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, characteristically worse in the late afternoon and evening.

The crying is typically paroxysmal and often accompanied by:

• drawing up of the knees

• clenched fists

• a red face

• back-arching

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

• support the exhausted family – including recognising the small but catastrophic risk of harm to the baby

Source: Rome IV criteria · NHS