If you are currently holding an otherwise healthy infant who is crying—no, screaming—inconsolably, especially in the evening, you are likely in the throes of infant colic. This common, yet exhausting, phase affects 10–40% of babies worldwide, peaking around six weeks of age.
The most important thing to know is that colic is a benign, self-limited condition. While it feels endless now, it typically resolves on its own between three and six months of age.
What is Colic? The “Rule of Threes”
Colic is defined clinically by the Rome IV criteria as recurrent and prolonged periods of crying, fussing, or irritability in an otherwise well-fed infant under five months of age.
Healthcare providers often use the “Rule of Threes” to diagnose it:
- Crying for more than 3 hours per day.
- Occurring for more than 3 days per week.
- Lasting for longer than 3 weeks.
Crying episodes often occur in the evening and may be accompanied by a flushed face, legs drawn up to the abdomen, and flatulence or visible abdominal distension.
Causes: Why Is This Happening?
The exact cause of colic remains unclear and is likely due to several factors working together:
- Gut Health: Imbalances in gut bacteria (altered gut microbiota) or inflammation, gut dysmotility.
- Behavioral factors: Feeding technique, parent-infant interactions
- Development: The infant’s nervous system may be immature.
Because a small percentage (about 5%) of babies with severe crying have a serious underlying medical problem, a complete medical assessment is warranted to rule out other conditions before confirming a colic diagnosis.
Management: Practical Strategies for Relief
The overall focus of management is parental reassurance and education because the condition will resolve on its own. However, there are evidence-based interventions that can help shorten the duration of crying:
For Breastfed Infants
- Lactobacillus reuteri Probiotic (Strain DSM 17938): Moderate-certainty evidence supports the use of the specific probiotic strain Lactobacillus reuteri (DSM 17938) for exclusively breastfed infants with colic.
- Effectiveness: Benefits typically emerge within the first week and peak by two to three weeks, potentially reducing daily crying time by 25 minutes or more. Approximately one in three breastfed infants will respond to this treatment.
- Maternal Diet: Reducing allergens in the breastfeeding parent’s diet may also be beneficial.
For Formula-Fed Infants
- Formula Switch: Switching to a hydrolyzed formula may help alleviate symptoms.
- Probiotics: Current evidence is insufficient to recommend probiotics for formula-fed infants, as studies show minimal to no benefit.
Probiotic effects differ dramatically by feeding type.
What Not to Use
Some common treatments, such as simethicone and proton pump inhibitors, have been found to be ineffective for colic. Furthermore, dicyclomine is contraindicated and should not be used.
Safety of Probiotics
For otherwise healthy, term infants, probiotics like L. reuteri DSM 17938 appear safe, with no serious safety concerns and minor side effects (like gas or regurgitation) that occur at rates similar to placebo.
Important Safety Note: Special caution is warranted for high-risk babies, including premature infants (especially those under 1000g birth weight), immunocompromised infants, and those with central venous catheters, short-gut syndrome, and cardiac valvular disease. Always ensure that any probiotic products used are pharmaceutical-grade to avoid contamination risks. Do not use probiotics if your child is in a high risk category, unless approved by your physician.
Hope and Support
Colic is tough for families and infants, but remember that it is a temporary stage in your infant’s development. Seek reassurance and support from your pediatrician, knowing that you are doing everything you can to comfort your baby until this phase naturally passes.
Medical Disclaimer
This content is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider, such as your pediatrician, with any questions you may have regarding a medical condition or before making any changes to your child’s care plan. Never disregard professional medical advice or delay in seeking it because of something you have read here.