Summary
Infantile colic is a benign condition characterized by paroxysmal bouts of crying in an otherwise healthy infant with appropriate weight gain. Crying is typically unprovoked, inconsolable, and often occurs in the late afternoon or evening. During these episodes, infants may have facial flushing, grimacing, flexion of the hips, and increased gas. Symptoms usually peak at approximately 6 weeks of age and typically resolve by 5 months. Infantile colic is a clinical diagnosis; use of the Rome IV diagnostic criteria for infantile colic or the rule of threes (colic) may support the diagnosis. The condition is self-limited, and management consists of reassurance and identifying caregiver barriers to coping. While select probiotics may benefit exclusively breastfed infants, physical therapies and other medications are not effective.
Etiology
The etiology of infantile colic is not well understood. Proposed causes include: [1][2]
- Gastrointestinal (e.g., altered intestinal flora, dietary triggers)
- Hormonal (e.g., increased serotonin levels)
- Environmental (e.g., in utero exposure to nicotine) [3]
- Neurodevelopmental
Although the etiology is unknown, pain (e.g., abdominal) is not believed to cause colic.[4]
Clinical features
Infantile colic is characterized by bouts of crying in an otherwise healthy infant with appropriate weight gain. [4]
- Crying episodes are often described as: [1] [2]
- Unprovoked, prolonged, and inconsolable
- Occurring in the late afternoon or evening
- Physical manifestations may include: [1][4]
- Grimacing, clenching fists, flushing
- Flexion of the hips
- Increased gas
Symptoms typically peak at ∼ 6 weeks and resolve by 5 months of age. [2][4]
Red flags for infantile colic [2][5][6]
-
Red flags for inconsolable crying [2]
- Fever
- Gastroinestinal symptoms (e.g., bilious and/or projectile vomiting, explosive diarrhea, abdominal distension, bloody stools) [5]
- Poor feeding
- Lethargy
- Potential symptoms of nonaccidental injury (e.g., tenderness to palpation over the clavicle, scalp, long bones)
- Inguinal and/or scrotal swelling
- Extreme or high-pitched crying
- Growth faltering or weight loss
- Family history of atopy or migraine
- Abnormal examination findings
- Maternal drug use
- Symptoms persisting beyond 5 months of age
- Parental mental health disorders (severe anxiety, depression) [6]
Differential diagnoses
| Differential diagnoses of infantile colic [2] | |
|---|---|
| | Potential conditions |
| Gastrointestinal [2] | |
| Localized cutaneous or mucosal pain [1][2] | |
| Surgical conditions [2] | |
| Injury/trauma [1][2] | |
| Infection [2] | |
| Neurological [1] |
|
Approximately 5% of children with suspected colic are found to have an organic cause. [4]
The differential diagnoses listed here are not exhaustive.
Diagnosis
General principles
- Infantile colic is primarily a diagnosis of exclusion. [4][6]
- Obtain a detailed history, and perform a thorough physical examination, including assessment for: [6]
- Screen for red flags for infantile colic.
- If abnormalities are present, investigate as needed (e.g., abdominal ultrasonography) to exclude differential diagnoses of infantile colic. [2]
- Consider asking parents to keep a diary of infant behavior. [6]
- Rome IV diagnotic criteria for infantile colic are preferred but the rule of threes (colic) is also widely used. [2][4]
Diagnostic studies (e.g., laboratory studies, imaging) are not required in a healthy infant with normal growth and normal phsyical examination. [6]
Rome IV diagnostic criteria for infantile colic [4]
Must meet all of the following criteria:
- Symptoms that begin in infancy and resolve before 5 months of age
- Repeated and prolonged periods of crying, fussiness, and/or irritability without an obvious reason that the caregiver is unable to stop or soothe
- No signs of growth faltering or evidence of underlying illness (e.g., fever)
Rule of threes (colic) [2][4][7]
Crying in an otherwise healthy infant that lasts: [6]
- ≥ 3 hours per day
- ≥ 3 days per week
- For ≥ 3 weeks
Management
- Infantile colic is a self-limited condition but may lead to caregiver exhaustion and negatively affect bonding with the child. [4]
- Provide reassurance that the condition typically resolves by 5 months of age. [2]
- Identify caregiver barriers to coping, and offer resources. [6]
- Ensure appropriate nutritional intake and feeding volume and/or frequency. [5]
- The following interventions are commonly offered but have little to no supporting evidence:
- Modified feeding techniques [1]
- Dietary interventions, e.g.: [2][6][8]
- Low-allergen diet for breastfeeding parents
- Hydrolyzed formula for formula-fed infants
- Probiotics in exclusively breastfed infants [9]
Medications are not recommended for infantile colic as they are either ineffective (e.g., simethicone, medications for GERD) or are contraindicated in this age group (e.g., dicyclomine). Physical therapies (e.g., chiropractic and osteopathic manipulation) are also ineffective for treating colic. [2][4]