What really works to treat infant colic?

The Pediatric Insider

© 2014 Roy Benaroch, MD

Colic is not fun.

You’ve got your little wee baby home, and you’re exhausted. Just when you need some rest the most, Junior cries. And cries, and cries. And nothing seems to help for more than a few moments.

Colic has a medical definition, sometimes called “Wessel’s criteria”: inconsolable crying in an infant less than three months of age, for at least three hours a day, for at least three days a week, for three weeks or more. I doubt many practicing pediatricians or parents rely on all of those “threes.” We use a simpler definition: lots of crying in a baby who we’d hope would cry less.

Babies cry. And that’s the catch, here. They all cry. They don’t have much else they can say. And they’re overwhelmed by all of the changes they’re experiencing, and they haven’t yet learned how to transition from wakefulness to sleep. And some of them don’t like the feeling of rumbly gas in their tummies. And some are scared of their little baby farts. And some of them have parents who are exhausted and strung out and depressed. Honestly, I’m surprised more of them don’t cry all of the time.

But the crying, it can really wear parents down. So all sorts of things have been tried to help soothe crying babies. The latest hip idea (for colic, and almost everything else) is probiotic supplements. These are oral powders that are made of billions of healthy bacteria meant to populate a baby’s gut to help digestion. There’s a lot of research into the “gut biome” and the effect of gut bacteria on the health, specifically relating to digestion and abdominal pain and allergy. Why not toss these at colicky babies, see what helps?

Some studies have shown good promise. Just last month, a study of 589 infants in Italy compared babies given probiotics versus placebo, and found that the babies on a probiotic L reuteri supplement cried for fewer minutes each day (38 versus 71 minutes, on average.) This study looked essentially at the prevention of colic, by giving probiotic supplements to babies whether they had excessive crying or not.

However, the most recent study, a controlled trial of the same probiotic supplement given to colicky babies, showed no effect on any important outcome. The babies, whether given probiotics or not, cried about the same.

Still, there is some good news in common between the studies. The babies, when followed over time, all experienced decreased crying. In other words, colic improved in all groups, whether or not probiotics were given. Also, there we no side effects observed in the probiotic groups. They’re safe, even if they don’t work.

So what does and doesn’t work to help decrease infant crying?

Medicines, universally, don’t seem to work. This includes simethicone (widely available as “Mylicon”, an OTC “gas reliever.”) Studies of medications that reduce acid have also failed to show any effectiveness in improving infant fussiness or crying.

For nursing moms, dietary changes seem to help sometimes—specifically, eliminating dairy consumption. However, this is effective <50% of the time, and you have to weigh a trial of no-dairy-intake versus the effect this has on mom. She needs to be able to eat. Eliminating dairy is difficult (but not impossible)—but eliminating all of the foods possibly implicated in infant crying would be ridiculous. What’s mom supposed to eat, rocks and water? Besides, I don’t like pinning the blame for an upset baby on Mom.

For bottle-feeding families, using a hydrolyzed (hypoallergenic) infant formula has some mixed support from studies. It may be worth a try. What’s unlikely to really help, though, is the endless parade of changing formulas based on manufacturer claims that some are “soothing” or some help in other vague ways.

An insider pro tip I’m not supposed to tell you: As a pediatrician, I can suggest countless alternative formulas for you to try. There are enough alternatives that I can keep changing formulas once a week for at least a few months. By then, baby colic improves. So you’ll think I was smart to finally find the right formula, when in reality I was just changing formula once a week until your baby was going to get better anyway!

So what works best? First, colicky babies need a good, thorough evaluation to make sure that there isn’t a medical problem going on that needs to be addressed. Sometimes that takes more than one visit, and sometimes, if things aren’t going as expected, we have to revisit and re-assess.

But as long as there isn’t a medical issue contributing to the crying, the most important interventions are reassurance, education, and social support. Reassurance that colic does get better, education about safe soothing techniques and signs to look out for, and social support so exhausted parents can get a break once in a while. If parents want to try some safe interventions, that’s fine. But colic isn’t necessarily a medical problem that needs probiotics, diet changes, or medicine. Sometimes, babies just need to cry.

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4 Comments on “What really works to treat infant colic?”

  1. Carina Says:

    What an honest description of the “treatment” for colic – thank you.

    Our 2nd baby had colic, though at the time, we just thought it was a really long “witching hour”. For 2-5 hours every night sometime between 5 and 10 my little girl would cry and cry and cry, that sad pathetic little cry a 1-3 month old baby has. Lucky for me, there were other adults in the house, so I was free to disappear into a dark room with a rocking chair and just cuddle, rock, pat, shush and sing lullabies. Most of that I’m guessing was for me, to convince myself that I was doing all I could to make her feel safe and loved. But it also showed my toddler that we love our baby even when she cries incessantly. Sometimes my son would ask why she was crying and we would tell him that those were her words and she was just telling me all about her day and everything that happened. He was concerned she was hungry, wet, tired, etc. since most of her daytime crying we’d taught him were also her words to tell us what was wrong.

    And, just as you report, this phase passed. We didn’t even really notice right away that the nightly ritual had ended. An added bonus though was that our toddler, who previously had demanded he needed only Mommy to put him to bed and that he needed me by his side till he fell asleep, all of a sudden decided that he didn’t need me there if it included his baby sister during her crying time.


  2. Thank you for sharing valuable information. And It’s really ridiculous how many medications don’t work. Fortunately my baby has passed through colic stage already.

    -Rachel Dee


  3. Ginger Says:

    My colic baby is now 7 years old, but I still remember you telling me to wait through the “4th trimester” and that between 90-100 days old, it should pass. And it did. I don’t remember the actual number of days – something like 95. But I have a picture of the day he turned the corner and was HAPPY for the first time. Unfortunately for me – it happened just in time to go back to work. But I try to pass on your words of wisdom to other parents that have babies that cry a lot.

    And then the BEST advice you gave me…. hire a babysitter and get a break. It did wonders for my patience (and still does!).

    Thanks, Dr. Roy.


  4. […] from The Pediatric Insider. Republished with […]


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