Colic In Babies: Causes, Symptoms And Remedies

Colic is not actually a disease or a diagnosis, but is instead a state of discomfort, and occurs when a healthy baby cries for an extended period of time with no apparent reason. “The crying and the fussiness are a collection of symptoms that occur together in a pattern,” says Patti Ideran, a pediatric occupational therapist and co-author of The CALM Baby Method: Solutions for Fussy Days and Sleepless Nights.

Roughly one in four newborns (and their parents) suffer from colic^[1]Colic. Johns Hopkins Medicine. Accessed 7/11/ 2021. . “We do know colic is equally distributed across races and socioeconomic status and between boys and girls,” says Ideran. “And whether you are breastfeeding or bottle-feeding does not seem to increase or decrease the chances of your baby having colic either.”

How Does Colic Differ From ‘Normal’ Crying?

Babies cry when they’re hungry, need a diaper change, are sick, too hot, too cold, overstimulated—and the list goes on. What seems to set colic crying apart from “normal” crying is the sound and the frequency.

Colic sounds as if your baby is in pain, and it’s excessive. If you suspect your baby has colic, ask yourself:

• Is your otherwise healthy baby crying for more than three hours a day?
• Does this crying pattern happen more than three days a week?
• Has it been going on for more than three weeks?

If you answered “yes,” to all of these questions, then your baby meets the commonly used set of diagnostic criteria for colic—which dates back to observations in the newborn nursery at Yale University in the 1950s.

Infants With Colic May Have Physical Symptoms

“Babies with colic act normally between their crying fits, but when they start [crying], it can be really intense,” says Elizabeth Donner, M.D., a pediatric hospitalist at Nemours Children’s Hospital in Orlando, Florida. “They will naturally want to pull their legs up or stretch their legs out and it can be difficult to comfort [them] no matter what you do,” she says. “Sometimes, the crying ends after the baby passes gas or has a bowel movement, but it isn’t always the case.”

She notes the gas is likely the result of swallowed air caused by excessive crying.

Monitor Colic Symptoms at Well-Baby Visits

Making sure your baby is healthy and growing well is important before making a colic diagnosis, says Dr. Donner. “We’ll want to rule out other possible things causing the symptoms such as an injury or an underlying health condition. But, these are things we monitor and discuss at well-baby visits and hopefully are able to provide plenty of reassurance that the baby is not sick, these symptoms are not harmful, and it will end.”

The AAP recommends babies see their primary care provider at the following intervals in the first year of life:

• The first-week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old

However, the exact schedule that works for you and your baby might differ—be sure to ask your chosen provider what routine for well-baby check-up visits they recommend.

“This too shall pass”—an adage that applies to colicky babies. But when? In general, Dr. Donner says, colic starts when a baby is 2 to 4 weeks of age, peaks around 6 weeks, and resolves between 4 and 6 months in 90% of infants. But every baby is different.

If it’s possible for there to be a bright side to colic, it’s that it can be predictable, usually occurring in the late afternoon and evening.

A sudden onset of extended crying during that time frame, however, doesn’t necessarily mean your baby has suddenly developed colic. “If a bout of excessive crying is abrupt and completely out of character for your baby, we as pediatricians consider other things causing the crying like a scratch to the eye or a strand of hair tightly wrapped around a finger or toe,” says Dr. Donner. These types of concerns require a trip to the pediatrician, so call your doctor if you’re worried.

The cause of colic is unknown, but there is no shortage of theories in scientific literature. One study suggests colic has many causes, which could include^[2]Mai T, Fatheree NY, Gleason W, Liu Y, Rhoads JM. Infantile Colic: New Insights into an Old Problem. Gastroenterol Clin North Am. 2018;47(4):829-844. :

• Gastrointestinal: It could be related to a cow’s milk protein allergy, intolerance to something in a breastfeeding mother’s diet, excessive gas production, lactose intolerance or feeding too much or too little.
• Hormonal: The cause could be a higher level of serotonin (a key hormone that can stabilize mood).
• Neurodevelopmental: This could include infant temperament or migraine.
• Psychosocial: It may be related to high parental anxiety, depression during pregnancy or maternal smoking.

Dr. Donner cautions parents not to automatically attribute colic to reflux or a milk protein intolerance and to avoid going down a rabbit hole of anti-reflux medications (which aren’t recommended) or switching formulas.

