Colic

What to Expect

Similarities and differences between normal crying and colic

Because infants cry more in their first 3 months than at any other time in their lives, it is often difficult to tell the difference between colic and expected crying behavior. Both types of crying gradually increase, peaking at about 6 to 8 weeks of age. Most crying episodes occur in the late afternoon and evening hours, although the timing may vary. The length and intensity of crying episodes also may change from one day to the next.

The difference between colic and normal crying behavior is related to the frequency, duration, and intensity of crying. Babies with colic typically cry for more than 3 hours a day more than 3 days a week for at least 3 weeks in a row. A colicky baby cries very loudly, sometimes piercingly, and often continuously. During a colic episode, babies may clench their fists and stiffen their stomach and legs. Some babies arch their backs, and others pull up their legs to their stomachs.

Most babies with typical crying behavior are soothed and will cry less when they are held, fed, and given attention. But babies with colic are not easily soothed after they start crying. And their episodes typically last longer than expected.

Colic is usually worst when babies are around 6 to 8 weeks of age and goes away on its own between 8 and 14 weeks of age.

Other problems that can cause crying

By definition, colic is not caused by pain or discomfort. Most likely, your baby's crying is normal. But health problems or injuries can cause a baby to cry or make a colicky baby's crying worse.

Learn ways to tell the difference between normal colic and signs of a medical problem. For example, a baby may cry more when he or she has a digestion problem such as milk protein intolerance or milk sugar intolerance. Some mothers also say they notice their baby's crying gets worse after they have had certain foods or drinks and then breastfeed. Some foods may affect breast milk, such as garlic, broccoli, fresh fruits, and caffeine. They may contribute to intestinal gas or other digestive problems in the baby.

Home Treatment

After your baby has started to cry, use comforting and soothing techniques to try to shorten the episode or decrease its intensity. Certain preventive measures may also help. Colic gradually goes away on its own, regardless of what you do.

Prevention

Keep a diary to chart your baby's daily activities, including when he or she cries. The record may help you to notice patterns in your baby's crying and increase your ability to predict when colic episodes are likely to occur. You may be able to help prevent or decrease crying episodes during those times:

• Anticipate your baby's needs. Pay attention to your baby's natural habits and set a rough schedule for meals, nap, and play. That way, you can predict behavior and respond appropriately. You may also want to try holding and comforting your baby before his or her usual crying time. Use a front carrier or sling so you can do other things while you keep your baby close to you.
• Create a calm environment. During expected fussy times, touch your baby only if needed, and try to limit visitors, bright lights, loud noises, and chaotic situations. Overstimulation can trigger a crying episode or make one worse.
• Reduce stress. Babies are very sensitive to the moods of their caregivers and may cry more during times of family stress or tension. Take good care of yourselves to help keep your baby's environment calm and safe. Remember that this challenging time won't last, and know that you have personal limitations.
• Ask for help when you need it. It may help shorten a crying episode by having another caregiver try to soothe your baby during times when you feel overwhelmed and discouraged. Your baby may respond better to someone who is "fresh" and relaxed. Plan ahead by scheduling help before you need it. Have a list of people to call in case you need help unexpectedly.

Colic is not caused by health problems. But when your baby doesn't feel good, crying episodes may get worse. You can help minimize colicky behavior by taking preventive measures to reduce your baby's risk of illness.

• If you are breastfeeding, be aware of your diet. The foods you eat may affect your breast milk and cause abdominal (belly) pain in your baby, which may extend a crying episode.
• Feed your baby appropriately. Very young babies may be hungry 1 to 2 hours after a feeding. Offer food on demand. But to avoid overfeeding, be sure to watch for when your baby is full.
• Help prevent abdominal gas in your baby. Gas can cause pain, leading to extended crying.
• Practice good hygiene to avoid illness. A sick baby usually has more frequent and intense crying episodes. To help prevent illness as much as possible, use good hygiene, such as washing hands frequently, including your baby's. Ask visitors to do the same. Avoid being around large crowds during a baby's first weeks, especially around people who smoke. Breathing in secondhand smoke can increase a baby's risk for respiratory problems, ear infections, and asthma.

