What is infant colic?
The British NHS describes colic as a healthy baby crying a lot with no obvious cause. It is common and its cause is unknown. The NHS and the American Academy of Pediatrics (AAP) mention an immature digestive tract and nervous system, sensitivity to stimulation and, in some babies, cows' milk allergy.
For years colic was diagnosed using the rule of threes: crying for more than 3 hours a day, on at least 3 days a week, for at least a week according to the NHS and Medycyna Praktyczna (mp.pl, a Polish medical portal) or for 3 weeks according to the family physicians' journal AAFP and a Cochrane review.
The Rome IV criteria from 2016 stopped counting hours because, according to a review by Zeevenhooven and colleagues, the 3-hour cut-off was arbitrary. What matters is that the crying is long and cannot be soothed. Colic is diagnosed in a baby under 5 months when crying, fussing or irritability keeps coming back, lasts a long time, has no obvious cause and the parents cannot prevent or stop it. The baby must not have a fever, signs of illness or poor weight gain.
According to mp.pl, colic is not a disease but a temporary disorder that goes away on its own and, according to available research, does not affect the child's later development. If the baby gains weight well and develops normally, no tests are needed.
When does colic start and how long does it last?
Crying in healthy babies naturally increases in the first weeks: according to the NHS from about 2 weeks, and according to the AAP with a peak at about 6 weeks. With colic a baby cries clearly more and is harder to calm. The timing differs slightly between sources:
| Source | When it starts | When it usually ends |
|---|---|---|
| NHS | when the baby is a few weeks old | by 3 to 4 months |
| AAP | usually between 2 and 4 weeks | by 3 to 4 months, sometimes lasts until 6 months |
| mp.pl (Szymański, Pejcz) | around 3 weeks | around 4 months, at the latest around 5 months |
| Rome IV criteria | before 5 months of age | before 5 months of age |
If a newborn cries a lot in the first days of life, feeding and weight gain need checking first, which we cover in the article on newborn weight loss. The NHS advises seeing a doctor if colic-like symptoms continue after 4 months of age.
What are the symptoms of colic in a newborn and infant?
According to the NHS and the AAP, during a bout of colic a baby usually:
- cries for a long time and intensely, often screams and is hard to soothe,
- clenches their fists and goes red in the face,
- draws their knees up to the tummy or stretches the legs out, arches the back,
- has a rumbling tummy or passes a lot of wind,
- cries most often at the same time of day, usually in the afternoon and evening.
Between bouts a baby with colic feeds, gains weight, has no fever and behaves as usual. If the crying comes with fever, vomiting, blood in the stool or drowsiness, it is not colic.
Colic or hunger? How to read your baby's crying
Before you put the crying down to colic, check the usual causes. The NHS lists hunger, a dirty nappy, tiredness, wanting closeness, wind, being too hot or too cold, boredom and too much stimulation. Mp.pl advises keeping the room at 20 to 21 degrees Celsius.
Crying is a late sign of hunger. NHS Grampian divides feeding cues into three stages:
| Stage | What the baby does | What to do |
|---|---|---|
| Early cues | stirs in sleep, opens the mouth, turns the head and looks for the breast | this is the best moment to feed |
| Mid cues | stretches, moves more and more, brings a hand to the mouth | feed as soon as possible |
| Late cues | cries, moves in an agitated way, goes red | calm the baby first with a cuddle or skin-to-skin contact, then feed |
The NHS also suggests offering the breast for comfort. With colic, parents cannot prevent or stop the crying, including by feeding. If the baby cries during feeds or gains weight poorly, the problem may be the feeding itself. The NHS then advises checking positioning and attachment at the breast, which a midwife can help with. If feeding hurts you, read our article on pain when breastfeeding.
How can I help my baby with colic?
There is no method that always works. The NHS, the AAP and mp.pl suggest:
- Hold and cuddle your baby, also in a sling or carrier. Rock, talk, sing.
