold under brand names like Mylicon, Infacol, or Gas Drops) is an anti-foaming agent that breaks up gas bubbles in the stomach. While considered safe for infants, clinical trials have generally not shown significant benefit over placebo for reducing colic symptoms. Some parents report they help, which may be due to placebo effect or natural variation in symptoms.

Probiotics

Probiotics, particularly Lactobacillus reuteri DSM 17938, have shown more promising results in research studies. A 2019 meta-analysis published in Pediatrics found that this probiotic strain reduced crying time in breastfed colicky infants by an average of about 40 minutes per day compared to placebo. However, the benefits were less clear for formula-fed infants. Consult your pediatrician before giving probiotics to your baby.

Gripe water

Gripe water is an herbal remedy that has been used for generations, but there is no scientific evidence that it effectively treats colic. More concerning, gripe water products vary widely in their ingredients, and some may contain:

• Alcohol (which should never be given to infants)
• Sugar (which can contribute to dental problems)
• Sodium bicarbonate (which can affect the baby's blood pH)
• Herbal ingredients that haven't been tested for safety in infants

What about other remedies?

Other remedies sometimes suggested for colic include:

• Fennel tea: Some small studies suggest benefit, but safety in infants is not established
• Sugar water: May temporarily calm babies but has no lasting effect on colic
• Herbal drops: Generally lack evidence and may contain unsafe ingredients
• Chiropractic manipulation: Research does not support this as a treatment for colic

How Can Parents Cope with a Colicky Baby?

Caring for a colicky baby is exhausting and emotionally draining. Essential coping strategies include taking breaks, sharing responsibilities with a partner or helper, accepting that the crying isn't your fault, maintaining realistic expectations, and seeking support from healthcare providers, family, or parent support groups when needed.

The impact of colic extends beyond the baby to affect the entire family. Research has linked infant colic to increased rates of parental depression, anxiety, relationship strain, and even premature breastfeeding cessation. Recognizing that colic is hard, and that your feelings of frustration, exhaustion, or even anger are normal, is the first step toward coping effectively.

Taking care of yourself is not selfish. It's essential. You cannot care for your baby effectively if you're depleted, and your wellbeing matters independently of your role as a caregiver.

Strategies for managing stress

• Remember it's temporary: Keep reminding yourself that colic ends. Most babies are significantly better by 3-4 months.
• Take turns: If you have a partner or family member who can help, share the responsibility of soothing during fussy periods.
• Accept help: When someone offers to help, say yes. Let them hold the baby while you shower, eat, or simply rest.
• Sleep when possible: Sleep deprivation makes everything harder. Nap when your baby naps if you can.
• Connect with others: Talk to other parents who have been through colic. Online forums, parent groups, and friends can provide valuable support and reassurance.
• Maintain some routine: Try to keep some normal activities in your day, even brief ones, to maintain a sense of normalcy.

When to seek help for yourself

Contact your healthcare provider or a mental health professional if you experience:

• Persistent feelings of sadness, hopelessness, or overwhelming anxiety
• Difficulty bonding with your baby
• Thoughts of harming yourself or your baby
• Inability to sleep even when your baby is sleeping
• Loss of interest in activities you normally enjoy
• Feeling that you're not coping or that things will never get better

These feelings can be signs of postpartum depression or anxiety, which are treatable conditions. Seeking help is a sign of strength, not weakness, and getting support will help both you and your baby.