Crying is common among infants. However, when crying occurs repeatedly, for long periods of time and for no apparent reason, it may be a sign of colic. It is estimated that up to 25 percent of all infants get colic, according to the American Academy of Family Physicians.

Infants with colic may cry until they are red in the face and only stop when exhausted. Pulling the arms and legs into the torso, clenching the hands, cold feet, and a bulging and tightness of the abdomen are additional signs of colic. Repeated or forceful vomiting and fever are not signs of colic, and may indicate another medical condition.

Colic usually begins in the first few weeks of life, may peak by 6 weeks of age, and usually goes away on its own by the age of 3 months. Colic usually occurs suddenly, at the same time every day (most often in the late afternoon and early evening). Infants with colic are otherwise perfectly healthy, with normal stool, weight gain and sleeping patterns.

The cause of colic is unknown, and no single factor seems to be responsible for the condition. Rather, many factors may play a role, including oversensitivity to stimulation (e.g., bright lights, loud noises, meeting new people), which may be due to a child’s temperament (emotional disposition) and/or an immature nervous system. A developing digestive system may also be responsible. In addition, exposure to tobacco smoke has been linked to an increased risk of colic.

A physician can usually diagnose colic based a parent’s description of the child’s behavior. It may be helpful for parents to keep a diary of an infant’s crying (e.g., when it occurs, how long it lasts) and weight gain. A physician will likely take a medical history, ask about the child’s general health, and may perform a physical examination to rule out any other possible causes, such as reflux or allergies.

There is no way to prevent or cure colic. It resolves on its own, with time. Treatment consists of methods to relieve any discomfort the child may be experiencing. There are no medications that can do this safely and effectively in young children. Thus, most treatments focus on soothing a child, such as swaddling or rocking a baby, or helping the infant to pass gas or stool, which may provide some relief. Feeding techniques that may help include keeping an infant upright during feedings and frequent burping. Methods that help some children may not work for others. Parents are advised to try different methods to discover what works best for their child.

Colic, a condition that affects otherwise healthy infants, involves repeated, prolonged episodes of intense crying for no apparent reason. The crying may last for three or more hours, and usually occurs in the late afternoon or evening. It is estimated that up to 25 percent of all infants get colic, according to the American Academy of Family Physicians. Efforts to console a colicky child are usually unsuccessful.

Colic usually occurs in infants under 3 months of age. Most cases normally begin at about 3 weeks of age, peak at around 6 weeks of age and clear by the time a child is 3 months old. In some cases, colic may last until the fourth or fifth month of an infant’s life. Colic is rare after the age of 6 months. 

Newborns spend a lot of time crying. The amount of time an infant spends crying begins to decrease at approximately 6 weeks of age. According to some studies, the average amount of time spent crying in early life is:

Colic comes from the Greek word for colon (kolikos) because it was originally believed to be of gastrointestinal origin, although this has never been proven. Colic is neither a symptom of a medical illness, nor is it an illness itself. Infants with colic are well-fed and show no signs of physical illness.

The cause of colic is not known. No single factor has been identified, although many different factors appear to be associated with colic.

Colic affects infants of both genders, full-term and premature babies, as well as those who are breastfed and bottle-fed. Colic affects the infants of first-time parents as well as those of more experienced parents. There is little evidence that colic is associated with allergies or food intolerance (e.g., lactose intolerance), although infants with allergies can also have colic.

It was initially assumed that colic was caused by gas. Research now indicates that gas buildup may occur in babies with colic because they swallow a great deal of air during prolonged crying spells. In addition, certain feeding techniques (e.g., infrequent burping, swallowing of air during feedings) may aggravate gas buildup in infants with colic.

Colic appears to be associated with oversensitivity to stimulation. This includes environmental stimuli (e.g., bright lights, loud noises, lots of activity) and new experiences (e.g., meeting new people). One theory is that colic occurs when the stimulation babies are exposed to throughout the day is released – in the form of crying – in the evening.

An infant’s sensitivity to stimulation may be affected by their temperament (unique emotional disposition), which affects the way a child handles stress. Overly sensitive children may react strongly to changes in routines or stimuli that startle or frighten them. In addition, the developing nervous system of a child may make a baby more sensitive to stimuli such as bright lights and loud noises.

Immature digestive systems in babies may also be related to colic. Digestive systems that are not yet fully developed can affect the time it takes food to pass through the digestive tract and cause strong intestinal contractions and stomach pain.

