Colic is defined as prolonged, intense, and unexplained crying in an otherwise healthy infant. This temporary phase affects approximately one in five infants, characterized by episodes of inconsolable fussiness. The distress associated with these crying spells can be significant for the entire household. While the exact cause remains unknown, colic typically starts around two to three weeks of age and resolves on its own.
Identifying Colic and Ruling Out Other Issues
Colic is often diagnosed using the “Rule of Threes.” This rule suggests colic is likely present when an infant cries for more than three hours a day, for at least three days a week, for a minimum of three weeks. Colicky crying is often loud, high-pitched, and may be accompanied by physical signs like a flushed face, clenched fists, or legs drawn up to the abdomen.
Colic is a diagnosis of exclusion, meaning a healthcare provider must first rule out serious medical conditions. Signs warranting immediate medical attention include fever, projectile vomiting, lethargy, or blood in the stool. Once these symptoms are dismissed, parents can be assured they are dealing with a self-limiting developmental phase.
Immediate Environmental and Physical Soothing Techniques
Parents can employ the “5 S’s” for immediate relief, which mimic the sensory experience of the womb.
Swaddling
Swaddling involves snugly wrapping the infant to provide a secure, contained feeling that suppresses the startle reflex. The swaddle should secure the arms straight at the sides while allowing the hips to remain loose and flexed for proper development.
Side or Stomach Position
The Side or Stomach Position is used for calming, as the back-lying position is often the least effective for soothing a fussy baby. Holding the baby on their side or over the shoulder on their stomach can help settle them. They must be placed on their back once asleep for safe rest.
Shushing
Shushing replicates the loud, rhythmic sounds the baby heard constantly in the womb, such as the mother’s blood flow. This sound should be surprisingly loud, matching the volume of the baby’s cry, and can be achieved through white noise machines or direct mouth shushing.
Swinging and Sucking
Swinging or rhythmic movement provides gentle vestibular stimulation, similar to the motion experienced inside the uterus. This should be a slow, small-range sway or rock, rather than vigorous shaking. Sucking is an innate reflex that promotes deep tranquility. Offering a clean finger, a pacifier, or the breast can satisfy this powerful calming need.
Combining these techniques often works better than using them in isolation, as the infant needs multiple sensory inputs to activate their calming reflex. Other forms of rhythmic motion, such as a gentle car ride, a vibrating chair, or carrying the baby in a sling, may also provide relief.
Dietary Adjustments and Gastrointestinal Interventions
Excessive crying may be linked to gastrointestinal discomfort, making feeding techniques and dietary changes relevant options.
Bottle-Feeding Techniques
When bottle-feeding, using a slower nipple and paced feeding techniques can reduce the amount of air swallowed. Ensuring the baby is frequently and thoroughly burped during and after feeding may also help relieve gas buildup.
Formula Changes
A small percentage of formula-fed infants may react to cow’s milk protein. This can be addressed by switching to a specialized formula. Extensively hydrolyzed formulas contain proteins broken down into very small peptides, making them hypoallergenic and easier to digest. Partially hydrolyzed formulas are not considered hypoallergenic and are not typically recommended for managing suspected cow’s milk protein allergy.
Breastfeeding and Maternal Diet
For breastfed infants, the mother’s diet can transmit proteins that cause discomfort, with cow’s milk protein being the most common culprit. A trial elimination diet involves removing all dairy products, and sometimes other potential allergens, for two to four weeks to see if symptoms improve. Mothers should also limit caffeine intake, as it can increase infant irritability.
Over-the-Counter Options
Over-the-counter interventions have varying scientific support. The probiotic strain Lactobacillus reuteri DSM 17938 has shown some effectiveness in reducing crying time, particularly in exclusively breastfed infants. Evidence is less conclusive for formula-fed infants. Medications like simethicone drops and herbal remedies such as gripe water are widely used, but scientific literature does not support their efficacy for treating colic.
Seeking Professional Guidance and Supporting Caregivers
If crying remains excessive or if parents are unable to cope, seeking professional guidance is necessary. The pediatrician can re-evaluate the baby for subtle medical issues and provide evidence-based management strategies. They can also help the family navigate the transition to specialized formula or a maternal elimination diet, ensuring the infant’s nutritional needs are met.
Caring for an infant with colic is emotionally and physically taxing. It is important for parents to prioritize their own mental health by accepting offers of help and taking short breaks. Parents should be reassured that colic is a temporary biological phase and not a reflection of their parenting skills. Support groups, hotlines, and counseling can provide valuable resources to help parents cope until the colic naturally resolves, typically by three to four months of age.