Colicky babies cry excessively and inconsolably. But what is colic, really? And what causes it?
These aren’t easy questions to answer. In part, it’s because
researchers are still figuring it out. But it’s also because people
disagree about how to define colic.
Still, there is agreement on several points:
• Colic affects all kinds of babies--breastfed and formula-fed;
girls and boys; Westerners, Asians, and Africans (Barr 1998; Chen and
Chwo 2006; Oshikoya et al 2009)
• In most young babies--including those without
colic--crying tends to increase over the first 6 weeks. Thereafter,
crying tends to taper off. By 3 to 5 months, most babies cry much less,
and colic has gone away (Barr 1998).
• Most babies with colic don’t have any serious medical problems,
i.e., their colic isn’t caused by a dangerous or life-threatening
condition (Barr 1998).
Nevertheless, colic should be taken seriously.
1. Caring for a colicky baby can be extremely stressful and
frustrating, so much so that parents sometimes make terrible, tragic
mistakes. Studies suggest that inconsolable crying is a trigger for baby
shaking, an act that can cause head trauma and brain damage (Barr et al
2. Colic can threaten your mental health and harm your
relationship with your baby. Studies suggest that mothers are more likely to become depressed when their babies suffer from colic or cry inconsolably (Maxted et al 2005; Vik et al 2009; Radesky et al 2013). And babies with depressed mothers are more likely to develop
insecure attachment relationships
(Murray and Cooper 1997; Akman et al 2006), perhaps because their
mothers are struggling with feelings of helplessness, anger, and
rejection (Pauli-Pott et al 2000).
3. Colicky babies aren’t just crybabies. Colicky babies aren’t
crazy, and they aren’t trying to manipulate you. Research suggests that
some colicky babies suffer from treatable medical conditions, including cow's milk protein allergy and even migraine (Critch 2011; Romanello et al 2013). Other babies may exhibit distinctive brain chemistry profiles that make it harder for them to calm down.
So it seems to me there’s a lot at stake, and parents shouldn’t let their concerns be trivialized or brushed off.
Parents can take steps to protect themselves and their babies
from the worst effects of colic. The first step is learning about the
What is colic really about?
In this article, I cover
• the pattern of crying in normal infants
• differing definitions of colic, and
• possible causes of infantile colic
As I note below, it’s important to have your colicky baby
examined by a pediatrician. Babies cry for many reasons, and some of
them require immediate medical attention.
The University of Michigan Health System recommends that you call
your doctor or take your baby to the emergency room if your baby’s
cries sound strange, are unusually intense, or continue for 3 hours
You should also seek immediate medical advice if your baby has a
fever, is vomiting, has diarrhea, or seems to be otherwise ill or in
What is colic? Understanding the normal crying curve
All healthy, young babies cry and fuss--sometimes inconsolably and
frequently without any obvious cause. Typically, crying is more common
in the late afternoon and evening.
It also seems that most healthy babies cry according to a
schedule (of sorts). During the first few weeks after birth, babies
increase the amount of time they spend crying. Crying peaks some time
during the second month. By the time babies are 3 or 5 months old, they
cry considerably less.
That’s normal for babies in Western countries. And ethnographic
research suggests it’s normal for hunter-gatherers, too (Barr et al
1991). So what is colic?
The "rule of 3s"
Some physicians follow Wessel’s “rule of threes," diagnosing a baby
with colic if she cries more than 3 hours a day, for more than 3 days a
week, for more than 3 weeks in a row (Sijmen et al 2001).
But these cut-offs are rather arbitrary, and they result in a
great many babies getting labeled as “colicky." For example, some
studies of Western babies estimate that up to 40% of young babies meet
the Wessel criteria (Soltis 2004)!
But to me, a better marker of colic is that the colicky baby’s cries are very hard to stop.
Several Western studies bear this out. Colicky babies don’t cry more frequently than other babies do. But once they get started, they take much more time to quiet down (Barr 1998).
In addition, research suggests that colicky babies are upset by
things that don’t bother normal babies very much. Some newborns are much
more upset by being undressed, handled, or put down, and these babies
are more likely to develop colic (St James-Roberts et al 2003).
