Infant colic

Disease Description (Causes and Symptoms)

• Definition summary: Infantile colic is a symptom in infants without a clear physical disease (mainly from several weeks to 2–3 months of age) in which they cry and fuss intensely in attacks. It usually refers to a pattern lasting about 3 hours or more per day and 3 or more days per week (at least 1 week, based on the provided information). In most cases, it naturally improves around 3–4 months of age.
• Causes and pathophysiology (summary):
  • The exact cause is unknown. Several theories have been proposed, including immature gastrointestinal motility and intestinal gas/abdominal discomfort, intestinal hypersensitivity (increased pain sensitivity), and psychosocial factors (parental stress and the caregiving environment).
  • There have been reports that foods consumed by the mother during breastfeeding (such as caffeine and dairy products) may be related, but this is uncertain.
• Main symptoms:
  • Sudden-onset, prolonged, intense crying (from several minutes to several hours), occurring more frequently mainly in the evening (18:00–22:00).
  • Clenched fists, drawing the legs toward the abdomen, a flushed face, and postures suggestive of abdominal tension and pain.
  • When normal development and weight gain are maintained, the condition is often considered colic.

Treatment Methods

• General principles: There is no specific highly effective medication, and conservative and supportive treatment are the main approaches. Most cases improve naturally.
• Lifestyle and behavioral measures (first-line recommendation)
  • Provide a calm environment: soothing measures such as a quiet room, stroking, holding the baby, gently rocking the baby (with safety precautions), and taking a short ride in a car.
  • Feeding and care: Frequently attempt burping, avoid overfeeding, use proper positioning and abdominal massage (gently clockwise), and perform bicycle-leg movements.
  • Establish regular sleep and daily routines and manage parental stress (parents also need rest).
• Dietary adjustment for breastfeeding mothers
  • In some cases, improvement has been reported when the mother avoids potentially triggering foods such as caffeine, dairy products, and onions, but the evidence is inconsistent. Broad dietary restrictions without testing are not recommended.
• Changing infant formula
  • If cow’s milk protein hypersensitivity is suspected (such as vomiting, bloody stool, or problems with weight gain), consider changing to a partially or extensively hydrolyzed formula (in consultation with a pediatrician).
• Medications and supplements
  • Consult a pediatrician in severe cases or when conservative measures fail.
  • Strong sedatives and anticholinergic drugs (e.g., dicyclomine) have been reported to be harmful and are contraindicated/not recommended.
  • Anticholinergic drugs such as Simicos (in severe cases) carry a high risk of side effects.
  • The effectiveness of medications used to relieve severe abdominal pain is limited.
  • Probiotics (such as Lactobacillus reuteri) reduced crying time in breastfed infants in some studies, but they are not universally recommended for all cases — use is recommended after consultation with a pediatrician.
  • Simethicone (an antiflatulent) has shown inconsistent results in efficacy studies.
• Tests and procedures
  • Additional testing is generally unnecessary when the diagnosis is infantile colic.
  • If abnormal findings are present (fever, vomiting, bloody stool, weight loss, abdominal distension, etc.) or suspected diseases need to be ruled out, abdominal ultrasonography, plain radiography, blood tests, stool tests, and other examinations may be performed.
• Precautions (during treatment)
  • If suspicious symptoms (fever, persistent vomiting, bloody stool, reduced fluid intake, weight loss, etc.) are present, visit a pediatrician immediately.
  • Excessive parental stress can increase the risk of child abuse (including shaking), so alternative caregiving and emergency support may be needed.

Outpatient Visit Checklist (Including Preparation, Records, and Example Questions)

• What to bring and record
  • When the crying began, its frequency (number of episodes per day), duration (per episode/total), and weekly pattern (especially whether it occurs in the evening).
  • Feeding method (breastfeeding, mixed feeding, or formula), feeding intervals, amount consumed at one time, and whether the baby burps.
  • Bowel movements and vomiting patterns (whether bloody stool, mucus, or bilious vomiting is present), urine volume, and weight-gain trend (recent weight records and growth chart).
  • Whether there is a fever and when it occurs, changes in sleep patterns, and medication history (including the mother’s medications).
  • The mother’s diet during breastfeeding (such as recent caffeine and dairy intake) and environmental stress factors.
  • A video of the crying (recorded on a smartphone) — this is very helpful for diagnosis and differential diagnosis.
• What to bring to the outpatient visit
  • The baby’s vaccination record, recent weight and growth records, medications currently being taken or prescriptions (including medications taken by the mother), and a video of the crying.
• Example questions (questions you can ask the doctor directly during the outpatient visit)
  • "How can we distinguish whether this symptom is colic or a sign of another disease?"
  • "What signs indicate that tests or urgent treatment are needed right now?"

Examples of General Questions to Ask the Doctor

• What are the expected effects and side effects of this medication (or supplement)?
• How long is it okay to wait with conservative management, and at what point are additional tests or referral to a specialist needed?
• Do I need to restrict specific foods while breastfeeding? Specifically, which foods should I avoid?
• If we need to switch to formula, which type should we try first (partially hydrolyzed, hydrolyzed, hypoallergenic, etc.)?
• The stress caused by the colic is severe. Can parents receive support, education, or counseling?

Examples of Disease-Specific Questions

• If I stop a specific food (e.g., milk or caffeine) while breastfeeding, how quickly will my baby’s symptoms improve? (What observation period is needed?)
• If the crying pattern suddenly becomes “paroxysmal” and repeats briefly, how can it be distinguished from serious diseases such as intussusception? What symptoms require an immediate visit to the emergency room?

(Note: Red flags requiring immediate emergency evaluation: high fever, persistent or severe vomiting (especially bilious vomiting), bloody stool, weight loss or reduced fluid intake, decreased consciousness or a state in which the baby cannot be soothed, abdominal distension, etc.)