- Author: Prashant G Deshpande, MD; Chief Editor: Carmen Cuffari, MD more...
Colic is commonly described as a behavioral syndrome in neonates and infants that is characterized by excessive, paroxysmal crying. Colic is most likely to occur in the evenings, and it occurs without any identifiable cause.
Essential update: Study suggests that colic is a form of migraine headache
A recent meta-analysis indicated that colic may be a form of migraine headache rather than, as has been proposed, a gastrointestinal condition. The analysis utilized 3 studies (891 subjects total), one of which indicated that there is a greater likelihood of colic in infants whose mothers have migraine headaches and the other two of which indicated that infants with colic are more likely to experience migraine in childhood and adolescence. Using a pooled random effects model in their analysis, Gelfand and colleagues found the odds ratio for an association between migraine and colic to be 5.6.[1, 2]
In a secondary analysis, which included two additional studies (both of which also looked at the colic/migraine link but addressed a different primary research question), the odds ratio for the association between migraine and colic was 3.2.
Signs and symptoms
In the setting of colic, a detailed history should be obtained regarding the following:
Timing of crying: Crying by infants with or without colic is mostly observed during evening hours and peaks at the age of 6 weeks
Amount of crying: The amount of crying is not related to an infant’s sex; the mother’s parity; or the parents’ socioeconomic status, education, or ages
Characteristics of crying: Compared with regular crying, colicky crying is more turbulent or dysphonic and has a higher pitch
Family’s daily routine
Possible other causes of excessive crying (eg, having hair in the eye, strangulated hernia, otitis, sepsis); colic remains a diagnosis of exclusion
On physical examination, the keys to the diagnosis are as follows:
Normal physical findings
Weight gain: Infants with colic often have accelerated growth; failure to thrive should make one suspicious about the diagnosis of colic
Exclusion of potentially serious diagnoses that may be causing the crying
Demonstrated and suggested causes of colic may include the following:
Gastrointestinal causes (eg, gastroesophageal reflux disease [GERD], over- or underfeeding, milk protein allergy, early introduction of solids)
Inexperienced parents (controversial) or incomplete or no burping after feeding
Exposure to cigarette smoke and its metabolites [3, 4]
Food allergy [5, 6]
Low birth weight 
Characteristic intestinal microflora [8, 9]
See Clinical Presentation for more detail.
The following should be kept in mind in the workup of a patient with colic:
Laboratory studies are usually not indicated unless another condition is suspected
If the patient’s stools are excessively watery, testing them for excess reducing substances may be worthwhile; positive results may indicate an underlying GI problem
Stool may be tested for occult blood to rule out cow’s milk allergy
Irritability and crying may be associated with GERD because of the pain associated with esophagitis
See Workup for more detail.
General management principles include the following:
Rule out common causes of crying
Recommend that the parents not exhaust themselves, and encourage them to consider leaving their baby with other caretakers for short respites
Drug treatment generally has no place in management of colic unless GERD appears likely; although the anticholinergic agent dicyclomine hydrochloride is effective against colic, it has rare but serious adverse effects and cannot be recommended
Consistent follow-up and a sympathetic physician are the cornerstones of management
Various benign but unproven treatment modalities are available, including the following:
Maternal low-allergen diet (ie, low in dairy, soy, egg, peanut, wheat, shell fish) may offer relief from excessive crying in some infants.
Oral hypertonic glucose
Spinal manipulation (to recommended with caution, if at all)
Nutritional supplements and other complementary medicines
Dietary changes may include the following:
Elimination of cow’s milk protein in cases of suspected intolerance of the protein
In infants with suspected cow’s milk allergy (CMA), a protein hydrolysate formula is indicated
Uncommonly, amino acid–based formulas may be needed to manage suspected CMA, though evidence may be lacking for use in colic
Soy-based formulas are not recommended, because many infants who are allergic to cow’s milk protein may also become intolerant of soy protein
Colic is commonly described as a behavioral syndrome characterized by excessive, paroxysmal crying. Colic is most likely to occur in the evenings, and it occurs without any identifiable cause. During episodes of colic, an otherwise healthy neonate or infant aged 2 weeks to 4 months is difficult to console. They stiffen, draw up their legs, and pass flatus. Colic is one of the common reasons parents seek the advice of a pediatrician or family practitioner during their child's first 3 months of life.
The most widely used definition of colic was used by Wessel et al. Their definition is based on the amount of crying (ie, paroxysms of crying lasting >3 h, occurring >3 d in any week for 3 wk).
Colic is a poorly understood phenomenon. It is equally likely to occur in both breastfed and formula-fed infants. Although potential adverse sequelae have been described, the disorder is generally believed to be self-limited and benign. Different feeding practices and crying may result in large amounts of air entering the gastric lumen, which suggests that excessive aerophagia may be associated with colic. Colonic fermentation is the second proposed source of excessive intestinal gas in infants. However, no experimental evidence supports either theory.
Increased levels of certain biochemical markers, such as motilin, alpha lactalbumin, and urinary 5-hydroxy-3-indole acetic acid (5-OH HIAA) have been associated in infants with colic. Data from one study suggested that psychosocial stress during pregnancy is associated with babies who develop colic. Further research is needed to establish a causal relationship of these factors to colic.
Although anticholinergic drugs have proven effective, they are not recommended because of their serious adverse effects. Parental anxiety can be minimized if the physician discusses colic, offers insight on future expectations, and answers the parents' questions. Reassure the parents about the generally benign and self-limiting nature of the illness. A caring and compassionate healthcare provider remains the cornerstone in the management of colic, a problem for which effective therapy remains elusive.
The term colic derives from the Greek word kolikos or kolon, suggesting that some disturbance is occurring in the GI tract. Researchers have also postulated nervous system, behavioral, and psychologic etiologies.
Colic affects 10-30% of infants worldwide.
Increased susceptibility to recurrent abdominal pain, allergic disorders and certain psychological disorders may be seen in some babies with colic in their childhood.
This condition is encountered in male and female infants with equal frequency.
The colic syndrome is commonly observed in neonates and infants aged 2 weeks to 4 months.
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