At the two-week well-child check, I often tell parents that their newborn will soon start to “find their voice.” As their pediatrician, this is a gentle way of warning them about the upcoming period of increased crying known as colic. Just when you’ve adjusted to having a quiet little bundle at home, expect changes around the one-month mark.
What is colic? How do you know when there’s a medical problem? And what are the options for comfort? I’ll explain it all below so you’re prepared for this sometimes challenging phase of infancy.
What is colic?
“Colic,” derived from a Latin word related to “colon,” means severe fluctuating abdominal pain, but we’re actually not sure what causes this crying in babies. Parents often assume it’s abdominal pain as they watch their baby’s stomach strain during crying. However, this may not be the most convincing evidence, as even an adult’s stomach would strain during vigorous crying. Unfortunately, these little pre-verbal beings aren’t able to tell us what’s going on.
What we do know is that colic is a normal developmental period that usually resolves by three or four months of age. In most infants, the crying is concentrated to certain times of the day, often evenings or, unfortunately, nights. A helpful way to think of this is that these are the baby’s low-tolerance times. Activities like pooping, farting, and burping may bother the baby during these hours, even though they tolerate these activities well during the rest of the day. This pattern is good evidence that there are no major problems with constipation, reflux, food intolerance, or gas. If there were, the crying would occur throughout the day. The way I phrase this is: if the problem is limited to a single period of the day, then it’s a tolerance problem and not a content problem. And this concept is familiar to us in other life stages.
We know that toddlers will break down hysterically at the end of the day for a slight that they wouldn’t bat an eye at if it happened mid-morning. Or, in my personal case, I’m a morning person who married a night person, and none of my stories or jokes are appreciated at 6 a.m. Tolerance problem; the content is good.
Going back to the crying baby, a good rule of thumb for parents is that if the crying is isolated to a consistent period of the day, it should be regarded as a normal developmental stage for which parents should look to comfort the baby but not go overboard trying to “solve” the problem. However, if the crying is constant throughout the day or associated with every feeding or stooling event, consult a pediatrician to rule out conditions like reflux, food intolerance, or constipation. Other red flags include drastic changes in stool consistency, blood in the stool, decreased energy, lack of smiles after six weeks, or a decrease in food intake. But if they’re gaining weight and generally happy most of the day, then we can safely focus on comforting them through the colic rather than looking for underlying causes, knowing this is developmentally normal and will pass with time.
What are the options for comfort?
Well, there are lots and lots of options to try — so many that if you cycle through each option, your baby will likely grow out of their colic and you’ll be convinced that one of them worked. Nonetheless, let’s go through some of the treatment modalities that are out there and what the data says about whether they are worth trying.
The five S’s: Tried and true. Safe and effective. Researchers have looked at these techniques for calming babies during vaccines or other episodes of fussiness, and the results are consistent. These techniques can soothe most babies:
- Sucking: Love those pacifiers, don’t be concerned with nipple confusion for something that doesn’t give milk, and they are easier on the orthodontics than a thumb (which is also harder to take away). Use a paci!
- Swaddle: Get that kid straitjacketed. Most babies prefer to have a snug wrap that reminds them of the womb.
- Shhh: A little white noise, a soft song, a hum. Babies relax with a gentle soft sound.
- Swing: Gentle, rhythmic motion, whether in a swing, a stroller, or a parent’s tired arms, helps calm many babies.
- Side: Some babies prefer a side position to calm. While they should be on their back to sleep, it’s okay to put them in a side position to calm them while you’re watching them.
Probiotics: Lactobacillus reuteri has shown modest to good effects on decreasing crying times in breastfed babies in multiple randomized controlled trials. Of all the options that one would consider putting in their baby’s mouth to lessen colic, this is the one with the strongest evidence of effectiveness.
Maternal food restrictions in breastfeeding mothers: There are observational studies that report less crying in breastfed infants whose mothers restrict cruciferous vegetables (leafy greens, broccoli, brussels sprouts, and cauliflower), but it’s hard to put much weight on that type of evidence. In 2018 there was a systematic Cochrane review of diet changes for infant colic, and while the authors found 15 randomized controlled trials, they still found the quality of the studies low and that many of the results conflicted with one another. I encourage moms who breastfeed to eat the food they want, and I don’t dare take away their ice cream unless their baby is showing some of the red flags mentioned above.
Formula changes: Trying different formulas is also covered in the Cochrane review, and the evidence is similarly not great. I try not to have patients get on the formula carousel, although it’s not uncommon for parents to swear to an improvement after a formula switch. The evidence is just really inconsistent and unconvincing. Again, if red flags appear, it may be worth trialing it, but know that the formula companies charge more for their sensitive or lactose-free formulas, and there is little objective evidence of their effectiveness.
Medications: Simethicone, often referred to as gas drops under the brands Gas-X, Mylicon, and Little Remedies, is the most popular medication for colic, but there’s no good data on the effect. I tell parents it’s a safe placebo, and placebos can be a wonderful thing.
Gripe water: Gripe water used to be effective for stopping crying because it had alcohol in it. Strangely, since that was removed, the effectiveness has gone away. Unlike simethicone, it is not considered a medication by the FDA and is not regulated, and some brands from time to time have had contamination in their products. It’s a “stay-away.”
Sugar water: This actually does have some evidence of effectiveness and is commonly used in neonatal ICUs during procedures, for infant comfort. I don’t see many families going this route, and I imagine their sound judgment is balancing the comfort provided against the early training of their baby’s palate on sweet sugar.
Herbal remedies: Fennel and herbal teas are the two most common, but everyone’s great aunt likely has a recommendation. There’s not much evidence, nor much evidence of harm, in giving these to newborns.
Windi: This is basically a small tube to insert into a baby’s rectum to release gas. Anecdotally, some parents like it, but there are no studies, so it’s a use-it-if-you’d-like scenario.
Parental education: There is evidence that parental education about colic can decrease crying time and parental stress. Knowing what to expect, that it’s normal developmentally, some calming techniques, and that it will get better can all lead to reduced family distress and anxiety. Congratulations, you just did this one!
The bottom line
When the crying times come, it will be stressful. Knowing that they will pass and understanding which red flags require escalation to your pediatrician will help you maintain your calm in the storm. There are a lot of remedies out there, and most lack evidence of effectiveness, but a touch of probiotics, a pinch of reassuring education, and maybe some earplugs can get you through this challenging period.
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My daughter supposedly had colic – but her crying didn’t really match many of the criteria here. She started crying intensely from the day she was born and it she cried all day, anytime she wasn’t sleeping or nursing. Was this colic? If not, what are the other options? We tried probiotics, I cut lots of things out of my diet (eggs, wheat, dairy), but nothing help. Started to phase out at 3-4 months.
So helpful, all the data and knowledge in one place. Thank you! My son had colic for a few weeks, it would strike around 4pm every evening, we tried everything and have been beating ourselves up thinking he was just hungry bc around that time I quit trying to BF and switched to exclusively pumping. Now I know, if we go for baby 2, that it probably had little to do with his feeding and more to do with his stage of development.
Wow, thanks. I did know that colic most likely does not have that much to do with digestion yet still learned a lot from this article! It’s a great “package of knowledge” that I will surely use once the baby’s here.