Experience | Leaflets | Support | News | Products | Other
This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Infantile Colic
Post your experienceSee others (4 there)
Infantile colic is now commonly defined as distress or crying in an infant, which lasts for more than three hours a day, for more than three days a week for at least three weeks in an otherwise healthy infant. It is a common condition and, despite much research on the subject, the underlying cause is still the subject of debate.1 There is some evidence that the condition is linked to high levels of motilin and ghrelin, hormones secreted by cells in the small intestine which have an effect on intestinal motility.2
Other theories include food allergy, disturbed gut motility and visceral hypersensitivity.3
Infantile colic is very common in occurring but the precise incidence is unknown as many parents do not seek professional help. Others may seek professional help for what may be considered as normal levels of crying.4,5 One population-based study found the incidence of infantile colic to be 3.3-17%, depending on the definition used and whether the symptoms were reported prospectively or retrospectively.6
One study suggested that maternal smoking and passive infant smoking at the age of five weeks were risk factors. Breast-feeding tended to ameliorate these effects.7
Symptoms
The symptoms seen in infants described as having colic are all non-specific and infantile colic must be a diagnosis of exclusion when the clinician is satisfied that the child is otherwise healthy. Commonly described features of colic include:8
- Inconsolable crying - typically high-pitched and occurring frequently in the afternoon or evening
- Redness of the face
- Drawing up of knees
- Flatus
A history should include:
- Feeding - breast/bottle
- Weight gain
- Bowel habit- stool consistency/colour/blood
- Vomiting or reflux
- Timing of crying
- Duration of crying
An examination should include:
- General examination - size of infant/hydration/apparent injury
- Abdominal examination including hernial orifices and genitalia
Inconsolable crying and distress may indicate pain or other physical discomfort and other possible causes of pain should be sought in an acute situation, although many parents will present with a history of inconsolable crying and an infant who appears to be thriving and content.
In an acute situation when faced with a distressed infant consider:
- Physical discomfort - cold, wet, hungry
- Severe nappy rash
- Corneal abrasion from infant's nails
- Intussusception
- Volvulus
- Strangulated hernia
- Torsion of the testis
- Non-accidental injury
When the history is over a longer period of time consider:
- Reflux oesophagitis
- Lactose intolerance
- Parenting skills and experience of parents
- Maternal post-natal depression
The diagnosis is usually made using history and examination alone and does not normally require any further investigations. Infants who exhibit atypical features, or in whom the diagnosis is in doubt, should be referred for a specialist opinion either as an emergency or to an out-patient clinic depending on the clinical presentation.
Infantile colic may be associated with cow's milk intolerance in some cases.
Non-drug9
- The parents of infants with colic may require support as they will be anxious as to the cause of the crying and their apparent inability to help the child. General advice to the parents may be all that is needed in terms of feeding regimes, temperature of the child's room, clothing worn by the child, together with an explanation of the likely course of the condition. Parents may be advised to share childcare with each other and friends/grandparents until this stage is passed in order to prevent physical/mental exhaustion.
