by Dr Clare MacDonald, General Practitioner
Colic is a diagnosis of exclusion when no other cause can be found for an infant with excessive and frequent crying. Typical onset is in the first weeks of life, with resolution usually around 3-4 months, 6 months in some cases. It commonly occurs in the evening and is often associated with the baby drawing up his/her knees or arching his/her back during feeds. A widely accepted definition known as the ‘rule of 3s’ is that babies have1:
- Unexplained fussing and crying lasting more than 3 hours a day
- More than 3 days a week
- For more than 3 weeks
These criteria do not need to be strictly met though for infants with excessive crying and ‘fussiness’, who are otherwise healthy, to be managed clinically as per colic guidance. It is a common problem with a reported prevalence of 5-20% 2 and breastfed and formula fed babies are equally affected.
The scenario of an excessively crying baby presenting in primary care is a familiar one. The role of the GP in eliciting the parental concern is paramount; the impact of caring for an apparently inconsolable baby on a worried parent should not be underestimated. Parents may view the incessant crying as a reflection of their ability to care for the child. A thorough history and examination should be performed.
Colic is a self-limiting condition without any specific, proven pathological sequalae (there is conflicting evidence for a link between colic and allergic disease3), however there are risks of potential distress to parents, risk to the parent-infant relationship and the risk of early cessation of breastfeeding or early introduction of complementary foods. As such, the management is based largely around minimising these risks.
NICE CKS: Colic- Infantile is the most recent guidance on the management of colic in 2017.
Reassurance is crucial, and a caring and compassionate healthcare professional can help allay parental anxiety4. Support from the health visitor should be sought3, 5.
If there is a suspicion of cows’ milk allergy as a cause for the symptoms, infants should be managed as such.
General measures to soothe the baby, and advice for parents include:
- Holding / Carrying the baby
- Motion may help eg. walking with the pram
- White noise eg. hairdryer or vacuum cleaner noise
- Ensuring optimal winding after feeds (if needed)
- Bathing the infant in a warm bath
- Encouraging parents to look after their own wellbeing; resting when possible and accepting help from family and friends
If the mother is breastfeeding, she should be encouraged to continue wherever possible3. Good positioning and attachment may help to reduce colic, as can ensuring that the first breast offered is effectively drained before offering the second. As such, referral to an appropriate infant feeding expert should be considered6.
NICE CKS states that the following should NOT be recommended due to insufficient evidence:
- Simeticone (eg. infacol) or lactase (eg. colief) drops
- Changes to maternal diet (if breastfeeding) or changing formula preparation (if formula feeding)
- Herbal supplements
- Spinal manipulation or cranial osteopathy
Follow up should be based on clinical judgement, and referral to paediatricians considered if reassurance in primary care has not been possible, of it there is diagnostic uncertainty – remember colic is a diagnosis of exclusion.
Information and support for parents
Purple Crying Website A useful resource to explain colic to parents.
CRY-SIS A charity offering help and support to parents with babies who cry excessively or have sleeping problems.
- Wessel M, Cobb J, Jackson E, Harris G, Detwiler A. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics. 1954;14(5):421-35.
- Lucassen P, Assendelft W, Gubbels J, van Geldrop W. Systematic review of the occurrence of infantile colic in the community. Archives of Disease in Childhood 2001;84(5), 398-403.
- NICE CKS: Colic- Infantile last revised July 2017
- Drug and Therapeutics Bulletin. Management of infantile colic BMJ 2013; 347 :f4102
- Long T, Johnson M. Living and coping with excessive infantile crying. Journal of Advanced Nursing. 2001;34(2):155-162.
- The Breastfeeding Network: Assessing the Evidence- Treatments for Colic March 2002