Written by:

Dr Sarah Montgomery-Taylor

BM BCh, BA (Oxon), MRCPCH

Dr Montgomery-Taylor is a paediatrician working in London with particular clinical interests in acute paediatrics. Her wider areas of research include child public health, delivery of integrated care, and digital health.

Colic (excessive crying)

In this article:

  • What is colic?
  • What causes colic?
  • What else could it be?
  • What are the treatment options?
  • How long does colic last?
  • Main points

Colic (excessive crying)

Having a newborn baby is exciting and rewarding, but it can also be exhausting and confusing. One of the things that can be most difficult about having a newborn baby is when they are persistently crying. If this is your experience, it is important to know you are not alone in feeling this and lots of help and support is available. Sometimes it is obvious that your baby is crying because they are tired, hungry or need a nappy change. But beyond that, it can be distressing when your baby cries for long periods of time, and it may feel scary to not know why this is happening. One cause of crying in babies is colic.

What is colic?

Colic is a confusing problem because we do not understand the underlying cause, we cannot make a clear diagnosis and there is no medication to treat it. Colic is commonly defined as crying or distress in a baby that lasts for more than three hours a day and occurs more than three days a week for more than a week. Colic symptoms often affect babies later on in the day, in the afternoon or evening. Babies may also pull their knees up, go very red in the face and have excessive wind.

Colic is very common and can affect around 1 in 3 babies. It happens in both those that are breastfed and formula fed. Some babies are more at risk of developing colic, including those that are:
– born prematurely (before 37 weeks gestation)
– small for their gestation at birth (less than the 10th centile)
– exposed to smoking and nicotine substitutes during pregnancy

What causes colic?

Despite extensive research, the cause of colic is not well understood and, as a result, treatment is unclear. This may be because there are many different factors involved. Some ideas around the underlying cause are that it may be related to extra sensitive pain signals or inadequate ‘good bacteria’ in the gut. Other theories include the role of stress, parental anxiety and tensions within the family environment.

What else could it be?

There are other causes of regular and persistent crying, but in most of these situations crying is not the only symptom. Some of these include:
Reflux
– Cow’s milk protein intolerance
– Lactose intolerance
– Constipation

There are also other underlying illnesses which may present with crying, but in these cases, as with those listed above, there are usually other symptoms to suggest this. If your baby is otherwise growing normally and developing well, these are more unlikely. Ensuring your baby is regularly weighed and has their growth plotted in their red book at the GP or health visitor clinic is important and will reassure you. If you are worried about something else going on, or if your baby’s growth is failing, see your GP.

It is important to get urgent medical help when your baby is crying in the following situations as there may be another more serious cause:
– Their crying is weak, high pitched or continuous
– They’re not feeding at all
– They are floppy when you pick them up
– You see green in their vomit or blood in their poo
– Your baby has a temperature of more than 38°C
– They are struggling to breathe
– They are pale, blue or mottled colour
– You find a bulging soft spot on their head (fontanelle)

What are the treatment options?

Treatments for colic are mostly focussed on supporting parents through what can be a stressful and exhausting time. This can involve ensuring that they have support from friends and family and are able to get a break and rest while others help with care. Sometimes some of the stress is due to concern that your baby has an untreated alternative problem. In this case it can be helpful to see your GP or get advice from your health visitor who will be able to reassure you. Unless there are other signs pointing to allergy or reflux, there is no benefit in treating babies with hydrolysed milk or anti-reflux medication.

General strategies for soothing babies that are crying or distressed are helpful and can include holding or gentling rocking babies, gently massaging their tummy, warm baths and playing ‘white noise.’ Ensuring that babies are well winded after a feed can also help in some situations.

Studies have been carried out looking at the effectiveness of some other treatments of colic such as simeticone (e.g. Infacol) or lactase (e.g. Colief), probiotic and herbal treatments or manipulation strategies (e.g. cranial osteopathy or spinal manipulation). When these studies were reviewed by experts, it was felt that there was insufficient evidence to suggest that any of these treatments are effective and so they are not recommended. Most anecdotal evidence of the effectiveness of such treatments is likely to be related to the fact that colic naturally improves over time as babies grow.

How long does colic last?

Colic is not harmful to your baby and it is often a far more distressing problem for parents than it is for babies. There are no long-term effects related to having colic and babies grow out of the problem, most by about 4 months of age.

Main points

  • It is sometimes obvious to tell why your baby is crying if they’re tired, hungry, or need their nappy changing. However, if they cry for long periods of time and cannot be soothed, this can be described as colic.
  • Many parents find colic upsetting and confusing because it is not understood what the underlying cause is.
  • Colic is defined as excessive crying that lasts for more than three hours a day and occurs more than three days a week for more than a week.
  • Colic symptoms often affect babies later on in the day, in the afternoon or evening.
  • Colic is very common, affecting around a third of babies. If a baby is born prematurely, is small for their gestational age at birth, or is exposed to smoking and nicotine substitutes during pregnancy, they are at an increased risk of developing colic.
  • There are theories that the underlying cause is related to sensitive pain signals or inadequate ‘good bacteria’ in the gut. It’s also thought that stress and tensions within the family environment are a factor.
  • Other conditions cause persistent crying, such as reflux and lactose intolerance, but these are usually accompanied by other symptoms. If your baby is crying and failing to grow at a normal rate, see your GP.
  • Colic on its own will not harm your baby, but you should seek urgent medical help if your baby is crying and you notice other problems, such as if they have a temperature of over 38°C or are struggling to breathe, as thee are indicative of a much more serious problem.
  • As the cause of colic is not well understood, it is also unclear what the best treatment methods are. Treatments are often focussed on supporting parents through what is likely to be a stressful and tiring time. This involves ensuring you have enough support from friends and family.
  • Methods for soothing colicky babies include gentle rocking, massaging their tummy, warm baths, and playing white noise.
  • It’s important to remember that colic is not harmful to your baby and most babies grow out of it by about 4 months of age.