- There is some evidence to support the substitution of cow's milk with soya milk, casein hydrolysate milk or low lactose milk. Other measures which require further investigation include sucrose solution, herbal tea, reduction of stimulation of the infant and bathing in warm water.10 Probiotics may be of benefit.11
- One study found some benefit from the use of a minimal acupuncture technique.12
Drugs
There are no clear management guidelines for the treatment of infantile colic and no evidence-based cures.13 If parents feel unable to tolerate the child's crying until the condition has resolved spontaneously, symptoms may be relieved by the use of simethicone although evidence of benefit has not been borne out by randomised controlled trials.9 Drugs in the anti-muscarinic group, such as dicycloverine, have demonstrated effectiveness in clinical trials but their use is limited by adverse effects and they are contra-indicated in infants under the age of 6 months.4,14 Other agents have been tried, although at present there is insufficient evidence to recommend any single agent for routine use in infant colic.15
One study found that 29% of infants aged 1-3 months suffered from colic but by 4-6 months of age the prevalence had fallen to 7-11%.9
There is some evidence to suggest that the condition is linked to maternal smoking. These findings could act as a stimulus for health promotion advice during pregnancy.16
Document references
- Leung AK; Infantile colic. Am Fam Physician. 1987 Sep;36(3):153-6. [abstract]
- Savino F, Grassino EC, Guidi C, et al; Ghrelin and motilin concentration in colicky infants. Acta Paediatr. 2006 Jun;95(6):738-41. [abstract]
- Gupta SK; Update on infantile colic and management options. Curr Opin Investig Drugs. 2007 Nov;8(11):921-6. [abstract]
- Lucassen PL, Assendelft WJ, van Eijk JT, et al; Systematic review of the occurrence of infantile colic in the community. Arch Dis Child. 2001 May;84(5):398-403. [abstract]
- Zwart P, Vellema-Goud MG, Brand PL; Characteristics of infants admitted to hospital for persistent colic, and comparison with healthy infants. Acta Paediatr. 2007 Mar;96(3):401-5. [abstract]
- Canivet C, Hagander B, Jakobsson I, et al; Infantile colic--less common than previously estimated? Acta Paediatr. 1996 Apr;85(4):454-8. [abstract]
- Canivet CA, Ostergren PO, Jakobsson IL, et al; Infantile colic, maternal smoking and infant feeding at 5 weeks of age. Scand J Public Health. 2008 May;36(3):284-91. [abstract]
- Reust CE, Blake RL Jr; Diagnostic workup before diagnosing colic. Arch Fam Med. 2000 Mar;9(3):282-3.
- Wade S, Kilgour T; Extracts from "clinical evidence": Infantile colic. BMJ. 2001 Aug 25;323(7310):437-40.
- Arikan D, Alp H, Gozum S, et al; Effectiveness of massage, sucrose solution, herbal tea or hydrolysed formula in the treatment of infantile colic. J Clin Nurs. 2008 Jul;17(13):1754-61. [abstract]
- Savino F, Pelle E, Palumeri E, et al; Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics. 2007 Jan;119(1):e124-30. [abstract]
- Reinthal M, Andersson S, Gustafsson M, et al; Effects of minimal acupuncture in children with infantile colic - a prospective, quasi-randomised single blind controlled trial. Acupunct Med. 2008 Sep;26(3):171-82. [abstract]
- Cohen-Silver J, Ratnapalan S; Management of infantile colic: a review. Clin Pediatr (Phila). 2009 Jan;48(1):14-7. Epub 2008 Oct 2. [abstract]
- British National Formulary for Children; British Medical Association and Royal Pharmaceutical Society of Great Britain. London.
- Roberts DM, Ostapchuk M, O'Brien JG; Infantile colic. Am Fam Physician. 2004 Aug 15;70(4):735-40. [abstract]
- Shenassa ED, Brown MJ; Maternal smoking and infantile gastrointestinal dysregulation: the case of colic. Pediatrics. 2004 Oct;114(4):e497-505. [abstract]
Document ID: 2317
Document Version: 22
Document Reference: bgp24917
Last Updated: 9 May 2009
Planned Review: 9 May 2011
The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.
Patient UK Hearing Impairment Survey
Patient UK are grateful to the 550 people who took part in this survey.
To see the results click here.
If you'd like to leave your feedback, please go to our interactive forum.
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicine
View Patient Experience for 'Infantile Colic' (4 there)Health Topic information leaflets related to this topic (^ top of page)
Baby ColicSupport Groups related to this topic (^ top of page)
Cry-sisPatient UK Newspaper (^ top of page)
Latest Health News
View current health newsRelated Products (^ top of page)
Online Pharmacy
Dentinox Infant Colic Drops
Infacol Suspension
Infacol Suspension Triple Pack
Woodward's Gripe WaterMedical equipment

Books

Other - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
UK Guidelines
Online Videos
Medline
Other good health sites
Want to search some more? Use the Google Search box below to search our site.
Disclaimer: Patient UK has no control over the content of any external links above. Inclusion does not imply endorsement by Patient UK.
Want to advertise on this site? Find out how >>
Here you can follow a link to view existing patient experiences on this subject, or to add your own
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Note: this will open in a new window
Note: this will open in a new window
Here you can follow a link to view existing patient experiences on this subject, or to add your own
This will offer you the usual PDF options i.e. document navigation, search, zoom and formatted print
Note: this is the best way to print the document
Note: this will open in a new window
Note: this will open in a new window