Other factors believed to play a role in the development of colic for some infants include:

• Hormones (e.g., serotonin levels)
• Levels of emotional tension in the household
• Changes in feeding/comfort routine
• Anxiety, anger, frustration or excitement of the baby
• Nursing mother’s diet

Exposure to tobacco smoke has been linked to an increased risk of colic, according to some studies. Smoke is associated with a rise in the level of the hormone motilin in the blood, which can increase contractions of the stomach and intestines. Babies may be exposed to smoke while still in the womb, via a mother’s breast milk, or by being around a smoker after birth.

Other studies also have indicated that maternal stress during pregnancy, especially in the last trimester (last three months), may contribute to colic in some babies. More research is needed to confirm this link.

Most infants can be fussy and will cry to communicate any number of things, including hunger, fatigue, and urine or feces in the diaper. These cries often sound different, depending on whether the child is hungry, tired or wants attention. The cries of an infant with colic may seem more intense or distressing than usual. They may be louder, higher pitched and more variable in pitch.

Colic involves prolonged periods of crying (more than three hours per day, at least three days a week, for more than three weeks). The crying begins suddenly and usually only ends when an infant appears exhausted. Crying occurs at the same time every day – most often during the late afternoon or evening. A child with colic will often be inconsolable. The normal methods of soothing the child will not stop the crying.

In addition, there will be no apparent trigger preceding the crying. The cries of a colicky baby do not appear to be related to what the infant was doing prior to the crying spell. It is important to note that crying that occurs after feedings may indicate another condition, such as reflux or allergies.

Colic occurs in otherwise well-fed, healthy babies. Infants with colic will have normal-looking stool and show no signs of illness. They will have a healthy sucking reflex and a hearty appetite, and will gain the appropriate amount of weight for their age and size. (If an infant refuses feedings, it may indicate another condition, such as an ear infection.)

Additional signs of colic in infants include:

• Face reddens and appears flushed
  
  
• Area around the mouth is pale
  
  
• Hands are clenched
  
  
• Arms and legs are pulled in close to the torso (but may also periodically extend and stiffen)
  
  
• Abdominal distension (abdomen bulges out)
  
  
• Tense abdominal muscles (abdomen feels hard to the touch)
  
  
• Feet are cold
  
  
• Flatulence and/or a bowel movement occur at the end of a crying episode

Parents should consult their child’s pediatrician if the infant experiences any of the following, which may indicate another medical condition:

• Fever
• Repeated or forceful vomiting
• Halt in weight gain
• Watery, bloody or hard stool

Diagnosis of colic by a pediatrician is generally made based on a parent’s description of the infant’s behavior. Thus, parents may wish to keep a diary of their child’s crying episodes (e.g., when they occur, and for how long) as well as the infant’s physical development (e.g., weight gain). A child with colic will be otherwise healthy and experiencing normal weight gain.

Parents can expect a physician to collect a medical history, as well as information regarding the general health of their child (e.g., the child’s growth, diet, stool, urination and sleeping patterns). Questions a pediatrician may ask include:

• When does the crying occur and for how long does it last? (Crying that occurs after feedings may indicate reflux or allergies.)
  
  
• What does the cry sound like? (Cries from a baby with colic will sound different than the cries used to indicate hunger or fatigue.)
  
  
• What is done when the baby cries? (This may determine what methods of soothing the child are effective.)

A pediatrician may also conduct a physical examination of the child. This is usually done to rule out other possible medical conditions that may be causing the crying (e.g., reflux, allergies, intestinal obstruction, urinary infections, intussusception). If other conditions are suspected, a physician may recommend additional tests, including blood tests, x-rays and other imaging tests.

In the absence of any other cause, physicians may apply the “rule of three” in diagnosing colic:

• Crying occurs for three consecutive hours or more per day
  
  
• Crying episodes occur at least three days a week
  
  
• Crying episodes persist for more than three weeks (this criteria is sometimes not included, since some parents do not wait three weeks before consulting a physician)

There is no cure for colic. Crying and fussiness are likely to occur, no matter what efforts are made to soothe an infant with colic. The only treatment for colic is the passage of time. The condition clears on its own, usually in a matter of months.

Managing colic typically focuses on easing a child’s symptoms and making the child as comfortable as possible. There is no single effective remedy for this. Parents may need to carefully observe what seems to work for their baby. Techniques that work for some children will not work for others. Making a child with colic feel better is often a matter of trial and error.

