Colic: What it is and signs and symptoms

What is colic?

The word colic refers to a muscle spasm (tightening of the muscles) that causes pain. Infant colic is a painful condition thought to occur as a result of muscle spasms in a baby’s tummy. The muscle spasms are more common in the late afternoon and evening compared to other times of day. Babies with colic typically cry more frequently than other babies because of the pain in their tummy, and have difficulty settling and sleeping, even when the muscle spasms stop.

How common is colic?

Colic is a common condition in young babies. About 1 in every 5 babies under 6 months old experiences colic. Baby boys and baby girls are equally likely to experience colic.

When does colic affect a baby?

Age

Colic occurs in well babies who are otherwise thriving and healthy. It is most common in newborn babies and typically begins between 2-4 weeks of age. Babies are usually worst affected at about 6 weeks of age when they may be fussy and cry persistently for up to 3 hours per day. Thereafter, symptoms decline to 1-2 hours of crying per day by 3-4 months of age, or may completely go away of their own accord by this age. However, for some babies it may continue until they are 6 months old.

Time of day

Colic is a condition that usually affects babies in the late afternoon or early evening. The reasons why colic only affects babies at a certain time of day are not understood. If a baby exhibits these unsettled colic-like symptoms at another time of day, the baby may be experiencing another condition, like gastro-oesophageal reflux disease.^ACT Babies with colic typically become fussy and cry a lot at the same time each day. This is usually at some time between 6pm and midnight, which unfortunately is usually when the parent is also feeling tired from the day.^AAP

What are the signs and symptoms of a colicky baby?

Frequent crying

The key symptom of colic is excessive and persistent crying for several hours a day on most days of the week, as well as fussiness and irritability. But new babies tend to cry a lot anyway, and parents may find it difficult to decide whether the time their baby spends crying is ‘normal’ or indicative of colic. In a recent study, 60% of Australian parents said their babies suffered from colic.

All babies, whether or not that have colic, will cry more in those first 3 months of their lives than at any other time. A normal pattern of baby crying is 2 hours per day at 2 weeks old, increasing up to 3 hours a day by 6 weeks old and then decreasing to 1 hour a day by 3 months old. 

A frequently used system for determining whether or not a baby’s frequent crying is a sign of colic, is the 3 x 3 x 3 rule, called Wessel’s rule of threes. According to this system, a baby does not have colic if it does not:

• cry for 3 or more hours a day;
• on 3 or more days per week;
• for 3 or more weeks in the first 6 months of life. 

Predictable pattern of crying

However, it is also important to consider the pattern of a baby’s crying, when determining whether they do have colic. Babies with colic experience regular periods of crying and restlessness, typically in the evening. Colicky babies usually crying at the same time each day, in some babies it may happen around the clock but even then it’s usually worse in the early evening.

Baby’s crying sounds

Colic crying is a piercing, high pitched scream for several hours often in the evening, even after being fed. The crying is inconsolable.

Baby’s posture

During these episodes of intense crying, the baby takes on one of two recognisable postures.

One posture is:

• The baby’s legs are pulled up towards the tummy; 
• Fists are clenched; 
• They furrow their brow (frown); and 
• The face will be flushed.

The other posture, the baby may arch their back and push their legs out straight.

Stomach gas

Babies with colic may pass gas during their crying period. Their stomach may become enlarged or distended due to excess stomach gas.

Calm and peaceful the rest of the time

It is important to be aware that babies affected by colic are usually quiet and peaceful for most of the day, but become fussy and cry for a period of time each day. If your baby is regularly fussy at a certain time of day, but then calms and is peaceful for the rest of the day, you shouldn’t worry. However if they are always fussy or their unsettled times are irregular (e.g. sometimes in the morning and at others times in the afternoon) there may be another condition causing their symptoms. Talk to your doctor.

When to worry about your baby’s crying and visit a doctor

You should visit a doctor or Child Health Nurse to discuss your baby’s crying at any time when you feel anxious or unable to cope. Even if there is no danger to your baby, visiting a doctor or Child Health Nurse and getting reassurance that nothing is wrong is important for parents. It’s also important to visit a doctor if you are feeling angry at your baby and having trouble remembering that the crying is not their fault. Negative emotions like anger can interfere with you developing a strong relationship with your baby, so it’s important to go to the doctor or Child Health Nurse and discuss it with them. You should also get professional help if your baby’s crying is affecting your relationship with your partner.

You should also visit a doctor if your baby has signs and symptoms that suggest they may have another condition affecting their health. These include:

• Your baby suddenly starts crying for extended periods after previously being well settled.
• If baby is not feeding well, for example they refuse to feed or are having less than half their normal feeds;
• If your baby appears weak or is unable to move;
• If your baby (under 12 weeks old) has a fever above 100.4°F or 38°C- take them straight to the doctor and do not give them medicine to treat the fever until they have seen the doctor.
• Periods of crying become longer (although bear in mind that crying may increase between two and six weeks of age and decrease thereafter);
• If you feel that there is nothing you can do to settle your baby; 
• If your baby seems to be in pain or injured; 
• If the soft spot on your baby’s head is bulging; 
• If your baby boy has a swollen scrotum; or
• Your baby is vomiting. 

(Kindly reviewed by Annie McArdle RN, RM, CHN, Master Adv. Prac. (Healthcare Research); Clinical Midwife at Mater Mothers’ Private Brisbane with over 25 years’ experience in parent information and education.)

More information

To read more about infant colic, what it is, causes and how to treat it, visit Infant Colic.

References

1. Australian Capital Territory Government Department of Health. Colic. 2015. [cited 31 July 2016. Available from: (URL Link)
2. American Academy of Pediatrics. Colic relief tips for parents. 2015. (cited 31 July 2016). Available from: (URL Link)
3. National Health Service. Colic. 2015. (cited 28 August 2016). Available from: (URL Link)
4. Roberts DM, Ostapchuk M, O’Brien JG. Infantile colic [Review]. Am Fam Phys 2004; 70(4): 735–40. [Abstract]
5. Queensland Health. Clinical Nutrition. Chapter 7 in A healthy Start in Life. 2008. (cited 7 August 2016). Available from: (URL Link)
6. Royal Children’s Hospital. Crying and Unsettled Babies. 2010. (Cited 18 September 2016). Available from: (URL Link)
7. Royal Children’s Hospital. Unsettled or crying babies (Colic). 2012. (Cited 18 October 2016). Available from: (URL Link)
8. Seattle Children’s Hospital Research Foundation. Should your child see a doctor? Crying baby before three months of age. 2016. (cited 18 September 2016). Available from: (URL Link)