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Colic ˈkäl-ik

by Deborah M. Consolini, MD

Colic refers to a specific pattern of excessive, intense crying (see Crying) and fussing that occur without any apparent reason (for example, hunger, illness, or injury) in otherwise healthy infants. Colic typically begins within the first month of life, is worst when the infant is about 6 weeks of age, and disappears, often rather suddenly, by 3 to 4 months of age.

Typically, doctors consider intense, unexplained crying and fussing to be colic when it lasts more than 3 hours a day and more than 3 days a week for more than 3 weeks. However, many doctors also consider sudden, severe, unexplained crying that lasts less than 3 hours a day for most days of a week to be colic.

The crying associated with colic typically

  • Is loud, piercing, and constant

  • Has no identifiable cause

  • Occurs at about the same time of day or night

  • Continues for hours for no apparent reason

  • Is separated by intervals when the infant acts normally

Causes

Although the term colic suggests abdominal cramps, there is no evidence that there is an intestinal or other abdominal disorder. People may have thought colic was caused by an abdominal disorder because crying infants often swallow air when they cry, resulting in passing of gas (flatulence) and a swollen abdomen. However, doctors feel these findings result from crying rather than cause it. Most infants with colic eat and gain weight normally. However, they may suck vigorously on pacifiers or toys. Colic does not appear to have any relation to development of an insistent, impatient personality.

Evaluation

Warning signs: Parents should be especially suspicious of illness or pain as the cause of their infant's fussing if the crying is accompanied by

  • Vomiting (especially if vomit is green or bloody or occurs more than 5 times a day)

  • Changes in stool (constipation or diarrhea, especially with blood or mucus)

  • Abnormal temperature (a rectal temperature less than 97.0 °F [36.1 °C] or over 100.4 °F [38 °C])

  • Irritability (crying all day with few calm periods in between)

  • Lethargy (excess sleepiness, lack of smiles or interested gaze, or a weak suck)

  • Poor weight gain

  • Difficulty breathing

  • Bruising or other signs of possible injury

  • Abnormal movements or twitching of any body part

When to see a doctor

Children who have any warning signs should be evaluated by a doctor right away.

If children without warning signs appear well otherwise, parents can try typical measures such as feeding, burping, changing, and cuddling. If crying continues after such measures, parents should call a doctor. A doctor can help parents determine how quickly the child needs to be evaluated.

What the doctor does

Doctors first ask questions about the crying to determine whether it meets the criteria for colic. Doctors ask about other symptoms and the infant's medical history and then do a physical examination. What they find during the history and physical examination often helps them distinguish colic from a disorder that is causing excessive crying (see Crying).

Testing

No testing is needed unless doctors detect specific abnormalities during the history and examination.

Treatment

Parents are reassured that the infant is healthy, that the irritability is not due to poor parenting, and that colic will resolve on its own with no long-term effects. Some general measures may help:

  • Being held, gently rocked, or patted

  • Rocking in an infant swing

  • Listening to white noise, such as the sound of rain or the electronically produced sounds made by a fan, washing machine, vacuum, or hair dryer

  • Listening to music

  • Riding in a car

  • Sucking on a pacifier

  • Being burped

  • Being fed (but parents should avoid overfeeding in an attempt to stop the crying)

  • Being snugly wrapped (swaddled)

Parents may change formulas for a short time to determine whether infants have a specific formula intolerance, but frequently switching formulas should be avoided unless directed by a doctor. Mothers who are breastfeeding can trying removing cow's milk or another food from their diet to see whether the infant’s crying decreases. However, a milk or food intolerance is rarely a cause of colic unless other symptoms such as vomiting, constipation, diarrhea, or poor weight gain are present.

Coping with excessive crying can be difficult for parents. Talking with a doctor can help. The doctor can provide strategies, reassurance, and support for parents experiencing the stress of excessive crying.