Colic affects 1 in 5 infants and is one of the leading causes of parental exhaustion and anxiety in the first 3 months. Dr. Sushma B explains what causes colic, what works, and what doesn't.
Key Points
- Infant colic is defined as crying >3 hours/day, >3 days/week, in an otherwise healthy baby under 3 months.
- The cause remains unknown — proposed mechanisms include gut microbiome immaturity, feeding issues, and parental anxiety.
- The '5 S's' technique (swaddle, side position, shush, swing, suck) is the most evidence-based calming strategy.
- Probiotics (Lactobacillus reuteri) have the best evidence for reducing colic crying in breastfed infants.
- Simethicone drops have no better evidence than placebo — though widely used in India.
10–40%
of infants experience colic — one of the most variable estimates in paediatrics
Source: NCBI
3 months
age at which virtually all colic resolves spontaneously
Source: IAP
70%
reduction in crying with L. reuteri probiotics in breastfed colicky infants
Source: Cochrane
"Colic is one of the hardest conditions for parents — a healthy, growing baby who simply screams for hours daily. I focus on ruling out serious causes (reflux, intussusception), giving parents the '5 S's', and most importantly — telling them it ends by 3 months in virtually every case."
Colic is defined as episodes of crying in an otherwise healthy infant lasting more than 3 hours per day, more than 3 days per week, for more than 3 weeks — the "Rule of Threes." It affects 10–25% of infants globally and typically begins around 2–3 weeks of age, peaks at 6 weeks, and resolves spontaneously by 3–4 months. Despite its self-limiting nature, colic places enormous strain on parents — sleep deprivation, helplessness, anxiety, and in some cases, postnatal depression.
What Causes Colic?
The honest answer is: not fully understood. Multiple theories exist — none proven as the single cause: intestinal gas and bloating; gut microbiome immaturity; overfeeding or underfeeding; cow's milk protein intolerance (in formula-fed or breastfed babies whose mothers consume dairy); an immature nervous system that is easily overstimulated; and parental anxiety amplifying the baby's distress response. In most colicky babies, no single identifiable cause is found.
What Actually Helps (Evidence-Based)
Probiotics (Lactobacillus reuteri): The most consistently effective intervention in breastfed colicky infants — multiple randomised controlled trials show reduced crying duration. Probiotic drops given daily reduce crying by approximately 50 minutes per day. Less effective in formula-fed babies.
Elimination diet for breastfeeding mothers: If there is clinical suspicion of cow's milk protein intolerance (family history of allergy, eczema, blood in stools), a 2-week trial of maternal dairy elimination is reasonable. If the baby improves, a hypoallergenic formula or continued maternal dairy elimination is appropriate.
Holding and movement: Carrying the baby in a forward-facing position with gentle rhythmic movement — walking, rocking, or car rides — reduces crying in some infants. White noise (fan, running water) mimics womb sounds and calms many colicky babies.
Feeding adjustments: Ensure a good latch if breastfeeding to minimise air swallowing. In formula-fed babies, check teat flow rate — too fast causes swallowing of air.
What Does NOT Help
Simethicone drops (gas drops — "gripe water with simeticone"): Multiple RCTs show no benefit over placebo. Still widely prescribed in India. Herbal gripe waters containing alcohol: contain up to 4% alcohol — not safe for infants. Changing formula repeatedly without clear indication: increases parental anxiety without benefit. Fennel and herbal preparations: limited evidence, some safety concerns.
For colicky infant assessment: Dr. Sushma B at Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.
Dr. Sushma B
DNB Paediatrics · Fellowship PICU · Sri Anand CNC, Chanda Nagar Hyderabad · Sri Anand Child and Neuro Center
MD Paediatrician with 10+ years of clinical experience in child health, vaccination, developmental paediatrics, and newborn care. Practices at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad.
References & Sources
- 1.Infantile Colic — NCBI StatPearls — NCBI StatPearls
- 2.Colic — NHS — NHS UK
- 3.Infant Health — IAP — Indian Academy of Pediatrics
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