Comfort

After a colic episode begins, comforting measures may help.

• Respond to the crying quickly and appropriately. Quickly assess whether a cry likely indicates "I'm hungry" or "I need to be changed," and so on, and act accordingly. Doing so may prevent your baby from getting so upset that he or she cannot be consoled. For more information on figuring out what your crying baby needs, see the topic Crying, Age 3 and Younger.
• Burp your baby, especially if you suspect abdominal gas started the crying episode.
• Reduce the activity around your baby. Overstimulation from noise, lights, and too much attention can trigger a crying episode. Move your baby to a quiet and calm environment.
• Try infant massage. Some parents use infant massage to try and relieve colic.
• Soothe your baby by helping him or her to be more comfortable. Don't worry that you may be spoiling your baby by giving frequent and loving attention.

If you find that you are losing patience or are afraid that you may hurt your baby, act immediately.

• Place your baby in a crib to cry while you go into another room and calm yourself.
• Ask someone to take over for you. If nobody else is home, call a friend who can help you calm down. If you are afraid you cannot control yourself and cannot get other help, call 911.

Call your doctor if you frequently feel overwhelmed or are unable to get adequate support.

Other measures

Do not use unproven or dangerous treatments for colic. Get advice from your doctor before using alternative therapies, which may have unknown effects.

Also, be careful about acting impulsively or using desperate measures to treat colic. For example, do not:

• Let your baby stay in the crib and cry until he or she is exhausted.
• Stop breastfeeding your baby. This will not cure colic.
• Give your baby aspirin or aspirin products, because of the risk for Reye syndrome.
• Give your baby alcohol (even a pacifier dipped in brandy or other alcoholic beverages).
• Shake or spank your baby for crying. Serious or even fatal brain injuries may result (shaken baby syndrome).
• Give your baby medicine unless it is recommended or prescribed by your doctor.

Some doctors prescribe probiotics, which are bacteria that help maintain the natural balance of organisms (microflora) in the intestines. Studies are being done to find out how helpful probiotics are for babies who have colic.

Self-care

It is important to take care of yourself and remember that colic is not caused by poor parenting. Colic is temporary, and it will not affect a baby's general health or future development.

If nothing seems to console your baby, keep trying comforting techniques, but realize that sometimes nothing works. If you are not successful and you become exhausted by these efforts, ask for someone else to take over for you.

When to Call a Doctor

Call 911 or other emergency services immediately if:

• You are afraid that you are about to harm your baby and you can't find someone to help you.
• Your baby has been shaken, has a change in their level of consciousness, or has signs of severe difficulty breathing.

Call your doctor now if your baby:

• Cries in a peculiar manner or for a very unusual length of time.
• Has not been diagnosed with colic but cries excessively and also has symptoms such as vomiting, diarrhea, fever, or blood or mucus in the stool.

Call your doctor for an appointment if:

• Your baby is not gaining weight.
• Your baby has no symptoms other than crying, but you want to check for health problems that may be related.
• Your baby seems to be acting odd, and you can't identify exactly what concerns you.
• You have tried comfort measures repeatedly and still can't console your baby.

Also, think about your own health and well-being. Call your doctor if you:

• Often feel anxious or think you may be depressed.
• Feel that you can't nurture or emotionally connect with your baby.

Routine Checkups

You can ask your doctor about your concerns regarding your baby's crying during regularly scheduled well-baby visits. But don't hesitate to call and discuss your concerns at any time. This is especially true if comfort measures keep failing or if you notice other symptoms along with the excessive crying.

At the checkup, your doctor will want to find out whether your baby has colic or whether crying is possibly related to an illness, an injury, or a medical condition. To find out, your doctor:

• Will take a medical history.
• Will perform a physical exam of your baby.
• Will ask if your baby has other symptoms besides crying.
• May ask you to keep a diary of your baby's activities.
• May ask you to show how you feed and burp the baby.
• May ask how your baby's crying affects you.

If the baby cries excessively and has other worrisome symptoms (such as vomiting, diarrhea, blood or mucus in the stool, or fever), lab tests or X-rays may be done to help the doctor find out whether a condition other than colic is present.