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This guidance has been developed from NICE CKS (2017): Colic – infantile and NICE clinical guideline CG37 (2015): Postnatal care up to 8 weeks after birth.
The aetiology of infantile colic is uncertain; it is a self-limiting condition which is defined clinically as repeated episodes of excessive and inconsolable crying in an infant that otherwise appears to be healthy and thriving.
It describes episodes of irritability, fussing, or crying that begin and end for no apparent reason and last at least three hours a day, at least three days a week, for at least one week, in an infant up to 4 months of age with no evidence of faltering growth. Reassure parents and carers that infantile colic usually improves by 3-4 months and resolves by 6 months of age.
Parents and carers should be encouraged to use simple physical measures such as holding, rocking, or bathing the infant; and ensuring an optimal winding technique is used, to calm and settle infants. Check growth; plot weight, length, and head circumference on a centile chart. Organic causes of excessive crying are unlikely in the absence of other symptoms and if the baby has normal growth and neurodevelopment.
If babies with colic concurrently have faltering growth, eczema requiring treatment and/or alternating bowel habit consider cow's milk allergy. Formulary guidance can be found here.
Parents and carers should also be encouraged to look after their own well-being. Where a mother is suffering from post-natal depression, a child may cry more. Formulary guidance relating to depression in the post-natal period can be found here.
Health visitors may be a source of information and support. "Cry-sis" is a self-help support organisation for families with excessively crying or sleepless children and runs a national telephone helpline 9am to 10pm (0845 122 8669).
There is insufficient evidence to support the use of medication for colic.
There is insufficient, good-quality evidence that lactose-free formulae are beneficial, or that lactase (such as Colief®) and simethicone (such as Infacol®) drops are useful in treating colic and as such these products are not recommended.
The use of unlicensed herbal preparations is also not recommended; formulary guidance on the use of herbal treatments and homeopathy can be found here.
For the management of paediatric reflux disease see Paediatric reflux disease guidance