- During feeds hold your baby as upright as possible so they swallow less air, and help them bring up wind afterwards.
- Rock your baby over your shoulder, in a cot or in a pram, go for a walk or a drive. If they fall asleep in the car seat, move them to a firm, flat surface as soon as possible.
- Turn on steady background noise, such as a fan. The AAP warns never to place a baby on top of a washing machine or dryer.
- Lay your baby tummy-down across your knees and gently stroke their back. If they fall asleep, put them in the cot on their back.
- A warm bath or a gentle tummy and back massage calms some babies, though it upsets others.
- Limit noise, bright light and visitors. Keep your baby away from cigarette smoke.
- A dummy calms some babies, though some will not take one.
- Keep feeding as before. The NHS advises not changing how you feed because of colic.
Mp.pl advises keeping a crying diary for a week to see whether a given method works, and talking to a doctor before you buy colic products or change how you feed.
Colic drops, probiotics, herbs: do they work?
According to mp.pl, the small number of studies and their poor quality make it impossible to point to a clearly effective method. This is what is known:
| Product or method | What the sources say |
|---|---|
| Simethicone drops (for wind) | In the AAFP review simethicone worked no better than placebo. Mp.pl rates it as probably ineffective. The NHS does not recommend colic drops because there is no evidence they help. |
| Lactase drops | Probably ineffective according to mp.pl. A 2018 Cochrane review found three studies, but none gave data that could be analysed. |
| Probiotic L. reuteri DSM 17938 | The best studied; it may shorten crying in breastfed babies (details below). The NHS does not recommend probiotics for colic. |
| Herbal teas and drops | Single studies showed less crying with an extract of fennel, chamomile and lemon balm, but according to AAFP more research is needed, and the NHS does not recommend them. Gripe water has not been shown to work and may cause harm. |
| Chiropractic, osteopathy, craniosacral therapy | The NHS advises avoiding them: there is little evidence and they may hurt the baby. A 2012 Cochrane review found the studies small and prone to bias. When parents did not know whether the baby had received the therapy, the improvement was not significant, and there are too few safety data. An older 2014 summary on mp.pl rated these methods more favourably. |
Sources disagree about probiotics. In a 2018 meta-analysis by Sung and colleagues (4 trials, 345 infants), L. reuteri DSM 17938 shortened crying by about 25 minutes a day on average after 21 days, clearly in breastfed babies and not significantly in formula-fed babies. The European paediatric gastroenterology society ESPGHAN in 2023 allows it to be considered for breastfed babies (weak recommendation) and makes no recommendation for formula-fed babies. The Zeevenhooven review notes that one larger trial did not confirm a benefit. Mp.pl warns that many probiotics in pharmacies contain other strains whose effectiveness has not been shown. Choose a probiotic together with a doctor.
Do not give your baby colic medicines without talking to a doctor. AAFP describes, for example, dicyclomine, which reduced crying but is contraindicated in babies under 6 months because it can cause apnoea.
Colic and breastfeeding: does the mother's diet matter?
Here the sources clearly differ. The NHS says a breastfeeding mother does not need to change her diet. The AAP allows cutting out one food at a time, such as dairy, caffeine, onions or cabbage, with an effect after about 2 weeks. Mp.pl suggests a week without dairy, eggs, soy, wheat, fish and nuts, and a return to the usual diet if there is no clear improvement.
A 2018 Cochrane review rated the studies on diet in colic as few and of very low quality and did not recommend any change. So do not start a strict elimination diet on your own. The AAP advises discussing any change with a paediatrician, and if a doctor suspects cows' milk allergy, they will plan the diet with you.
For formula-fed babies, mp.pl, the AAP and AAFP allow a trial of a hydrolysed protein formula after talking to a doctor, although Cochrane rates the results of such formulas as inconsistent. According to mp.pl, if there is no clear improvement after a week, the baby goes back to the previous milk.
Constant crying in a baby: when to see a doctor and when to call 112?
