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Infantile colic: Clinical features and diagnosis

Teri Lee Turner, MD, MPH, MEd
Shea Palamountain, MD
Section Editor
Marilyn Augustyn, MD
Deputy Editor
Mary M Torchia, MD


Persistent or excessive crying (colic) is one of the most distressing problems of infancy. It is distressing for the infant, the parents, and the clinician [1]. The parents may view the crying as evidence of illness or as an indictment of their caregiving ability [2]. Colic is a benign self-limited condition that resolves with time. However, the family's beliefs concerning the cause of crying and their interactions with the healthcare system related to the crying may affect the way in which they view the child and the healthcare system long after the crying has resolved.

The clinical features, etiology, and diagnosis of prolonged or excessive crying in young infants are reviewed here. The management is discussed separately. (See "Infantile colic: Management and outcome".)


Normal patterns of crying — All infants, whether or not they have colic, cry more during the first three months of life than at any other time. In a meta-analysis of 24 studies of parental crying diaries, mean duration of crying was 110 to 118 minutes per day during the first six weeks of life, and decreased to 72 minutes per day by 10 to 12 weeks, but varied widely from infant to infant [3].

Few people agree as to how much crying is considered excessive. The average duration of crying during the first three months of life varies from 42 minutes to 2 hours per day [2]. One author argues that a cutoff point based upon duration is wrong in principle and not helpful clinically because "normal" and "abnormal" crying depend upon the context and quality of crying [4]. In addition, adhering to a strict definition is not helpful to the families whose child does not meet the definition of abnormal.

As patterns of crying are better delineated and understood, clinicians may be better prepared to help parents cope when an identifiable organic etiology is not found.


