Colic

• Rome IV criteria states that colic occurs in infants under 5 months old and is characterised by recurrent and prolonged episodes of crying, fussing (intermittent distressed vocalisations) or irritability that occur without obvious cause and cannot be prevented or resolved

• The infant appears healthy and is thriving but has repeated episodes of excessive and inconsolable crying, mostly in the late afternoon or evening

• The infant pulls his/her knees up towards the abdomen or arches the back when crying. The infant may also clench their fists

• Parents/carers are very anxious

• Infant appears unwell or is not thriving

• Symptoms not resolved or worsening after 4 months of age

• Colic normally resolves by the time the infant is 3-4 months old and in almost all cases by 6 months of age. Symptoms that have not resolved, or are worsening, after 4 months warrant referral (see Referral criteria)

• Provide reassurance that it is common, not usually serious, and will resolve in time (as outlined previously)

• Signpost to colic leaflets which mention measures such as warm bath, taking the infant out in the pram, swinging, for a drive in the car, massaging the infant gently with baby oil and white noise (vacuum cleaner or washing machine)

• Direct parent/carer to support groups such as CRY-SIS support group

• Check teat size (if bottle-fed) and feeding technique

• Dispel myths that colic signifies a lactose-intolerance

• Advise against rectal catheters sold for personal use (sold as ‘gas relievers’ or ‘colic relievers’). The MHRA issued Device Safety Information DSI/2026/008 on 18 August 2026 (updated 20 August 2026) advising parents, carers and healthcare professionals not to use these devices in infants — for colic, trapped wind or constipation — and to dispose of any already bought. They are sold without prescription online and in shops. The MHRA found insufficient evidence that they work, and is concerned about the risk of injury to the rectum and about relief of gas masking an underlying condition that needs medical attention. The MHRA has received no reports of rectal trauma, perforation, bleeding or pain in infants linked to these products. This applies to rectal catheters sold for personal use; it does not apply to catheters used for specialist medical treatment (for example Hirschsprung’s disease, meconium ileus or gastroschisis) where parents or carers have been trained by healthcare professionals

If parents/carers feel unable to cope despite reassurance and advice about suitable non-pharmacological measures, a short-term trial of either simeticone or lactase enzyme could be an option. However, the parent/carer should appreciate that evidence of effectiveness for these options is lacking.

FYI: A recent Cochrane Systematic Review, investigating the role of probiotics in infant colic found that probiotics made little or no difference to the occurrence of infantile colic when compared to placebo, but did appear to reduce crying time. While four serious adverse events were reported in one large study, these were clinically unlikely to be linked to the taking of the study products. See the Cochrane Library for comprehensive information about this review.