What is colic? Criteria that include symptoms of pain
But is colic just about fussing and crying? Not according to some
definitions. As noted by Joseph Soltis (2004), a more selective approach
to colic stipulates additional symptoms, such as
• Muscle tension and signs of pain (e.g., clenched fists, flexed legs, arched back, a hard, distended abdomen, and grimaces)
• high-pitched crying, or
• signs of gastric distress (flatulence, regurgitation, vomiting, diarrhea)
As you might imagine, babies meeting these additional criteria
are more likely to suffer from digestive problems or organic disease.
That’s one reason why there is so much conflicting information about the
causes of colic. Is colic caused by abdominal pain? Studies may suggest
different answers depending on the specific criteria researchers used
to identify colicky babies (Soltis 2004).
So what are the causes colic?
There are many theories, and I suspect that there isn’t any single
answer. In the rest of this article, I outline two major types of
1. Care-giving explanations (i.e., colic is caused by the way parents interact with—or fail to interact with—their babies)
2. Physiological or disease-based explanations (i.e., colic is
caused by a medical condition or reflects an infant’s problems with
Care-giving explanations of colic
Some researchers have suggested that colic is caused by child-rearing
practices that minimize responsiveness and physical contact between
parents and babies. According to this idea, colic might be prevented if
caregivers adopted a highly responsive, tactile approach to baby care--
• holding or carrying the baby at least 80% of the time, and
• giving the baby a breast or otherwise soothing him within seconds of hearing him cry.
That’s what happens to babies in hunter-gatherer
societies—societies where daily life most closely resembles life in the
Pleistocene and where colic is virtually unknown.
But while this approach has benefits, it’s not necessarily a cure for colic.
Studies of Western parents suggest that “Pleistocene" baby care
may promote secure attachments (e.g., Anisfeld et al 1990). It also
seems to reduce crying in normal babies (Hunziger and Barr 1986).
But it doesn’t seem to reduce the rate of crying in colicky babies
(Barr et al 1991b). So if you are a good “Pleistocene Parent" and still
have a colicky baby, you’re not alone.
Another care-giving theory of colic concerns stress. According to
this idea, babies become colicky because their parents are tense or
“stressed out." This isn’t implausible. But it’s also evident that colic
causes stress in parents. Which comes first, the parental stress or the
colic? Like the “Pleistocene" theory, the parental stress theory lacks
strong evidence in its favor.
The bottom line? While I don’t doubt that care-giving has
crucial effects on babies, it’s wrong to assume that babies have colic
because their parents aren’t being responsive, affectionate, or patient
When we ask “what is colic," many pediatricians emphasize that colic is usually not indicative of disease (e.g., Barr 1998).
But—as noted above—that depends on what definition of colic you
use. In studies that include symptoms of pain or gastric distress as
criteria for colic, a high proportion of colic cases are caused by
disease. Moreover, research suggests that colicky babies may have
different physiological reactions to stimulation.
If your baby shows signs of colic, it makes sense to consult your
pediatrician about the possibility of disease. Excessive crying may be a
sign that your baby suffers from a disease, like cow’s milk protein
intolerance, isolated fructose intolerance, infantile migraine, or acid
reflux (Barr 1998).
It’s also possible that your baby is experiencing abdominal pain
caused by elevated levels of motilin (a hormone that stimulates
intestinal contractions), intestinal inflammation, and/or an unfavorable
balance of gut microflora (Savino et al 2007; Rhoads et al 2009; Savino
et al 2009). Research suggests that colicky babies may benefit from
treatment with specific types of probiotic (Savino et al 2006).
The colicky brain: Are colicky babies just different?
There is intriguing evidence that babies with colic may react
differently to both disruptive and soothing stimuli. For instance,
colicky babies may be more upset by handling and less comforted by sweet
flavors. For more information, see this article about
colic and the brain.
What is colic? The bottom line...
Babies diagnosed with colic may have a variety of underlying
problems. These might include medical conditions (like cow’s milk
protein intolerance, gut inflammation, or gas). Or they might include
differences in brain chemistry--differences that affect the ways that
colicky babies respond to being moved, handled, and soothed.
But whatever the cause of your baby’s colic, coping with colic is
very stressful. It can make you anxious, depressed, resentful, and
angry. And excessive, inconsolable crying is a trigger for baby-shaking, which can damage a baby’s brain.
So if your baby has colic, it’s important to avoid blaming
yourself or the baby. Get social support, ask for medical advice, and
take time out if you find yourself losing patience. It’s better to let
the baby cry in a cot or crib than risk a momentary loss of control.
For more information relevant to baby colic, see these articles: