Colic in Babies: the Signs, How to Soothe, and When to Call the Doctor

It is a little after seven in the evening. The feed went in, the diaper is fresh, the room is quiet, and your baby is screaming anyway: red in the face, knees pulled up to the belly, fists shut tight.

Your mother says it is gas. A neighbour has already sent the name of a gripe water. A phone is open on a page about colic in babies, and you are reading it with one hand.

Colic has a plain description, and this guide takes it from the NHS, the American Academy of Pediatrics and a 2018 review in the journal Indian Pediatrics. The first thing it asks of you is not a remedy. It is a short list of checks, and then two limits: the baby's and your own.

Colic in babies: the pattern the NHS describes

The NHS puts it in numbers. Your baby may have colic if they cry more than 3 hours a day, 3 days a week, for at least 1 week, but are otherwise healthy. Doctors call this the rule of three, and the Indian Pediatrics review notes that the original version asked for three weeks of it before the word was used.

The baby colic symptoms the NHS lists alongside the crying: it is hard to soothe or settle your baby; they clench their fists; they go red in the face; they bring their knees up to their tummy or arch their back; their tummy rumbles or they are very windy.

Timing is part of the picture. The NHS notes the crying is often worse in the afternoon and evening, and the AAP agrees that the spells can occur around the clock but often become worse in the early evening.

As for age, the AAP gives the onset as usually between the second and fourth weeks, affecting about one in five babies. The Indian review gives the whole course in one line: it begins by 2 to 3 weeks of age, peaks by 6 weeks and resolves by 3 months.

What colic is not: baby colic vs gas, and the cause

The phrase "otherwise healthy" carries most of the weight. The review quotes the current Rome IV criteria: an infant under five months when the symptoms start and stop, with no evidence of failure to thrive, fever or illness. Crying that comes with any of those is something else, and the doctor section below covers it.

Colic is not a sign of anything you did. The NHS states that it is not known exactly what causes it; babies may find food harder to digest when young, or, less often, there is a food allergy such as cows' milk allergy. The AAP puts food sensitivity at less than 5% of colicky crying.

Nor is colic the same thing as gas, though "gas problem" is the phrase most Indian families reach for. A windy tummy is on the NHS list of signs, and the AAP notes that colicky babies pass gas, but neither source names gas as the cause. Babies swallow air while they scream, which is why the NHS asks you to feed them upright and wind them afterwards.

Check these first, before any remedy

Before colic is the explanation, both sources ask you to rule out the ordinary reasons. The NHS guide to soothing a crying baby lists hunger, a dirty or wet nappy, tiredness, wanting a cuddle, wind, being too hot or too cold, boredom and overstimulation. The AAP adds a strand of hair caught around a finger or toe, and clothing that is pressing somewhere.

• Hunger: offer a feed, even if the last one was recent.
• The diaper: wet or dirty, change it. Our guide on changing a diaper at night covers the sleeping-baby version.
• Temperature: feel the chest or the back of the neck, then remove or add a layer.
• Wind: hold upright against your shoulder and pat the back for a few minutes.
• Clothing: look for a tight band, a label, a thread or a hair wound round a finger or toe.
• Tiredness, or too much going on: dim the room, lower the voices, stop passing the baby around.
• Fever: if the baby is inconsolable, take the temperature. The AAP's line is 38°C (100.4°F) or higher, and for a baby under 2 months any fever means call the doctor right away.

Two or three minutes covers the list. If every line is clear and the crying carries on, you are in colic territory, and the next section is for you.

How to soothe a colicky baby: what the NHS and AAP list

Neither source promises that a method will work. The AAP's wording is honest: the motion and contact of a carrier will reassure a baby even if their discomfort persists. Here is what the two NHS pages and the AAP pages list, side by side.

Two notes on the table. Try one method for a few minutes before switching, because the NHS warns that too much rocking and singing can keep a baby awake. And a baby who dozes off on your lap or in a car seat goes back to a firm, flat surface on their back, as the NHS and the AAP safe sleep guide both ask.

Feeding is where the sources differ a little. The NHS advises keeping feeds as usual, with no change to your own diet if you are breastfeeding. The AAP allows a breastfeeding parent to remove milk products, caffeine, onions and cabbage one at a time, after discussing it with the paediatrician, and to wait about two weeks for a change. Do not change a formula or your diet without asking your doctor first.

The AAP also suggests keeping a diary of when your baby is awake, asleep, eating and crying, which turns a vague "cries all evening" into something a doctor can read.

Gripe water, colic drops and baby colic home remedies

Here is where most Indian families go first, and where the evidence is thinnest. The NHS states that remedies such as anti-colic drops and herbal or probiotic supplements are not recommended, and that there is no evidence they help colic.

The Indian Pediatrics review (Sarasu, Narang and Shah, 2018) goes item by item. Simethicone, the ingredient in most drops sold for gas, had no role in decreasing the symptoms of colic. Gripe water is not recommended as there are no proven health benefits, and the review notes that its use is common in this part of the world, citing a Puducherry survey in which 64.3% of mothers used it.

Dicyclomine is not recommended in children younger than six months. Herbal medicines reduced symptoms in some trials but were associated with side effects. Probiotics are the one open question: the review found trials in which a probiotic strain reduced crying in breastfed infants, and a later trial in which it did not. That is a conversation for your paediatrician, not a bottle to pick up at the chemist.

Hing on the navel and ajwain water appear in no guideline found for this guide. What the sources do give you is the NHS line above on herbal remedies, and the WHO advice that a baby is fed only breast milk for the first 6 months, avoiding additional food or drink, even water, unless medically necessary. Ask the doctor before the baby, not after.

The NHS also asks you not to try spinal manipulation or cranial osteopathy: little evidence it works, and it may hurt your baby. What the review puts first is less dramatic. Proper counselling of the parents is the first line of management, shown to be more effective than dietary change at reducing crying time. Knowing what colic is, and that it ends, is part of the treatment.

When crying needs a doctor

The NHS gives two lists, and they are worth saving on your phone.

Call your paediatrician, or the hospital's helpline, if you are worried about your baby's crying; if nothing seems to be working; if you are finding it hard to cope; if your baby is not growing or putting on weight as expected; or if the colic symptoms continue after 4 months of age.

Go to emergency care now if your baby has a weak or high-pitched cry, or a cry that does not sound like their normal cry.

The NHS soothing guide adds the signs that need an ambulance: a fit; blue, grey, pale or blotchy skin, lips or tongue, checked on the palms and soles on brown skin; a baby who is floppy, unresponsive or not waking as easily as usual; difficulty breathing or breathing very fast; projectile vomiting; a high or low temperature; a rash that does not fade when pressed; or no wet nappy in the past 8 hours.

That last item is a check you can do tonight by counting diapers; our guide to how many diapers a baby uses a day gives the usual count by age. Not feeding is on neither list by name, but two of its signs are: no wet nappy in 8 hours, and not waking for feeds as easily as usual.

Keep the paediatrician's number where any adult in the house can find it; our newborn essentials checklist puts it in the paperwork folder.

The plan for tonight, and your own limit

This is the part to remember. Colic is not cured; it is managed until it passes, and the plan has four steps in a fixed order.

First, the checks: hunger, diaper, temperature, wind, clothing, fever. Second, two or three methods from the table, a few minutes each, in a dim and quiet room. Third, the doctor lists above; if anything on them is true, stop soothing and call. Fourth, your own limit.

That fourth step is the one the sources are most direct about. If you have no one to take over and the crying is making you stressed, the NHS advises putting your baby somewhere safe such as a cot or pram, closing the door, going into another room and calming yourself, with a time limit such as 10 minutes before you go back.

The AAP gives the same permission: it is OK to lay the baby on their back in the crib or another safe place and leave the room for a few minutes.

Both say it without softening: never shake your baby. The AAP warns that shaking can cause blindness, brain damage or even death, and asks you to share this with anyone else who cares for your baby, which in an Indian home means the grandmother, the aunt and the house help as much as the two of you.

Hand over when you can. The AAP suggests having another adult take the baby while you leave the house, and even an hour or two away helps. The NHS adds that it is common to feel this way and nothing to be ashamed of; the AAP asks you to tell your doctor if you feel low or are having trouble dealing with your emotions.

Baby colic: how long does it last

The NHS expects colic to stop by the time a baby is 3 to 4 months old. The AAP agrees on 3 to 4 months, though it can last until 6 months. The review's peak at 6 weeks is a date to circle, because the worst evening is usually behind you earlier than it feels.

Ordinary fussing has its own curve. The AAP describes it peaking at about 3 hours a day by 6 weeks old and falling to 1 or 2 hours a day by 3 to 4 months.

After the worst of it

When the evenings settle, what is left is a baby who still has no clock. Our guide to a baby sleep schedule by age picks up there, with the light, sound and wind-down anchors that fit an Indian evening.

This guide shares general information for parents and is not medical advice. Speak to your baby's doctor about any persistent skin irritation or health concern.