Baby Colic

Colic is paroxysms of crying and irritability in an infant. Although the term colic suggests an intestinal origin, etiology is unknown. Colic often begins at about 6 wk and spontaneously improves between 3 and 4 mo. Paroxysms of crying and unhappiness develop at roughly the same time of day or night and continue for hours for no apparent reason. A few infants cry almost incessantly. Excessive crying may cause aerophagia, which results in flatulence and abdominal distention. Typically, the colicky infant eats and gains weight well, although vigorous non-nutritive sucking may suggest excessive hunger. Colic probably has no relation to development of an insistent, impatient personality.

Evaluation
History and physical examination: History should establish whether the infant's crying is outside the normal range (up to 3 h/day in a 6-wk-old infant). Then it must distinguish colic from other causes of excessive crying, including fever, UTI, ear infection, and maltreatment. Thorough questioning may reveal that crying is not the chief concern but a symptom that the parents have used to justify their visiting the physician to present another problem—eg, concern over the death of a previous child or over their feelings of inability to cope with a new infant. A thorough physical examination typically detects no abnormalities but reassures parents that the doctor understands how stressful a colicky infant can be for parents.

Testing: No testing is necessary unless specific abnormalities are detected by history and examination.

Treatment

Parents should be reassured that the infant is healthy, that his irritability is not due to poor parenting, and that colic will resolve on its own with no long-term adverse effects. The infant who cries for short periods may respond to being held, rocked, or patted gently. An infant with a strong sucking urge who fusses soon after a feeding may need to suck more. If a bottle feeding takes < 15 to 20 min, nipples with smaller holes should be tried; a pacifier also may quiet the infant. A very active, restless infant may respond, paradoxically, to being swaddled tightly. An infant swing, music, and white noise (eg, from a vacuum cleaner, car engine, or clothes or hair dryer) may also be calming.


A milk-substitute formula may be tried briefly to ascertain whether milk intolerance exists, but frequent formula switching should be avoided. Sometimes in breastfed infants, removal of milk or another food from the mother's diet brings relief.