• No standard definition of this phenomenon
• Best definition available: more than 3 hours a day of irritability, fussing, or crying on more than 3 days in any 1 week during the first 3 to 4 months of life in an infant who is otherwise healthy and well fed. Some add the criterion of a duration of 3 weeks or more.
• Crying is not qualitatively different, but quantitatively, it is considerably more than the average.

• No single cause is always found.
• Typically, the problem lies in the interaction between factors in the infant and the environment.
  • In infant: There is a normal physiologic or temperamental predisposition to be more sensitive, irritable, intense, or harder to soothe than average for the age.
  • Parents generally have not yet learned how to read correctly and respond appropriately to the infant’s needs. They may be manipulating the infant in ways that increase rather than decrease the amount of crying.
• Colic generally occurs in the absence of any abnormality in the infant or the parents, but rather when the parents have not yet learned to interact harmoniously with the infant.
• There is no evidence that the bowel is at fault; flatus is more likely to be the result of the crying than the cause.
• Psychosocial risk factors, such as poor support for the mother and various stressors, are probably more common than in noncolicky infants, but they are not necessary.
  • When such external factors present, they seem to exert their effects by reducing the parent’s ability to respond appropriately to the infant.
• In the case of a physical problem in the infant, such as milk allergy, the prolonged crying is, by definition, not colic.

• Colic typically begins shortly after a baby comes home from a newborn nursery.
• It can last until 3 to 4 months of age if not successfully managed.
• If excessive crying lasts after 4 months, other diagnoses should be considered.

• Excessive crying does not turn into any other condition, but the factors that caused it may contribute to sleep problems and other behavioral concerns in the infant after the colic has gone.
• Parents are usually exasperated by it.
• The most serious outcome is that, due to parental exasperation, the infant may be physically abused.
• The infant is likely to be overfed.

• Normal crying. Average, normal infants cry about 2 hours a day at 2 weeks of age, just under 3 hours at 6 weeks, and then decrease to about 1 hour by 12 weeks. Normal crying, like colic, tends to occur predominantly in the evening.
• Prolonged or excessive crying from physical causes:
  • Faulty feeding techniques: overfeeding or underfeeding and inadequate burping or sucking
  • Physical problems in the infant: acute disorders such as otitis media, intestinal cramping with diarrhea, corneal abrasion, and incarcerated hernia; or chronic ones such as gastroesophageal reflux
  • Cow’s-milk allergy, lactose intolerance, or transmission of irritating substances such as caffeine via breast milk

• Define symptoms: intensity, duration, and frequency of crying. Some parents complain more than others about the crying.
• Ask parents to describe a typical day.
  • Description of a typical day or keeping a crying diary is helpful.
  • This will give insights into the daily routine, feeding, rest, and interpretive skills of parents.
• Ask parents to describe and demonstrate their soothing techniques.
• Information on the baby’s temperament can be obtained by asking the parents to describe the baby’s typical reaction patterns.
• Medical history should include concerns about the pregnancy and the newborn period, anxieties related to parents’ own experiences as children or with previous children, and the quality of family supports and other stressors.

• No findings are expected if the child has colic. However, examination should always be performed in order to reassure both parents and physician.
• Attempts at management over the telephone without a physical examination are likely to be unsuccessful.

• The most effective form of treatment is counseling, which should consist of these main points:
  • The infant is not sick. Crying may be persistent, but there is no evidence of a physical problem. There is no proof the infant is having pain, just distress. Avoid iatrogenic problems caused by suggesting that something is wrong with the infant. The infant is probably just overaroused and tired.
  • Education about infant crying. Parents need to know how much normal infants cry and how they vary in sensitivity, irritability, and soothability. The way parents react to their infants can affect the amount of crying. Parents often do not understand that a common reason for infant crying is fatigue and a need to be left alone.
  • The excessive crying can be reduced. Parents have to learn to tune in more sensitively to infants’ needs and to be more effectively responsive to them.
• Basic strategy: Soothe more, as by a pacifier, repetitive sound, or a hot water bottle, and stimulate less by decreasing the picking up, holding, and feeding the infant when it is not appropriate.
  • A quiet environment, correction of any faulty feeding techniques, and a minimum of unnecessary handling without changing the composition of the feedings. Pertinent psychosocial issues should be dealt with.
• Expression of optimism by the pediatrician about the immediate outcome is justified and in itself improves chances of success. Simply saying that the colic will be gone by 3 to 4 months of age is not comforting and may be quite the opposite.
• Extra carrying does not help.
• Drugs, such as phenobarbital or diphenhydramine, are seldom necessary. Some observers have reported beneficial effects, when used for a week or two in conjunction with counseling, but these results have not as yet been subjected to double-blind studies. Simethicone has not been shown to be helpful.
• Formula changes are frequently attempted by physicians hoping for a simple solution, but they rarely are effective. Sometimes they seem to be helpful for a few days, only to cease being so a day or two later.
• Almost any procedure done with conviction is likely to be followed by a temporary reduction in crying because of the placebo effect.

• It is important to keep in close touch with parents of an excessively fussy baby. Telephone contact every 2 to 3 days is essential until improvement. Reexamination is rarely needed.
• Standard pediatric textbooks state that colic usually goes away by itself by 3 to 4 months of age and that little can be done to change that pattern. However, several studies report that colic can be sharply reduced within 2 to 3 days if management such as that described above is used. Some infants take longer, but virtually all respond to suitable management.

• Overdiagnosing the condition of the infant or caretaking inadequacies of parents
• Overtreatment of the infant with changes of feedings, medications, and various inappropriate procedures such as enemas and rectal manipulations. Despite the widely held, popular view that cow’s-milk allergy is a principal reason for excessive crying, no study of acceptable double-blind design has demonstrated its occurrence in infants who are free of respiratory, gastrointestinal, or cutaneous manifestations of allergy.

Q: What is wrong with my baby? What can we do to relieve the pain? Why is he/she so gassy? How do you know that it is not due to an allergy? Shouldn’t we strengthen the formula? You mean it’s all my fault? Will this ever stop? What will he/she be like later?
A: All the answers are to be found above.

Carey WB. “Colic”: prolonged or excessive crying in young infants. In: Levine MD, Carey WB, Crocker AC, eds. Developmental–behavioral pediatrics, 3rd ed. Philadelphia: WB Saunders, 1999.

Carey WB. The effectiveness of parent counseling in managing colic. Pediatrics 1994;94:333–334.

Lester BM, Barr RG, eds. Colic and excessive crying. 105th Ross Conference on Pediatric Research, 1997, Columbus, OH: Ross Products Division, Abbott Laboratories.

Wessel MA, Cobb JC, Jackson EB, et al. Paroxysmal fussing in infants, sometimes called “colic.” Pediatrics 1954;14:421–434.