Feeding challenges

Infantile colic

Infantile colic is marked by excessive and unsoothable crying, resulting from a multifactoral genesis. Suspected factors are the immaturity of the intestinal and nervous system, but also microbial dysbiosis. Several management options are available for colic, which include complementary and pharmacological solutions (Benninga et al. 2016; Zeevenhooven et al. 2018).


Infantile colic describes an infant with excessive, unsoothable crying, irritability or fussiness and is often associated with unexplained and acute abdominal pain (Benninga et al. 2016; Zeevenhooven et al. 2017).

Rome IV criteria and rule of three

Until release of the Rome IV criteria in 2016, the most commonly accepted diagnostic criteria was the “rule of three” or Wessel’s criteria. According to the rule of three, an infant who is otherwise well-fed and healthy but crying more than three hours per day, for more than three days per week, and for more than three weeks experiences colic (Zeevenhooven et al. 2018). New insights on infantile colic and other functional gastrointestinal disorders (FGID) resulted in broader diagnostic criteria. The more refined criteria specific to neonates and toddlers and also children and adolescents are summarized within Rome IV (Zeevenhooven et al. 2017). Here, diagnostic criteria for infantile colic must include all of the following (Benninga et al. 2016):

  • "Infant <5 months of age when the symptoms start and stop
  • Recurrent and prolonged periods of infant crying, fussing, or irritability reported by the caregivers that occur without obvious cause and cannot be prevented or resolved by caregivers
  • No evidence of infant failure to thrive, fever, or illness"


Infantile colic affects up to 25% of infants in the first six weeks of life (Wolke et al. 2017). Its pathophysiology is not yet fully understood and is assumed to be of multifactorial genesis. It has been postulated that infantile colic is caused by various factors, which include (Zeevenhooven et al. 2017; Savino et al. 2014):

  • disturbance or immaturity in the central nervous system or digestive system
  • psychosocial causes
  • food intolerance and allergies
  • microbial dysbiosis (e.g. decreased Lactobacilli species and increased E.Coli populations) and
  • altered gut hormones (e.g. increased ghrelin and motilin concentrations)

Management options

Coping with a colicky infant can lead to the caregiver's frustration and insecurity. One important goal of the management of infantile colic is to help caregivers cope with their infant’s symptoms and to strengthen the infant-family relationship (Zeevenhooven et al. 2018; Salvatore et al. 2018). It is important for healthcare professionals to recognize this and offer the family continuous support. The general recommendation is to continue with breastfeeding. Some treatment options are available to help manage infantile colic, such as:

  • Specific dietary advice
    Next to the continuation of breastfeeding also assurance of the infants' good latch while feeding to reduce intake of air is recommended. Mothers are encouraged to let the child reach the fat-rich hindmilk before switching breasts in one feeding to avoid lactose overload which can lead to colic-like symptoms (WHO 2009; WHO und UNICEF 1993). For formula-fed infants, a switch to hydrolysed protein formulas, use of probiotics also for breastfed children, or a low allergene diet for breastfeeding mothers have been suggested (Zeevenhooven et al. 2018; Savino et al. 2014).

  • Complementary and alternative approaches
    These include manipulative or behavioural interventions such as carrying, massage, modification of infant care routines and herbal extracts. For the latter, extracts from chamomile, fennel and/or lemon balm have been mentioned (Zeevenhooven et al. 2018; Savino et al. 2014). Learn more in our infographic on infantile colic (). 

Pharmacological solutions aim to reduce gas production (Zeevenhooven et al. 2018; Savino et al. 2014).