No medications, whether prescription or over-the-counter, are found to provide safe and effective relief for infants with colic. Sedatives, such as phenobarbital (Luminal), chloral hydrate (Aquachloral) and alcohol, should never be used and are not recommended. All medications (even antacids) have side effects, some of which may be dangerous for young children. Parents should always check with their child’s pediatrician before giving their infant any type of medication, including over-the-counter medications.

Techniques that may comfort an infant with colic include:

• Feeding the infant. Sometimes crying may indicate hunger, and a baby with colic may respond to feeding attempts. However, feedings should not be forced if the infant is not hungry. Plain water or an electrolyte solution may also be soothing to some infants.
  
  
• Helping pass gas or stool. Holding an infant in an upright position and gently massaging the belly may help release gas. Rocking a baby while they are lying face-down on the lap may also work, since rocking in addition to a gentle pressure against the abdomen may help release gas. Laying an infant belly-down in a crib, while gently massaging the back may also help. Sleeping infants should not be placed on their stomachs to avoid the risk of SIDS (sudden infant death syndrome).
  
  
• Swaddling the infant. Wrapping a baby in a soft blanket may help them feel warm and secure.
  
  
• Applying warmth to the belly. Application of warmth against a baby’s stomach may help relieve abdominal pain. Fill a hot water bottle with warm (not hot) water or use a heating pad. These may be placed on the infant’s abdomen, or the baby may be placed on them. A warm bath may also help.
  
  
• Trying rhythmic stimulation. Many types of rhythmic movement can have a calming effect on infants. A rocking chair, cradle or wind-up swing may be used. Parents should not place infants in a swing until the child is at least 3 weeks old and has good head control. Rhythmic stimulation may also involve holding an infant while walking, taking an infant for a walk using a stroller, or placing an infant in a car seat and going for a drive (many babies find the vibration of a moving car soothing).
  
  
• Providing soothing background sounds. Sound that is kept at a low, steady volume may help comfort a child with colic. This can include relaxing music or sounds (e.g., white noise, rainfall, ocean waves, beating heart). Singing lullabies to a child may also help. An infant may be placed in a carrier and safely positioned to listen to the steady, rhythmic sounds of certain household appliances while they are running (e.g., dryer, washing machine, dishwasher, vacuum cleaner). Never place a child on top of appliances to avoid falls and injury, and turn off the end-cycle buzzer on washers and dryers to avoid startling the baby. In addition, turn the telephone ringer off since it may be too jarring for a colicky child.
  
  
• Avoiding overstimulating environments. Colicky infants tend to be sensitive to loud noises, bright lights and increased movement in their environment. Parents may help soothe a child with colic by dimming the lights, keeping noise to a minimum, speaking in a gentle voice and limiting activity around the child.
  
  
• Maintaining a predictable daily routine. Keeping a child’s daily routine as calm and predictable as possible may help colicky babies who can be especially sensitive to change.
  
  
• Offering a pacifier. Infants often have an urge to suck as a method of calming themselves. Parents can help their child self-soothe by offering a pacifier.
  
  
• Opting for a change of scenery. Occasionally, being in a different environment can help reduce colic. Try taking a colicky baby outdoors (e.g., the park) or simply to another room in the house.
  
  
• Providing extra attention. Holding and cuddling may comfort an infant with colic. This is important even during times a baby is not fussy or crying. Placing an infant in a body carrier can allow parents more physical contact with their child throughout the day.    

In addition, parents may help relieve colic by altering how they feed their baby. Recommended feeding techniques include:

• Avoiding overfeeding or underfeeding. This may help alleviate abdominal discomfort. Infants may be fed every two hours, as long as the baby is hungry (colicky babies will have a normal appetite; feedings should not be forced). In general, infants with colic should be fed less food, more often.
  
  
• Feeding slowly. Feeding too quickly can lead to abdominal pain. Feedings are too fast if they take less than 20 minutes. To slow bottle feedings, try using a nipple with a smaller hole on the bottle.
  
  
• Keeping the infant upright. Feedings should be done with the infant in a vertical position to minimize the amount of air swallowed during feedings, which can cause gas and stomach upset. In addition, for the first six months, infants should be kept upright for 10 to 15 minutes after feedings to prevent milk from coming back up.
  
  
• Burping the baby frequently. This helps to prevent gas buildup that can cause abdominal pain. If bottle-feeding, a baby with colic should be burped every 2 to 3 ounces. During breastfeeding, burping can be done when switching breasts, or every five minutes. Always burp when feeding is completed. The need to burp should decrease as infants learn to feed without swallowing excess air.
  
