Patient information: Colic (excessive crying) in infants

Patient information: Colic (excessive crying) in infants


Teri Lee Turner, MD, MPH, MEd
Shea Palamountain, MD


UpToDate performs a continuous review of over 375 journals and other resources. Updates are added as important new information is published. The literature review for version 15.2 is current through May 2007; this topic was last changed on July 6, 2006. The next version of UpToDate (15.3) will be released in October 2007.

INTRODUCTION — Colic is one of the most distressing problems of infancy. It is distressing for the infant, the parents, and for the healthcare provider. The cause of colic is not well understood, but it resolves in most infants by 3 to 4 months of age. Nonetheless, many parents need reassurance and support to get through this difficult stage of an infant's life.

DEFINITIONS — The most widely accepted definition of colic follows the "rule of three": crying lasts for more than three hours per day, occurs on more than three days per week, and persists for more than three weeks (also known as the Wessel criteria).

Colic occurs in 8 to 40 percent of all infants. It occurs with equal frequency in the following groups:

Males and females
Breast- and bottle-fed infants
Full-term and preterm infants
The first and second child (and other siblings as well)
Normal crying patterns — All infants cry more during the first three months of life than during any other time. There is no standard definition for "excessive" crying; the average duration of crying during this period varies from 42 minutes to two hours per day. Infants without colic cry, although generally less frequently and for a shorter duration than infants with colic.

Colic — Colic may encompass more than excessive crying, at least in some infants. Some experts suggest that the diagnosis of colic requires three of four criteria, in addition to crying.

Onset — Each episode of colic has a clear beginning and end, and the onset is unrelated to what was happening before the episode started; the infant may have been happy, fussy, feeding, or even sleeping. The crying episode begins suddenly and often occurs in the evening hours.
Differs from normal crying - Colic episodes are more intense, louder, and higher pitched than "normal" crying. Infants with colic may sound as if they are in pain or are screaming.
Increased muscle tone - Infants with colic may have physical symptoms (show table 1).
Difficult to soothe - Infants with colic are difficult or impossible to soothe, no matter what the parents do. There may be periods of quiet, but infants often remain fussy. Crying may end after the infant passes gas or a bowel movement.
For all infants, colic is a temporary problem. It resolves by three months in 60 percent of infants and by nine months in 90 percent of infants