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Literature review current through: Sep 2016. | This topic last updated: May 31, 2016.
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  1. Taubman B. A new answer to the old question of colic. Contemp Pediatr 1991; 8:44.
  2. Lehtonen LA, Rautava PT. Infantile colic: natural history and treatment. Curr Probl Pediatr 1996; 26:79.
  3. Wolke D, Samara M, Alvarez Wolke M. Meta–analysis of fuss/cry durations and colic prevalence across countries: Proceedings of the11th International Infant Cry Research Workshop, June, 2011, The Netherlands.
  4. Barr RG. Normality: a clinically useless concept. The case of infant crying and colic. J Dev Behav Pediatr 1993; 14:264.
  5. Douglas P, Hill P. Managing infants who cry excessively in the first few months of life. BMJ 2011; 343:d7772.
  6. The period of PURPLE crying. http://purplecrying.info/ (Accessed on May 04, 2015).
  7. WESSEL MA, COBB JC, JACKSON EB, et al. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics 1954; 14:421.
  8. Gormally S, Barr RG. Of clinical pies and clinical clues: Proposal for a clinical approach to complaints of early crying and colic. Ambulatory Child Health 1997; 3:137.
  9. Benninga MA, Faure C, Hyman PE, et al. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016.
  10. Lester BM, Boukydis CF, Garcia-Coll CT, Hole WT. Colic for developmentalists. Infant Ment Health J 1990; 11:320.
  11. Lehtonen L, Korvenranta H. Infantile colic. Seasonal incidence and crying profiles. Arch Pediatr Adolesc Med 1995; 149:533.
  12. ILLINGWORTH RS. Three-months' colic. Arch Dis Child 1954; 29:165.
  13. Hide DW, Guyer BM. Prevalence of infant colic. Arch Dis Child 1982; 57:559.
  14. Rubin SP, Prendergast M. Infantile colic: incidence and treatment in a Norfolk community. Child Care Health Dev 1984; 10:219.
  15. Ståhlberg MR. Infantile colic: occurrence and risk factors. Eur J Pediatr 1984; 143:108.
  16. Wake M, Morton-Allen E, Poulakis Z, et al. Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study. Pediatrics 2006; 117:836.
  17. Reijneveld SA, Brugman E, Hirasing RA. Excessive infant crying: the impact of varying definitions. Pediatrics 2001; 108:893.
  18. Barr RG, Rotman A, Yaremko J, et al. The crying of infants with colic: a controlled empirical description. Pediatrics 1992; 90:14.
  19. Parker S, Magee T. Colic. In: The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed, Augustyn M, Zuckerman B, Caronna EB (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.182.
  20. Clifford TJ, Campbell MK, Speechley KN, Gorodzinsky F. Infant colic: empirical evidence of the absence of an association with source of early infant nutrition. Arch Pediatr Adolesc Med 2002; 156:1123.
  21. St James-Roberts I, Halil T. Infant crying patterns in the first year: normal community and clinical findings. J Child Psychol Psychiatry 1991; 32:951.
  22. Brazelton TB, Robey JS, Collier GA. Infant development in the Zinacanteco Indians of southern Mexico. Pediatrics 1969; 44:274.
  23. Rautava P, Helenius H, Lehtonen L. Psychosocial predisposing factors for infantile colic. BMJ 1993; 307:600.
  24. Räihä H, Lehtonen L, Korvenranta H. Family context in infantile colic. Infant Mental Health 1995; 16:206.
  25. Lester BM. Introduction. In: Colic and Excessive Crying: of the 105th Ross Conference on Pediatric Research, Lester BM, Barr RG (Eds), Ross Products Division, Columbus, OH 1997. p.1.
  26. StJames-Roberts I. Distinguishing between infant fussing, crying, and colic: How many phenomenon?. In: Colic and Excessive Crying: Report of the 105th Ross Conference on Pediatric Research, Lester BM, Barr RG (Eds), Ross Products Division, Columbus, OH 1997. p.3.
  27. Lucas A, StJames-Roberts I. Colic, crying, fussing, and feeding. In: Colic and Excessive Crying: ort of the 105th Ross Conference on Pediatric Research, Lester BM, Barr RG (Eds), Ross Products Division, Columbus, OH 1997. p.68.
  28. Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics 2000; 106:184.
  29. Lucassen PL, Assendelft WJ, Gubbels JW, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ 1998; 316:1563.
  30. Iacovou M, Ralston RA, Muir J, et al. Dietary management of infantile colic: a systematic review. Matern Child Health J 2012; 16:1319.
