Infant Colic

What is Infant Colic?

Infant colic is a common, harmless condition in which a healthy, well-fed baby has long periods of crying that cannot be soothed and that have no apparent cause. It begins in the first weeks of life and usually settles on its own.^{[1, 2]}

Common symptoms

The key feature is crying, irritability or screaming that lasts 3 hours or more, most often in the evening.^[1] Babies may have a red face, draw up their legs and have a tense belly, and the usual soothing methods often do not work.^[1]

Causes and risk factors

The cause is not known. Researchers think several things contribute, including how the nervous system and gut are maturing, gut bacteria, feeding and psychosocial factors.^{[2, 3]} Some studies link infant colic with later migraine, and this link is an active research area.^[4]

How it is diagnosed and treated conventionally

A pediatric provider diagnoses colic from the history and a physical exam, after ruling out other medical causes.^{[1, 3]} Parent education and reassurance are central, and a review of treatments found that no therapy has strong support because large, high-quality trials are lacking.^[3]

Among the options studied, the probiotic Lactobacillus reuteri DSM 17938 has the best support. A pooled analysis of four double-blind trials of 345 infants found less crying than with placebo, mainly in breastfed infants.^[5] Cochrane reviewers could not recommend any dietary change, because studies were small, at high risk of bias and of very low certainty.^[2] In studies that followed infants for several months, crying declined steeply over time in both treated and untreated groups.^[6]

Why Infant Colic calls for a whole-person approach

Infant colic is a pediatric condition, and the first step is a pediatrician's evaluation. The factors below are those researchers have explored, and they help explain why the family, not only the baby's belly, is part of the picture.^[3]

Because the cause is unclear and no treatment has strong support, most guidance centers on supporting the baby and the people caring for the baby.^{[3, 7]}

Gut and feeding

Gut immaturity, food sensitivity and gut bacteria are all proposed contributors, though the role of diet remains controversial.^{[2, 3]}

Nervous system and migraine link

Several studies have found an association between infant colic and migraine, and several treatment trials aimed at the gut have been negative.^[4]

Parent stress and family strain

Excessive crying in early infancy has been linked with early weaning and with maternal anxiety and depression, and parents of crying babies can become exhausted.^[7] Teaching parents how to respond to inconsolable crying is considered important, including for preventing shaken baby injury.^[4]

Acupuncture as supportive care in Infant Colic

What the research shows

The research on acupuncture for infant colic is limited and mostly does not show a benefit. Any decision about acupuncture for a baby belongs with the baby's pediatrician.

A pooled analysis of three randomized trials with 307 infants found that infants who got needle acupuncture cried about 25 minutes less than untreated infants at mid-treatment, but the difference was no longer significant at the end of treatment or at follow-up. It also disappeared when a trial with unsuccessful blinding was excluded, and parents reported more crying during the acupuncture itself. The authors advised against recommending needle acupuncture for infant colic in general.^[8]

A review of four randomized trials, all from northern Europe and all using gentle minimal acupuncture at one or two points, described a possible effect on crying, feeding and stooling. It called the evidence inconclusive because of small samples and differences between studies.^[9] A systematic review of interventions concluded that acupuncture trials showed no or minimal effect on crying time.^[6] An overview of 16 systematic reviews rated most of them as having low confidence and did not recommend acupuncture.^[10]

How acupuncture may work

No study has shown how acupuncture might ease infant colic, and this page does not claim a mechanism. The trials were designed to test whether crying time changed, not how.^[9]

What treatment involves

For adults, acupuncture uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. The infant trials used minimal needling at one or two points, a very different approach.^[9] Because the evidence does not support routine needle acupuncture for infants, we do not present it here as a treatment for a baby with colic.

Adults caring for a colicky baby may ask about acupuncture for their own stress, sleep or mood. For the postpartum period, meta-analyses of 9 and 12 trials found acupuncture improved some depression outcomes, but the evidence was inconclusive and trials had weaknesses.^{[11, 12]} This concerns postpartum depression, not colic. Serious problems from acupuncture are rare, and in prospective studies about 9 in 100 patients had a minor reaction such as brief soreness or bleeding at a needle site.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker.

