Definition

• A baby less than 3 months old with excessive crying
• Crying is the only symptom and baby is normal when not crying

Health Information

Symptoms

• A lot of crying once or twice per day
• Usually consolable when held and comforted
• Acts normal (happy, contented) between bouts of crying. The baby is not sick
• The baby is getting enough to eat and is not hungry
• Onset most often before 2 weeks of age

Cause

• Colic is due to your baby’s sensitive, alert temperament. It’s also called normal fussy crying. It usually occurs at times when your baby is sleepy.
• It has nothing to do with your parenting.
• It is not caused by gas, spitting up or stomach pain.
• Gas does not cause crying. All crying babies pass lots of gas. Their stomachs also make lots of gassy noises. The gas comes from swallowed air. The gas is normal. It does not cause any pains.
• Feeding too much. Some babies cry more because of a bloated stomach from overfeeding. Unlike gas, too much milk can cause discomfort that lasts a short time.

Care Advice

1. Overview:
   • Some babies are very hard to comfort when they cry.
   • Some babies also cry a lot (over 3 hours per day).
   • If growing normally and happy when they are not crying, this is normal.
   • Here is some care advice that should help.
2. Feedings:
   • For formula-fed babies, feed if more than 2 hours since the last feeding.
   • For breast-fed babies, feed if more than 1½ hours since the last feeding.
   • Be careful not to feed your baby every time she cries.
   • Caffeine. If breastfeeding, decrease your caffeine intake. Limit your coffee, tea and energy drinks to 2 servings per day. That’s 2 cups or 16 ounces (480 ml).
3. Hold and Comfort for Crying:
   • Hold and try to calm your baby whenever he cries without a reason. Hold your baby flat to help them relax and go to sleep.
   • Rock your child in a rocking chair, in a cradle or while standing. Many babies calm best with rapid tiny movements like vibrations.
   • Place in a windup swing or vibrating chair.
   • Take for a stroller ride, outdoors or indoors.
   • Do anything else you think may be comforting. Examples are using a pacifier, massage, or warm bath.
4. Swaddle your Baby in a Blanket for Crying:
   • Swaddling is the most helpful technique for calming crying babies. It also keeps your baby from waking up with a startle reflex.
   • Use a big square blanket and the “burrito-wrap” technique:
   • Step 1: Have the arms inside and straight at the sides.
   • Step 2: Pull the left side of the blanket over the upper body and tuck.
   • Step 3: Fold the bottom up with the knees a little flexed.
   • Step 4: Pull the right side over the upper body and tuck.
   • Caution: Don’t cover your baby’s head or overheat your baby.
   • Caution: Stop swaddling when your baby shows any signs of rolling over. Age limit: 2 months. The startle reflex will usually be gone by this age. At 2 months, it’s time to transfer to a sleep sack with the arms out.
   • Read the book (or view the DVD), “The Happiest Baby on the Block”. Both products are authored by Dr. Harvey Karp. It is the best resource on how to calm fussy babies.
5. White Noise for Crying:
   • Swaddling works even better when paired with a low-pitched white noise. Examples are a CD, vacuum cleaner, fan or other constant sound.
   • Caution: Avoid making white noise too loud. Reason: could damage hearing.
   • Keep the white noise on any time your baby is crying.
   • When your baby is awake and not crying, keep your baby unwrapped. Turn off the white noise. Reason: So she can get used to the normal sounds of your home.
6. Falling Asleep on Their Own:
   • Often, babies cry because they need to sleep. If over 2 hours have passed since the last nap, this could be the reason.
   • You have tried different ways to comfort your baby. You fed him recently. Nothing you do seems to help your baby relax. If so, it’s time to get out of the way.
   • Swaddle your baby. Place him on his back in his crib. Turn on some white noise or soothing music and leave the room.
   • Let your baby fuss until he falls asleep.
   • For some overtired babies, this is the only answer.
7. Encourage Nighttime Sleep (Rather Than Daytime Sleep):
   • Try to keep your child from sleeping too much during the daytime.
   • If your baby has napped 2 hours or longer, gently wake him up. Play with or feed your baby, depending on his needs. This will lessen the amount of time your baby is awake at night.
8. Warning:
   • Never shake a baby. It can cause bleeding on the brain and severe brain damage.
   • Never leave your baby with someone who is immature or has a bad temper.
   • If you are frustrated, put your baby down in a safe place.
   • Call or ask someone to help you.
9. What to Expect:
   • The right technique should start to reduce the crying. You may have to try several things before finding the best method.
   • The crying should start to decrease to about 1 hour per day.
   • Colic peaks at 4 to 6 weeks. It gets better after 2 months of age. Most often, it is gone by 3 months.

Call Your Doctor If

• Your baby starts to look or act abnormal
• Cries nonstop for more than 2 hours
• Your child can’t be consoled using this advice
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

#AAP