  31. Hall B, Chesters J, Robinson A. Infantile colic: a systematic review of medical and conventional therapies. J Paediatr Child Health 2012; 48:128.
  32. Miller JJ, McVeagh P, Fleet GH, et al. Effect of yeast lactase enzyme on "colic" in infants fed human milk. J Pediatr 1990; 117:261.
  33. Ståhlberg MR, Savilahti E. Infantile colic and feeding. Arch Dis Child 1986; 61:1232.
  34. Kanabar D, Randhawa M, Clayton P. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Diet 2001; 14:359.
  35. Kearney PJ, Malone AJ, Hayes T, et al. A trial of lactase in the management of infant colic. J Hum Nutr Diet 1998; 11:281.
  36. Moore DJ, Robb TA, Davidson GP. Breath hydrogen response to milk containing lactose in colicky and noncolicky infants. J Pediatr 1988; 113:979.
  37. Miller JJ, McVeagh P, Fleet GH, et al. Breath hydrogen excretion in infants with colic. Arch Dis Child 1989; 64:725.
  38. Hyams JS, Geertsma MA, Etienne NL, Treem WR. Colonic hydrogen production in infants with colic. J Pediatr 1989; 115:592.
  39. Miller AR, Barr RG. Infantile colic. Is it a gut issue? Pediatr Clin North Am 1991; 38:1407.
  40. STEWART AH, WEILAND IH, LEIDER AR, et al. Excessive infant crying (colic) in relation to parent behavior. Am J Psychiatry 1954; 110:687.
  41. FORUP S. Colonic hyperperistalsis in neurolabile infants; studies in so-called dyspepsia in breast-fed infants. Acta Paediatr Suppl 1952; 41:1.
  42. Lothe L, Ivarsson SA, Lindberg T. Motilin, vasoactive intestinal peptide and gastrin in infantile colic. Acta Paediatr Scand 1987; 76:316.
  43. Savino F, Grassino EC, Guidi C, et al. Ghrelin and motilin concentration in colicky infants. Acta Paediatr 2006; 95:738.
  44. Lothe L, Ivarsson SA, Ekman R, Lindberg T. Motilin and infantile colic. A prospective study. Acta Paediatr Scand 1990; 79:410.
  45. Rhoads JM, Fatheree NY, Norori J, et al. Altered fecal microflora and increased fecal calprotectin in infants with colic. J Pediatr 2009; 155:823.
  46. Savino F, Cresi F, Pautasso S, et al. Intestinal microflora in breastfed colicky and non-colicky infants. Acta Paediatr 2004; 93:825.
  47. Savino F, Cordisco L, Tarasco V, et al. Molecular identification of coliform bacteria from colicky breastfed infants. Acta Paediatr 2009; 98:1582.
  48. Savino F, Bailo E, Oggero R, et al. Bacterial counts of intestinal Lactobacillus species in infants with colic. Pediatr Allergy Immunol 2005; 16:72.
  49. Savino F, Pelle E, Palumeri E, et al. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics 2007; 119:e124.
  50. Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics 2010; 126:e526.
  51. Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr 2013; 162:257.
  52. Berseth CL. Immaturity in neonatal regulation of motor activity: Setting the stage for colic. In: Colic and Excessive Crying: Report of the 105th Ross Conference on Pediatric Research, Lester BM, Barr RG (Eds), Ross Products Division, Columbus, OH 1997. p.77.
  53. Baker J, Berseth CL. Postnatal change in inhibitory regulation of intestinal motor activity in human and canine neonates. Pediatr Res 1995; 38:133.
  54. Kurtoglu S, Uzüm K, Hallac IK, Coskum A. 5-Hydroxy-3-indole acetic acid levels in infantile colic: is serotoninergic tonus responsible for this problem? Acta Paediatr 1997; 86:764.
  55. Søndergaard C, Henriksen TB, Obel C, Wisborg K. Smoking during pregnancy and infantile colic. Pediatrics 2001; 108:342.
  56. Reijneveld SA, Brugman E, Hirasing RA. Infantile colic: maternal smoking as potential risk factor. Arch Dis Child 2000; 83:302.
  57. Milidou I, Henriksen TB, Jensen MS, et al. Nicotine replacement therapy during pregnancy and infantile colic in the offspring. Pediatrics 2012; 129:e652.
  58. Sillanpää M, Saarinen M. Infantile colic associated with childhood migraine: A prospective cohort study. Cephalalgia 2015; 35:1246.
  59. Romanello S, Spiri D, Marcuzzi E, et al. Association between childhood migraine and history of infantile colic. JAMA 2013; 309:1607.
  60. Jan MM, Al-Buhairi AR. Is infantile colic a migraine-related phenomenon? Clin Pediatr (Phila) 2001; 40:295.
  61. Katerji MA, Painter MJ. Infantile migraine presenting as colic. J Child Neurol 1994; 9:336.
  62. Bruni O, Fabrizi P, Ottaviano S, et al. Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. Cephalalgia 1997; 17:492.
  63. Gelfand AA, Goadsby PJ, Allen IE. The relationship between migraine and infant colic: a systematic review and meta-analysis. Cephalalgia 2015; 35:63.