“Reflux causes fussiness, excessive spitting up or irritability, turning red and arching of the back during feeds; it’s not the same thing as colic,” she says. “Milk protein intolerance is often paired with diarrhea, difficulties gaining weight and a skin rash. These are things you won’t see in an otherwise healthy infant with colic.”

Are Preemies At a Greater Risk for Colic?

In 2014, a large Danish study found low birth weight babies (those born under 4.4 pounds) or babies born before 32 weeks gestation had an increased risk of developing colic^[3]Milidou I, Sondergaard C, Jensen MS, Olsen J, Henriksen TB. Gestational age, small for gestational age, and infantile colic. Pardiatr Perinat Epidemiol. 2014;28(2):138-145. . Early intervention, Ideran says, could give you a positive outcome. “Parents of preemies and babies born small for gestational age should consider an evaluation by a pediatric occupational therapist experienced in working with preterm babies and fussy babies.”

Unlike most childhood ailments, there’s no standard approach for treating colic. Walk into any pharmacy and you’ll find over-the-counter, unregulated products claiming to help with colic—only leading to more confusion.

“A classic consequence of colic is that parents often revert to dysfunctional strategies [understandably], because nothing has worked,” says Ideran, who has spent the past 15 years working with colicky infants at Northwestern Medicine Central DuPage Hospital outside Chicago. “Parents come in after having tried numerous techniques at home to calm their babies. They are naturally exhausted and overwhelmed.”

Instead of relying on the unverified claims from the plethora of products that promise to provide colic relief, talk with your pediatrician about any symptoms your baby is having. Supplements like gripe water—which is often touted as a colic remedy—don’t need approval from the U.S. Food and Drug Administration to be sold on store shelves.

Instead of throwing spaghetti at the wall and seeing what sticks, Ideran recommends figuring out why and when the crying begins in the first place. Here’s how:

Listen to Your Baby’s Cues

• Every parent struggles to understand what their crying baby wants, and it can be especially difficult for those who aren’t primary caregivers. “Lip-smacking, turning the head with an open mouth or placing fists to the mouth are all typical hunger cues,” says Dr. Donner. “Parents get more confident in these cues over time and when they do, it definitely helps improve their confidence.” She also recommends trying to soothe with a pacifier, a snug swaddle or gently rocking your baby in swinging motions.

Learn Your Baby’s Arousal Levels

• Knowing how alert or how sleepy your baby is at different times of the day can help you plan your daytime (and nighttime) routine. For example, if you know your little one tends to lose it around 4 p.m., you may want to head out from that crowded birthday party at 3:30 p.m. Getting them back into a calm and familiar environment can help babies with poor tolerance to sensory input to regulate. Many parents also use sound (or white noise) machines that mimic the soothing sounds of the womb.

Practice infant massage

• A 2019 review of pediatric massage literature from the last decade suggests massage therapy can positively affect both baby and parent^[4]Field T. Pediatric massage therapy research: A narrative review. Children (Basel). 2019;6(6). . For example, one study assigned mothers to massage their newborns daily for 15 minutes before bedtime. After one month, babies slept longer and had fewer nighttime awakenings. Not surprisingly, mothers’ sleep also improved^[5]Field T, Gonzalez G, Diego M, Mindell J. Mothers massaging their newborns with lotion versus no lotion enhances mothers’ and newborns’ sleep. Infant Behav Dev. 2016;45(Pt A):31-37. .

Know When and How To Take a break

• Hearing your baby continuously cry can be incredibly stressful. It can cause feelings of inadequacy, guilt, anxiety and frustration, so it’s very important to know your limits. The most common trigger for abusive head trauma (known as shaken baby syndrome) is a crying baby, according to the American Academy of Pediatrics. If you need to blow off some steam, Dr. Donner recommends to first place your baby in a safe location, such as a crib. Put on headphones, call a friend, scroll your phone, have a snack and just breathe. Crying is not harmful to infants, even for an extended period of time—experts note that it’s perfectly safe to let your baby cry while you take a break.

Because perinatal mental health problems can negatively impact an infant’s health and affect mother-infant bonding and children’s health over time, Dr. Donner encourages parents to talk with their baby’s doctor during well-baby visits or any time in between. Thanks to telemedicine, there are even more options for support.

“It can be easy—especially in the weeds of new parenting—to want to blame yourself,” says Ideran. “But know this: Colic is not caused by anything a parent has done or not done. It happens in spite of excellent parenting.”