Ayurvedic medicine as supportive care in Infant Colic

The Ayurvedic view

Ayurveda is a traditional system that links digestive discomfort with the movement of Vata and the strength of digestion (agni). This is a traditional explanatory framework, not a biomedical diagnosis, and it has not been tested as a cause of infant colic.

Therapies that may be used

Ayurvedic care for infants is traditionally gentle and centered on feeding, routine and the caregiver's own diet and calm. Panchakarma procedures are not appropriate for infants, and are also not appropriate during pregnancy, acute illness or frailty. Ayurvedic herbs and oils should not be given to a baby without a pediatrician's agreement.

For the adults in the home, regular meals, steady sleep hours and calming daily routines are traditional parts of Ayurvedic care.

What the research shows

No clinical trials of Ayurvedic medicine for infant colic turned up in PubMed. Traditional gripe water preparations are widely given to infants in some regions. In a survey of 335 mothers in India, babies given gripe water had more colic, vomiting and constipation than those who were not, which cannot show cause and effect but gives no sign of benefit.^[14] Ayurvedic products also vary in quality: about one fifth of those bought online contained detectable lead, mercury or arsenic.^[15]

Herbal medicine as supportive care in Infant Colic

Herbs and formulas that have been studied

Fennel is the herb with the most research. The studies used fennel oil or extracts, in one case combined with chamomile and lemon balm, given to infants.^{[2, 16]}

What the research shows

The evidence is limited. A meta-analysis of three trials of fennel-containing preparations in breastfed or mixed-fed infants found about 72 fewer minutes of crying per day, with a very wide confidence interval (about 18 to 126 minutes) and limitations noted by the authors.^[16] The Cochrane review described one study of 93 infants given an extract of fennel, chamomile and lemon balm, which reported less daily crying than placebo, but it rated the overall evidence for dietary interventions as very low certainty.^[2] An overview of reviews judged fennel extract promising but with remaining concerns, and most reviews were at high or unclear risk of bias.^[10] These findings do not mean a home herbal product is safe or effective for your baby.

Safety and herb-drug interactions

Herbal products for infants carry real risks. A case report describes a 9-month-old who developed septic shock after taking a contaminated herbal supplement commonly used for colic.^[17] In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[15]

Do not give an infant any herbal product, tea, drops or oil without your pediatrician's approval. For adults, herbs can interact with prescribed medicines, and nursing parents should check any herb with their physician first.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Traditional frameworks describe infant crying in terms of digestive imbalance. Researchers study several overlapping ideas: gut maturation and microbes, feeding, nervous system immaturity and family stress.^{[2, 3]}

Fennel, a traditional digestive herb, is one place where a traditional use has been tested in infants, with limited and uncertain results.^{[10, 16]} No study has shown that a dosha or Chinese medicine pattern corresponds to a specific biological process.

How this care fits with your medical care

Complementary care does not replace your baby's pediatrician. Keep all well-baby visits and follow your pediatrician's advice about feeding, probiotics or any medicine. We do not diagnose colic or decide what is causing a baby's crying.

If you come to us for your own stress, sleep or mood while caring for a baby, please bring a list of your medicines and supplements and tell us if you are breastfeeding. Support for caregivers matters, because crying infants are linked with parental exhaustion and anxiety.^[7]

When to seek urgent medical care

Crying that is not ordinary colic can signal illness, so call your pediatrician for a crying baby who seems unwell.^{[1, 3]}

• Fever, especially in a baby under 3 months old
• Repeated vomiting, green or bloody vomit, or a swollen, hard belly
• Blood in the stool, or very few wet diapers
• Poor feeding, unusual sleepiness, limpness or a high-pitched cry that does not stop
• Difficulty breathing, blue lips, or a baby who cannot be consoled for many hours
• A parent who feels at risk of harming the baby: put the baby down in a safe place and call someone for help

For any emergency, call 911 or go to the nearest emergency department. If you are having thoughts of harming yourself or your baby, call or text the 988 Suicide and Crisis Lifeline.