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Colic and crying

Definition:

Colic is crying in a baby that lasts for longer than 3 hours a day and is not caused by a medical problem. Colic occurs in almost all babies to varying degrees. Almost all babies go through a fussy period.



Alternative Names:

Infantile colic



Causes, incidence, and risk factors:

About 1 in 5 babies cry long enough to be considered colicky. The timing varies, but colic usually affects babies beginning at about 3 weeks of age. It peaks somewhere between 4 - 6 weeks of age.

The crying associated with colic usually occurs at the end of the day. Babies with colic tend to be unusually sensitive to stimulation. Some babies have more discomfort from intestinal gas. Some cry from hunger, others from overfeeding. Some cannot tolerate certain foods or proteins in breast milk or formula. Fear, frustration, or even excitement can lead to colic symptoms. When other people around the baby are worried, anxious, or depressed, babies may cry more.

Colic eventually goes away. Symptoms begin to improve after about 6 weeks, and are generally gone by 12 weeks. If your baby still has colic at 12 weeks old, you should see a doctor to rule out another condition, such as reflux.



Symptoms:

Colic most often begins at the same time every day. Usually, babies with colic are most fussy in the evening.

Colic symptoms often begin suddenly. The baby's hands may be in a fist, the legs may curl up, and the belly may seem swollen. The episode may last for minutes or hours. It often winds down when the baby is exhausted, or when gas or stool is passed.

Despite apparent belly pain, infants with colic eat well and gain weight normally.



Signs and tests:

Your health care provider can often diagnose colic by asking questions about the baby's medical history and symptoms, including how long the crying lasts.

The health care provider will perform a physical exam to rule out other problems, such as a hernia, intussusception , or other medical problem. Further testing may be needed if the diagnosis is unclear.



Treatment:

Helping a baby with colic involves identifying and avoiding the things that trigger the crying episodes, if possible. It's also important to learn what most comforts your baby.

Possible colic triggers:

  • Foods: Foods passed through breast milk may affect your child. If you are breastfeeding, avoid stimulants such as caffeine and chocolate. Try to avoid dairy products and nuts for a few weeks, as these may be causing allergic reactions in the baby. People often hear that breastfeeding moms should avoid broccoli, cabbage, beans, and other gas-producing foods. However, there is not much evidence that these foods are a factor.
  • Formula: Some babies may be sensitive to proteins in formula. Switching formulas may be important for some babies.
  • Medicine: Medicines passed through breast milk can also make a baby cry. If you are breastfeeding, talk to your doctor about the medicines you take.
  • Feeding: Avoid overfeeding the baby, or feeding too quickly. If a bottle feeding takes¬†fewer than 20 minutes, the hole in the nipple may be too large.

TIPS FOR COMFORTING THE BABY

What comforts one child, may not calm another. Some babies like to be wrapped tight in a blanket (swaddled), while others prefer to be free. Try many different things, and pay attention to what seems to help, even just a little bit.

  • Holding your child is very helpful. The more hours a baby is held, even early in the day, the less time the baby will be fussy in the evening. This will not spoil your child. Infant carriers that you wear on your body can be a great way to keep your baby held tight.
  • Gently rock your baby. Rocking is very calming and can help the baby pass gas. When babies cry, they swallow more air. This creates more gas and perhaps more stomach pain, which causes more crying. This cycle can be difficult to break. An infant swing is a good alternative for babies at least 3 weeks old who can hold their head up.
  • Singing lullabies to your baby can be powerfully soothing.
  • Hold your child in an upright position. This helps move gas out of the body and reduces heartburn. A warm towel or warm water bottle on the baby's stomach may be soothing.
  • Some babies like to lie on their stomach, while awake, while someone gives them a back rub. Never place your baby to sleep on the stomach. Babies who sleep on their stomachs have a higher risk of SIDS.
  • Offer your baby a pacifier. Some babies are only happy when they are sucking on something.
  • If you breastfeed, you might reduce colic by allowing the baby to finish the first breast before offering the second. The concentration of breast milk changes during a feeding. At first, the milk is low in calories and fat. But the milk at the end of emptying each breast, called the hindmilk, is far richer and sometimes more soothing. If the baby still seems uncomfortable or is eating too much, then offering only one breast (as often as desired) over a 2 - 3 hour period. This might give the baby more hindmilk.
  • Some babies seem to be calmer when riding in a car. If this helps your child, ask your pediatrician about a device that mimics car motion and sound.
  • "White" noise may soothe some babies. You can buy white noise machines, or try the sound of a fan, vacuum cleaner, washing machine, or dishwasher.
  • Simethicone drops sold without a prescription may help reduce gas. This medicine is not absorbed by the body and is safe for infants. Stronger medicines may be prescribed by a doctor if your baby has severe colic.


Support Groups:



Expectations (prognosis):

An infant usually outgrows colic by 3 to 4 months of age.



Complications:

There are usually none.



Calling your health care provider:

Call your baby's health care provider if your baby is crying a lot. It is important that other, more serious, conditions are ruled out.

Call your baby's health care provider immediately if:

  • Your baby's behavior or crying pattern changes suddenly
  • The crying baby also has a fever, forceful vomiting, diarrhea, bloody stools, or other stomach problems

Do not be afraid to seek help immediately if you feel overwhelmed or have thoughts of harming your baby.



Prevention:

Your baby is likely to have a fussy period, regardless of any type of prevention.

However, good feeding techniques and identification of triggers can be helpful. If you are breastfeeding, talking to a lactation consultant can be helpful.

Learn what comforts your baby before colic may develop. Knowing what calms your baby can help stop the fussy period from becoming so intense.



References:

Herman M, Le A. The crying infant. Emerg Med Clin North Am. 2007;25:1137-1159.

This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.




Review Date: 8/2/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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