Infantile Colic

🧭 When to suspect

Suspect infantile colic in an otherwise healthy, thriving infant under 5 months who has recurrent episodes of excessive, inconsolable crying with no identifiable cause. The crying is typically paroxysmal and often accompanied by drawing up of the knees, clenched fists, a red face, or back-arching, and is characteristically worse in the late afternoon and evening.

A practical guide is the "rule of threes" (modified Wessel criteria): crying for > 3 hours a day, on > 3 days a week, for at least 1 week. The Rome IV criteria define it for clinical use as recurrent, prolonged crying, fussing or irritability that occurs without obvious cause and cannot be prevented or resolved by carers, in an infant whose symptoms start and stop before 5 months, with no faltering growth, fever or illness.

Colic is common, benign and self-limiting: onset is usually in the first few weeks of life and it typically resolves by 3–4 months, and almost always by 6 months. The two key clinical tasks are simple but vital: exclude an organic cause, and support the exhausted family – including recognising the small but catastrophic risk of harm to the baby.

Source: Rome IV criteria · NHS