According to the Zeevenhooven review, an illness explaining the crying is found in fewer than 5 in 100 babies with inconsolable crying, but these babies must not be missed. Trust your instincts: you know your baby best. If you are not sure which group a symptom belongs to, choose the more urgent one.
| What to do | Symptoms |
|---|---|
| Call 112 | A fit (seizure). Blue, grey, pale or blotchy skin, lips or tongue. The baby does not respond, is floppy or hard to wake. Difficulty breathing: grunting, sucking in under the ribs, fast breathing. A rash that does not fade when pressed. Repeated, forceful vomiting. No wet nappy for 8 hours. A weak or high-pitched cry that is not like the usual cry. |
| See a doctor urgently, the same day | Fever: in a baby under 3 months 38 degrees Celsius or more, at 3 to 6 months 39 degrees or more. Vomiting or heavy spitting up. Diarrhoea or blood in the stool. The baby feeds little. A sudden change in behaviour. |
| See a doctor or midwife in the next few days | The baby gains weight poorly. The crying continues after 4 months of age. Nothing helps or the crying worries you. You feel you are not coping. |
In the evening, at night and on days off, the night and holiday healthcare service (nocna i świąteczna opieka zdrowotna) is available (according to the NFZ, the Polish National Health Fund, from 18:00 to 8:00 on working days and around the clock on days off). You can go to a hospital emergency department (SOR) without a referral. You do not have to drive yourself: ask someone to take you or call an ambulance. We describe worrying stools in the article on newborn poo.
When you have had enough: never shake a baby
Hours of crying wear anyone out, and anger and helplessness do not mean you are a bad parent. AAFP links colic with postnatal depression and with shaken baby syndrome, so it helps to have a plan for the moment when you are about to snap.
Never shake a baby, not even for a moment. According to the NHS, violent head movements can cause brain damage, and according to the AAP shaking can cause blindness, brain damage or death. Neuropsychologist Anita Franczak-Young points out in an interview for mp.pl that a baby usually goes quiet after being shaken, and that is exactly the trap.
When you feel anger building up:
- If another adult is nearby, hand the baby to them.
- If you are alone, lay the baby on their back in a cot or pram, with no blankets or toys, and check that they are safe.
- Leave the room and close the door. Give yourself 10 to 15 minutes: take a deep breath and count to 10, listen to music, call someone close to you.
- The baby may cry during this time. The AAP advises checking on them without picking them up until you have calmed down.
If you feel helpless or low, tell your midwife or doctor. You can also call the free 24-hour number 800 70 2222 of the Support Centre for Adults in Mental Crisis (Centrum Wsparcia dla Osób Dorosłych w Kryzysie Psychicznym). We explain how to tell tiredness from depression in the article on the baby blues. If a baby has been shaken and is drowsy, vomiting, having a fit or struggling to breathe, call 112 immediately and say what happened.
How can a midwife help with colic?
After the birth, the POZ midwife (primary care midwife funded by the NFZ) makes at least 4 free home visits (wizyty patronażowe). The first takes place within 48 hours (excluding Saturdays, Sundays and public holidays) of being notified of the birth or the hospital discharge. According to the Polish perinatal care standard, during these visits the midwife, among other things:
- assesses the baby's health, physical development and weight gain,
- checks how often and how long the baby feeds, whether they suck eagerly, whether they are satisfied and whether they spit up,
- assesses the mother's breasts, the baby's mouth, feeding technique and how effectively the baby sucks,
- gives advice on caring for the baby and on coping with stress,
- assesses who can help you at home and suggests how your loved ones can support you.
This lets the midwife tell colic apart from a feeding problem or too little weight gain, which also cause crying. If a problem is beyond her competence, she tells you that a doctor or psychologist is needed. After the home visits, the standard says the baby's care passes to the POZ nurse, while the POZ midwife can still support you with breastfeeding. You can also book a private home visit from a midwife or a lactation consultation so that someone can calmly watch a feed and weigh the baby. Diagnosing illness and treatment are a doctor's job.
