Colic, Infantile



  • Colic is defined as excessive crying in an otherwise healthy infant.
  • A commonly used criteria is the Wessel criteria or the Rule of Three, when crying lasts for:
    • >3 hr/day
    • >3 days/week
    • Persists >3 weeks
  • Many clinicians do not strictly adhere to the criterion of persistence for >3 weeks because few parents or clinicians will wait that long before evaluation or intervention.
  • The Rome IV criteria refined the criteria for clinical purposes and for research purposes.
  • For Rome IV clinical diagnostic criteria, must include all the following:
    • An infant who is <5 months when symptoms start and stop
    • Recurrent and prolonged periods of crying, fussing, or irritability without obvious cause and unable to console
    • No evidence of failure to thrive, fever, or illness
  • Additional Rome IV criteria for clinical research purposes:
    • Caregiver reports crying/fussing for ≥3 hr/day during ≥3 days within a week.
    • Total daily crying is ≥3 hours when measured by at least one prospectively kept 24-hour diary.
  • Colic usually peaks at 6 weeks of life.
  • Some clinicians consider that colic represents the extreme end of the spectrum of normal crying, whereas most consider colic a distinct clinical entity.



  • Predominant age group is between 2 weeks and 4 months of age.
  • Equal predominance among males and females, breast-fed versus formula fed, full term versus preterm, and first-born versus subsequent-born.
  • Possibly more common in industrialized countries and in white infants


  • Wide range from 8% to 40% of infants; however, more likely affects 10–25% of infants
  • Causes 10–20% of pediatric visits during the early weeks of an infant’s life

Pediatric Considerations
This is a problem during infancy.

Etiology and Pathophysiology

The cause is unknown. Factors that may play a role include the following:

  • Infant gastroesophageal reflux disease
  • Intolerance to cow’s milk, soy milk, or breast milk protein
  • Intolerance to lactose and functional lactose overload (i.e., breast milk with lower lipid content can have faster transit time in the intestine, leading to more lactose fermentation in the gut and hence gas and distension)
  • Intestinal immaturity leading to incomplete absorption of carbohydrates in the small intestine, which result in excessive gas when the unabsorbed carbohydrate is fermented by colonic bacteria
  • Alterations in intestinal or fecal microflora
  • Swallowing air during the process of crying, feeding, or sucking
  • Overfeeding or feeding too quickly; underfeeding has also been proposed.
  • Inadequate burping after feeding
  • Family tension and/or stress
  • Parental anxiety, depression, and/or fatigue
  • Parent–infant interaction mismatch
  • Infant’s inability to console himself or herself when dealing with stimuli
  • Hypersensitivity after exposure to prolonged environmental stimuli
  • Fruit juice intolerance
  • Increases in the gut hormone motilin, causing hyperperistalsis
  • Tobacco smoke and nicotine exposure
  • Immature motor regulation
  • Increased serotonin concentration
  • Possible early manifestation of childhood migraine

Risk Factors

  • Physiologic predispositions in an infant may play a role, but no definitive risk factors have been established.
  • Maternal smoking or exposure to nicotine replacement therapy during pregnancy is associated with higher incidence of infantile colic.
  • Infants with a maternal history of migraine headaches are twice as likely to have colic.

General Prevention

Colic is generally not preventable.

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