  64. Gelfand AA. Infant colic--a baby's migraine? Cephalalgia 2015; 35:1243.
  65. Henderson LJ. The Fitness of the Environment: An Inquiry into the Biological Significance of the Properties of Matter, Macmillan Co, New York 1913.
  66. Carey WB. Infantile colic: a pediatric practitioner-researcher's point of view. Infant Mental Health J 1990; 11:334.
  67. Carey WB. "Colic"--primary excessive crying as an infant-environment interaction. Pediatr Clin North Am 1984; 31:993.
  68. Carey WB. Clinical applications of infant temperament measurements. J Pediatr 1972; 81:823.
  69. Carey WB. Maternal anxiety and infantile colic. Is there a relationship? Clin Pediatr (Phila) 1968; 7:590.
  70. Taubman B. Clinical trial of the treatment of colic by modification of parent-infant interaction. Pediatrics 1984; 74:998.
  71. Taubman B. Parental counseling compared with elimination of cow's milk or soy milk protein for the treatment of infant colic syndrome: a randomized trial. Pediatrics 1988; 81:756.
  72. BRAZELTON TB. Crying in infancy. Pediatrics 1962; 29:579.
  73. Spock B. Etiological factors in the hypertrophic stenosis and infantile colic. Psychosom Med 1944; 6:162.
  74. Petzoldt J, Wittchen HU, Wittich J, et al. Maternal anxiety disorders predict excessive infant crying: a prospective longitudinal study. Arch Dis Child 2014; 99:800.
  75. Paradise JL. Maternal and other factors in the etiology of infantile colic. Report of a prospective study of 146 infants. JAMA 1966; 197:191.
  76. Søndergaard C, Olsen J, Friis-Haschè E, et al. Psychosocial distress during pregnancy and the risk of infantile colic: a follow-up study. Acta Paediatr 2003; 92:811.
  77. van den Berg MP, van der Ende J, Crijnen AA, et al. Paternal depressive symptoms during pregnancy are related to excessive infant crying. Pediatrics 2009; 124:e96.
  78. Carey WB. Colic: Prolonged or excessive crying in young infants. In: Developmental-Behavioral Pediatrics, 4th ed, Carey WB, Crocker AC, Coleman WL, et al (Eds), Saunders Elsevier, Philadelphia 2009. p.557.
  79. Barr RG, Paterson JA, MacMartin LM, et al. Prolonged and unsoothable crying bouts in infants with and without colic. J Dev Behav Pediatr 2005; 26:14.
  80. Lester BM. Definition and diagnosis of colic. In: Colic and Excessive Crying: Report of the 105th Ross Conference on Pediatric Research, Lester BM, Barr RG (Eds), Ross Products Divisions, Columbus, OH 1997. p.8.
  81. Fuller BF, Keefe MR, Curtin M. Acoustic analysis of cries from "normal" and "irritable" infants. West J Nurs Res 1994; 16:243.
  82. Lester BM, Boukydis CF, Garcia-Coll CT, et al. Infantile colic: Acoustic cry characteristics, maternal perception of cry, and temperament. Infant Behav Dev 1992; 15:15.
  83. Pinyerd BJ. Infant colic and maternal mental health: nursing research and practice concerns. Issues Compr Pediatr Nurs 1992; 15:155.
  84. Fleisher DR. Coping with colic. Contemp Pediatr 1998; 15:144.
  85. Carey WB. Colic: Prolonged or excessive crying in young infants. In: Developmental-Behavioral Pediatrics, 4th ed, Carey WB, Crocker AC, Coleman WL, et al (Eds), Saunders Elsevier, Philadelphia 2009. p.557.
  86. Carey WB. The effectiveness of parent counseling in managing colic. Pediatrics 1994; 94:333.
  87. Drug and Therapeutics Bulletin. Management of infantile colic. BMJ 2013; 347:f4102.
  88. Reijneveld SA, van der Wal MF, Brugman E, et al. Infant crying and abuse. Lancet 2004; 364:1340.
  89. Levitzky S, Cooper R. Infant colic syndrome--maternal fantasies of aggression and infanticide. Clin Pediatr (Phila) 2000; 39:395.
  90. Vik T, Grote V, Escribano J, et al. Infantile colic, prolonged crying and maternal postnatal depression. Acta Paediatr 2009; 98:1344.
  91. Radesky JS, Zuckerman B, Silverstein M, et al. Inconsolable infant crying and maternal postpartum depressive symptoms. Pediatrics 2013; 131:e1857.
  92. Akman I, Kusçu K, Ozdemir N, et al. Mothers' postpartum psychological adjustment and infantile colic. Arch Dis Child 2006; 91:417.
  93. Howell EA, Mora P, Leventhal H. Correlates of early postpartum depressive symptoms. Matern Child Health J 2006; 10:149.
  94. Howard CR, Lanphear N, Lanphear BP, et al. Parental responses to infant crying and colic: the effect on breastfeeding duration. Breastfeed Med 2006; 1:146.