Colic is a state of excessive crying seen in infants, typically during the late afternoon or early evening. From 15% to 20% of infants develop colic, and it seems to be more common in firstborns and in boys than in later-born infants and in girls. Colic is not a disease or syndrome caused by bacteria or viruses. It is seen in otherwise healthy infants and can begin as early as 2 weeks of age. It is self-limited, only rarely lasting until the infant is 6 months old.

No cause has been proven for this disorder, but theories include those listed below.

• Stage in the development of an immature central nervous system or digestive system
• Response to emotional and family stress—need for comfort
• Reflection of differences in infant temperament and physiology
• Intolerance to foods in mother's diet, specifically, dairy products, caffeine, or gassy foods
• Introducing food into infant's diet too early

• In breast-fed infants, a maternal diet that includes dairy products, caffeine, or gassy foods
• In bottle-fed infants, cow's milk formula or iron-fortified formula intolerance
• Overstimulation or understimulation of infant
• Caregiver smoking
• Antibiotics given at birth or to mother during labor

• Inconsolable crying that lasts more than three hours for three or more days a week in a healthy infant 2 weeks to 3 months of age
• Crying accompanied by vigorous kicking, pulling the legs up tightly to the body, and making tight fists
• May have swollen or distended stomach, burp, or pass gas often
• Infant appears to be in pain
• Arched back and clenched fists
• Frequent spitting up after feeding

• Bladder infection
• Ear infection
• Kidney infection
• Gastrointestinal reflux
• Severe constipation
• Intussusception
• Volvulus
• Testicular torsion
• Occult fracture

Infant appears healthy, eats well, and is gaining weight, with no fever or diarrhea. Cradle cap and dry skin often occur with colic, in which case suspect food intolerance.

In the absence of poor feeding, diarrhea, weight loss, fever, black, green, or bloody stools in an infant less than 2 months old, or the persistence of crying beyond 6 months of age, no laboratory tests are needed.

• Make sure the infant is properly fed, burped, comfortably clothed, and has a clean diaper.
• Evaluate the history of crying offered by the caregiver.

Because there is no identified cause, treatment involves finding what is effective from among the items listed below, and supporting the parents.

• For a breast-fed infant, decrease the time between nursing sessions (nurse on demand) and have the mother eliminate dairy products, caffeine, and all foods that give the mother gas (sensitive foods may include citrus, spicy foods, and soy).
• For a bottle-fed infant, change to a formula that is not based on cow's milk. May need hypoallergenic formula.
• Do not offer solid foods to the infant before 6 months of age.
• Instruct parents to try holding the infant close, offering a pacifier, rocking, rubbing the back, giving infant a warm bath, taking a car ride, playing music, or placing the infant in an infant swing to ease the crying. Try these various strategies until one works.
• Remind parents that this condition should last only a few months. Encourage them to take breaks if the crying becomes unbearable,join a support group, or call the pediatrician if they fear they will harm the baby.
• Review with parents different methods of burping.

No drugs are currently recommended, although simethicone may be helpful.

Eliminating gas-producing foods and using supportive herbal or homeopathic therapies can help reduce or eliminate infantile colic. Reducing stimuli and placing the infant in a dim, quiet room may help to calm the baby.

Follow dietary changes as noted in "Treatment Strategy" above. Acidophilus (especially Bifidus spp.) can be given to both the breast-feeding mother and infant. Use 1 capsule with meals tid for adult; 1 capsule/day for infant (break capsule open and administer powder in divided doses throughout the day). This will help to normalize bowel flora.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

A tea made from fennel seed (Foeniculum vulgare) or anise seed (Pimpinella anisum) may be administered directly to the infant (1 tsp. before and after feedings) or drunk by the breast-feeding mother (1 cup three to six times/day). Both fennel and anise act as gastrointestinal relaxants and help to expel gas.

Other herbs that have relaxing effects and help reduce colic are lemon balm (Melissa officinalis), catnip (Nepeta cateria), peppermint (Mentha piperita), spearmint (Mentha spicata), and linden flower (Tilia cordata). These may be added to the above tea as needed.

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve. For infants, dissolve about 5 pellets in ¹/4 cup of water and give 1 tsp. every four hours.

• Carbo vegetalis for flatulent colic and burping.
• Chamomilla for colic with irritability that is relieved by constant holding and walking.
• Magnesia phosphoricum for colic that is better when bending double.

Combination remedies for colic, as commercially available, may be used as needed.

Warm baths may help to relax and soothe colicky infants. Add 3 to 4 drops of essential oil of lavender (lavandula angustifolia) or lemon balm to enhance the benefit.

Clockwise abdominal massage may help to relieve spasm and expel gas. Use 3 to 5 drops of tincture of catnip in 1 to 2 tsp. of almond or olive oil to enhance effectiveness. Apply warmth.

Additional diagnostic procedures may be required if the following symptoms develop:

• Colic persists or recurs daily: may be ear, bladder, or kidney infection; formula may need to be changed or further foods eliminated from nursing mother's diet.
• An infant less than 2 months old develops black or bloody stools, vomiting, diarrhea, or fever.

Colic may occur less often if one can:

• Nurse infant on demand (typically, every two to four hours) or use a non–iron-fortified formula for bottle-fed infant.
• Respond to the infant's cries quickly.
• Cultivate a support network of family/friends to help.
• Not smoke.
• Elevate infant's head during and after feedings.

Infants generally outgrow colic with no subsequent problems. Parents should be cautioned not to shake the infant, which can produce the potentially fatal shaken infant syndrome.

Colic usually responds to one or more treatments and typically resolves before the infant is 6 months of age. Colicky babies, however, often grow up to have other allergy-related conditions, such as otitis media, asthma, and digestive problems.

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Jones S. Crying Baby, Sleepless Nights: Why Your Baby Is Crying and What You Can Do About It. Boston, Mass: The Harvard Common Press; 1992.

Kemper KJ. The Holistic Pediatrician. New York, NY: HarperPerennial; 1996.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:126-128.

Schiff D, Shelov P, eds. American Academy of Pediatrics: The Official, Complete Home Reference Guide to Your Child's Symptoms, Birth Through Adolescence. New York, NY: Villard Books; 1997.

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