Colic is paroxysms of crying and irritability in an infant.

Although the term colic suggests an intestinal origin, etiology is unknown. Colic often begins at about 6 wk and spontaneously abates between 3 and 4 mo. Paroxysms of crying and unhappiness develop at about the same time of day or night and continue for hours for no apparent reason. A few infants cry almost incessantly. Excessive crying may cause aerophagia, which results in flatulence and abdominal distention. Typically, colicky infants eat and gain weight well, although vigorous nonnutritive sucking may suggest excessive hunger. Colic probably has no relation to development of an insistent, impatient personality.

Evaluation

History and physical examination

History should establish whether the infant's crying is outside the normal range (up to 3 h/day in a 6-wk-old infant). Then it must distinguish colic from other causes of excessive crying (see Approach to the Care of Normal Infants and Children: Crying), including fever, UTI, ear infection, and maltreatment. Thorough questioning may reveal that crying is not the chief concern but a symptom that the parents have used to justify their visiting the physician to present another problem—eg, concern over the death of a previous child or over their feelings of inability to cope with a new infant. A thorough physical examination typically detects no abnormalities but reassures parents. Physicians should also offer reassurance that they understand how stressful a colicky infant can be for parents.

Testing

No testing is necessary unless specific abnormalities are detected by history and examination.

Treatment

Parents should be 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 adverse effects. The following may help:

• For infants who cry for short periods: Being held, rocked, or patted gently
• For infants who have a strong sucking urge and who fuss soon after a feeding: Opportunity to suck more (eg, a pacifier)
• If bottle-feeding takes < 15 to 20 min: Nipples with smaller holes, a pacifier, or both
• For very active, restless infants: Paradoxically, being swaddled tightly

An infant swing, music, and white noise (eg, from a vacuum cleaner, car engine, or clothes or hair dryer) may also be calming.

A milk-substitute formula may be tried briefly to determine whether infants have milk intolerance, but frequent formula switching should be avoided. Sometimes in breastfed infants, removing milk or another food from the mother's diet brings relief.

Last full review/revision February 2010 by Eve R. Colson, MD; Rachel L. Chapman, MD; Melissa R. Held, MD