  
• Changing the bottle type. A curved bottle with a collapsible bag can reduce the amount of air a baby swallows during feedings, helping to alleviate gas buildup.
  
  
• Finishing one breast before switching. The milk initially drawn from the breast (foremilk) is low in calories and fat. Milk drawn toward the end of a feeding from a single breast (hindmilk) is rich in fat and may be more soothing for infants.
  
  
• Changing the formula. A physician may recommend trying a different formula for colicky babies.

Breastfeeding mothers may wish to alter their diets to eliminate certain foods that may aggravate some colicky children. This may include dairy products as well as foods that contain soy, wheat and nuts. In addition, products that contain caffeine (including chocolate) may upset a nursing child. However, mothers need extra nutrients while breastfeeding and should consult their physician before making any changes to their diet.

Alternative remedies are not proven to relieve colic in infants, but may provide relief for some. These therapies include certain herbal teas, oils or remedies (e.g., chamomile, peppermint, fennel, gripe water), chiropractic treatments, acupuncture and massage therapy. Parents should be warned that these alternative treatments need more study. Parents should consult their pediatrician before giving their child any medications, including herbal remedies like gripe water, which is commonly marketed for colicky babies. For example, the Food and Drug Administration (FDA) has advised against the use of star anise tea in infants because it contains small amounts of toxin that may cause seizures, jerky movements, vomiting and irritability.

Having an infant with colic can be an extremely stressful and exhausting experience. Because colicky babies are often inconsolable, parents may feel as if their caretaking skills are inadequate or that they are somehow to blame for the colic. Parents may feel frustrated, fatigued, angry, hopeless, guilty or depressed when their baby cries for prolonged periods of time.

It is important for parents to realize that a baby with colic will be difficult to soothe during crying episodes. Parents may discover methods to comfort their child that work, or they may not. What is important to remember is that a baby with colic is otherwise a healthy child. Colic is a common, temporary condition many infants experience. Parents should keep in mind that the crying spells usually improve significantly by the time the child is 3 months old.

Parents can use some of the following tips to help them cope while their child has colic:

• Take a break. Arrange for someone to watch the baby, even for a little while. This may include family members, friends, neighbors or babysitters. If backup care is not available, make sure the baby is in a safe, quiet place – then go into another room and try to relax (e.g., watch TV, listen to music).
  
  
• Get enough sleep. Adequate rest allows parents to better cope with the stress of a baby with colic.
  
  
• Express feelings. Feelings of frustration, discouragement, anger, helplessness and depression are normal in parents of colicky infants. Sharing feelings with family, friends, counselors, physicians or local support services can help alleviate the stress colic can have on the entire family.
  
  
• Recognize limits. It is important for parents with a colicky child to identify when they are losing control. Anyone afraid they may hurt their child should immediately remove themselves from the situation. For help or information at moments of crisis, contact a physician or a 24-hour/seven day a week crisis line, such as the Childhelp USA National Child Abuse Hotline (800-4-A-CHILD or 800-422-4453). No one should ever shake a child as it can result in brain injury and death (shaken baby syndrome).

Preparing questions in advance can help parents have more meaningful discussions with their child’s physician regarding their child’s condition. The following questions related to colic may be helpful:

1. My baby appears to be healthy but cries nonstop in the evenings. Could it be colic?
   
   
2. What signs indicate that my baby has colic? How do I know it is not an allergy or some other problem?
   
   
3. Should I bring my baby in to see you?
   
   
4. What is causing my baby to have colic?
   
   
5. Is there anything in our home environment that may be aggravating my child’s colic?
   
   
6. What should I do while my baby is crying?
   
   
7. Cuddling, holding and rocking my baby do not appear to help. Should I continue doing this during his/her crying?
   
   
8. Do you recommend that I offer my child a pacifier during a crying episode?
   
   
9. What can I do differently during feedings that may help with my child’s colic?
   
   
10. How often should I burp my child during feedings?
    
    
11. Is there a special diet I should eat while I’m breastfeeding a colicky baby? Are there certain foods I should avoid?
    
    
12. Would you recommend a change in my baby’s formula?
    
    
13. Are there medications I can give my baby for colic? What are their side effects?
    
    
14. How long will my baby’s colic last?
    
    
15. Will all this crying hurt my baby or cause any lasting damage?
    
    
16. What changes in my baby’s condition should I report to you?
    
    
17. I’m frustrated. How can I possibly make it through months of this?