1. Morin, Karen DSN, RN

Article Content

Colic, also known as unexplained infant crying, is "one of the most commonly encountered and least understood problems during infancy" (Keefe et al., 2006, p. 123). Occurring in both sexes, its incidence ranges from 15% to 25% (Keefe et al.) to as much as 40% (Clinical Update 119, 2008). Consequently, the possibility of encountering an infant with this condition is considerable. Nurses, therefore, need a solid understanding of the condition and its treatment.


What is colic?

The classic definition from Wessel, Cobb, Jackson, Harris, and Detwiler (1954) is useful because it includes the frequency, duration, and description of symptoms and employs the rule of "3s": unexplained crying and fussiness occurring for more than 3 hours, lasting more than 3 days in a week, and for more than 3 weeks. Typically, bouts of crying occur later in the day and into the evening. The condition presents when the infant is a few weeks old and usually disappears between the age of 4 and 6 months.


Infants may exhibit a variety of symptoms, ranging from excessive crying and high-pitched screaming to clenching of fists or arching their back. While colic resolves on its own, the time during which the infant experiences the condition can be very stressful for both the infant and parents.


Parents often associate the infant's crying bouts with dietary issues, although no one cause for its occurrence has been identified (Clinical Update 119, 2008; Keefe et al., 2006). Some authorities suggest that overfeeding, food allergies, and undiluted juices may contribute to colic (Clinical Update 119). Moreover, strategies to address infant colic often involve changes in dietary patterns.


What does the evidence tell us?

Interventions fall into three categories: dietary, behavioral, or pharmacological. An important first step is to rule out any physiologic conditions and normal hunger.


Dietary Approaches. The most common approach to colic is to decrease or remove cow's milk from the infant's diet, either by removing it from the diet of a breastfeeding mother or by substituting alternative formula preparations for the formula fed infant. However, trials employing this specific approach have not provided conclusive results. While some authorities may recommend the use of a lactase supplement, there is no evidence to support this approach (Clinical Update 199, 2008). Conversely, there is some support for employing a low allergen [decrease or not ingest eggs, wheat, nuts] diet for 1 week with women who breastfeed and who have a 6-week-old infant with colic. Given the use of sucrose to treat neonatal pain, one might hypothesize that its use would be equally beneficial for treating infant colic, and in fact, there is some evidence that administering sucrose may have a short-term effect [between 3 and 30 minutes] on decreasing colic (Clinical Update 199, 2008). Additional dietary suggestions for breastfeeding mothers include eliminating gaseous foods such as cabbage and cauliflower from their diet. Effectiveness of such strategies, however, has not been reported.


Behavioral Approaches:Keefe et al. (2006), in a randomized control trial, reported positive outcomes when an individualized intervention program was employed. Hours of crying and intensity of fussiness decreased in infants assigned to the treatment group. The intervention stressed structure and touch, and also utilized deliberate recognition of parental need for a "time-out" period of at least 1 hour each day.


Pharmaceutical Approaches: There is little evidence to support the use of drugs in the treatment of colic. Thus, drugs typically employed in the adult population to relax gastrointestinal smooth muscles are not generally used.


What advice should nurses offer?

Once other conditions are excluded, and keeping in mind that the cause remains elusive, nurses can reassure parents that colic is a time limited event, offer them support, acknowledge how stressful the situation is, discuss dietary alterations if appropriate, and encourage the use of evidence-based behavioral interventions. A caring, concerned attitude is essential in these cases.




Clinical Update 119. (2008). The effectiveness of interventions for infant colic. Australian Nursing Journal, 16, 31-34. [Context Link]


Keefe, M. R., Lobo, M. L., Froese-Fretz, A., Kotzer, A. M., Barbosa, G. A., & Dudley, W. N. (2006). Effectiveness of an intervention for colic. Clinical Pediatrics, 45, 123-133. [Context Link]


Wessel, M., Cobb, J., Jackson, E., Harris, G., & Detwiler, A. (1954). Paroxysmal fussing in infancy, sometimes called "colic." Pediatrics, 14, 21-35. [Context Link]