31/01/2026
Infantile Colic :
Infantile colic is excessive, inconsolable crying in an otherwise healthy infant, typically starting in the first weeks of life.
Wessel’s Rule of 3 (Diagnostic Criteria)
Colic is usually defined as:
• Crying > 3 hours per day,
• > 3 days per week,
• For > 3 weeks,
• In an infant < 3 months old,
• With no identifiable medical cause.
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Epidemiology
• Affects 10–30% of infants.
• Peak age: 6–8 weeks.
• Usually resolves spontaneously by 3–4 months.
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Clinical Features
• Crying is:
• Paroxysmal (sudden onset),
• Often in late afternoon or evening,
• High-pitched and intense.
• Associated behaviors:
• Clenched fists
• Drawn-up legs
• Facial flushing
• Abdominal distension
• Important: Baby feeds well, gains weight, and is otherwise normal between episodes.
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Proposed Causes (multifactorial)
No single proven cause; likely contributors include:
• Gut immaturity / dysmotility
• Gas and altered microbiome
• Sensitivity to stimuli
• Caregiver–infant interaction factors
• Possible cow’s milk protein sensitivity in a subset
Not caused by poor parenting or “spoiling” the baby.
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Red Flags — NOT colic (require evaluation)
If any of these are present, think organic disease, not colic:
• Fever
• Vomiting (especially bilious)
• Poor feeding
• Blood in stool
• Failure to thrive
• Lethargy
• Persistent abdominal distension
• Respiratory distress
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Management (mainstay = reassurance + support)
1) Reassure parents
Explain that:
• Colic is benign and self-limiting
• It will pass by 3–4 months
• Their baby is healthy
2) Soothing strategies
Try (no single method works for all babies):
• Swaddling
• Gentle rocking
• White noise
• Pacifier
• Burping well after feeds
• Smaller, more frequent feeds
3) Dietary measures (selected cases)
• If breastfed: consider maternal elimination of dairy for 2 weeks (only if strong suspicion).
• If formula-fed: trial of extensively hydrolyzed formula may help some infants.
4) Medications
Generally not recommended routinely:
• Simethicone — limited evidence
• Dicyclover — contraindicated in infants (serious side effects)
• Probiotics (e.g., Lactobacillus reuteri) — may help some breastfed infants, evidence mixed.
Key Takeaway :
Infantile colic = normal developmental phase, not a disease.
Reassurance and caregiver support are more important than drugs.
