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Infantile colic: Management and outcome

Infantile colic: Management and outcome
Literature review current through: Jan 2024.
This topic last updated: Nov 07, 2023.

INTRODUCTION — Persistent or excessive crying is one of the most distressing problems of infancy. It is distressing for the infant, the parents or caregivers, and the clinician [1]. The caregivers of the infant may view the crying as an indictment of their caregiving ability or as evidence of illness in their child [2]. Colic is a benign, self-limited condition that resolves with time. However, the family's beliefs concerning the cause of crying and their interactions with the health care system related to the crying may affect the way in which they view the child and the health care system long after the crying has resolved.

The management of infantile colic is reviewed here. The clinical features, proposed etiologies, and diagnosis are discussed separately. (See "Infantile colic: Clinical features and diagnosis".)

TERMINOLOGY — We broadly define colic as crying for no apparent reason (eg, hunger, soiled diaper, etc) that lasts for ≥3 hours/day and occurs on ≥3 days per week in an otherwise healthy infant <3 months of age. Stricter definitions include criteria for minimum duration (eg, three weeks) or associated clinical features. Other terms that are interchangeable with colic include "cry-fuss behavior," "excessive crying," "unsettled infant behavior," and "period of PURPLE crying" [3,4]. (See "Infantile colic: Clinical features and diagnosis", section on 'Definitions'.)

NATURAL HISTORY — Colic improves spontaneously with time [5-10]. In a systematic review and meta-analysis of 28 diary studies including 8690 infants, colic (defined as crying/fussing ≥3 hours per day on ≥3 days in any one week) was documented in 17 to 25 percent of infants age <6 weeks, 11 percent of those age 8 to 9 weeks, and 0.6 percent of those age 10 to 12 weeks [10]. The presumptive diagnosis of colic is confirmed after it resolves.

MANAGEMENT

Overview — Management of the otherwise well infant with prolonged or excessive crying is individualized based upon the history, examination, and family characteristics [11,12]. Some caregivers and families tolerate crying better than others.

Interventions are targeted to decrease crying and bolster the infant-family relationship. The goals of management are to help the caregivers cope with the child's symptoms and to prevent long-term sequelae in the caregiver-child relationship [13,14].

Caregiver support is the mainstay of management. First-line interventions consist of addressing feeding problems and suggesting techniques to soothe the infant and/or decrease environmental stimuli. Caregivers can be encouraged to experiment with these interventions to see which, if any, work. Although the evidence supporting first-line interventions is limited, they are inexpensive, unlikely to be harmful, and may be helpful for caregivers who find it hard to have nothing to do while awaiting spontaneous remission (which confirms the diagnosis) [15].

Several interventions for colic have been evaluated in randomized trials; however, most of the trials had methodologic weaknesses (eg, small sample size, inadequate blinding) [16-20]. The lack of strong supporting evidence for any one strategy, combined with the number of proposed etiologies, may lead practitioners to recommend a variety of interventions, alone or in combination [6]. Each of the soothing techniques may work in some infants or in a given infant, some of the time, but none of the interventions work all of the time. (See 'Soothing techniques' below.)

Caregiver support and education — Caregiver support is the mainstay of the management of colic. It may influence the way the caregivers view their ability to care for their child.

Important aspects of caregiver education and support include [11,15,21-25]:

Education that colic is common and usually resolves spontaneously by three to four months of age. (See 'Natural history' above.)

Reassurance that the infant is not sick. This may require frequent follow-up (either by phone or in person). (See 'Follow-up' below.)

Education that colic it is not caused by something that they are doing or not doing. It does not mean that the infant is rejecting them.

Acknowledging that the infant is difficult to soothe and that you know that they are doing the best that they can. This is essential in preventing the caregivers from feeling as if they have failed.

Providing tips for techniques to soothe the baby. (See 'Soothing techniques' below.)

Encouraging the caregivers to take breaks from the crying infant (eg, taking turns with the infant during the colicky period, asking a relative or friend to babysit so that they can have a break, placing the crying infant in their crib) and to have a "rescue" plan (a prearranged plan in which a relative or friend can step in if the caregivers feel overwhelmed).

Acknowledging that feelings of frustration, anger, exhaustion, guilt, and helplessness are normal.

Clinical studies of caregiver support/counseling for infantile colic usually find caregiver support/counseling beneficial [5,26-29], but the evidence is limited [30]. In a meta-analysis of three open-label randomized trials comparing caregiver training interventions (eg, how to respond to crying infant, sleep advice, soothing techniques) with control infants (eg, routine care, reassurance, empathy/support), parent training interventions reduced crying time at completion of the study (mean difference -1.9 hours/day, 95% CI -2.4 to -1.4 hours/day) [5,26,30-32]. In another randomized trial, caregiver counseling was more effective than dietary changes (crying decreased from 3.2 to 1.1 hours per day in the counseling group and from 3.2 to 2.0 hours per day in the dietary change group) [27].

Home-based nursing intervention or contact with other caregivers who have or had infants with colic also may be beneficial. In a randomized trial in 121 infant-family pairs, crying was reduced by 1.7 hours/day in infants following a four-week home-based intervention program (consisting of reassurance, empathy, support, and time-out) compared with infants who received routine care [26]. In another study of 92 mother-infant pairs, specific care suggestions provided by a trained lay counselor were associated with greater reduction in crying (51 percent reduction) than empathetic counseling by a lay counselor (37 percent reduction) or no treatment (35 percent reduction) [29].

First-line interventions — As first-line interventions for colic, we suggest changes to the feeding technique and/or experimenting with a number of techniques to soothe the infant [24,33]. These interventions address some of the potential etiologies of colic (eg, swallowed air, overstimulation). We generally initiate changes to feeding and soothing techniques at the same time, explaining the theories of the etiology of colic that they are meant to address. Although the evidence supporting these interventions is limited, they cost nothing, are unlikely to be harmful, and may be helpful for caregivers who find it hard to have nothing to do while awaiting spontaneous remission (which confirms the diagnosis) [15].

Feeding technique — Feeding changes may be helpful for infants whose colic is associated with feeding problems (eg, underfeeding, overfeeding, inadequate burping). Bottle-feeding the baby in a vertical position (using a curved bottle) in combination with frequent burping may reduce swallowed air. Using a bottle with a collapsible bag also may help reduce air swallowing [34]. Changes to breastfeeding technique also may be warranted. However, the management of breastfeeding problems should be individualized. Consultation with a lactation specialist may be warranted. (See "Common problems of breastfeeding and weaning".)

Soothing techniques — We suggest that caregivers experiment with one or more of the following techniques for soothing the infant and/or decreasing sensory stimulation. They should be instructed to continue those that are helpful and discontinue those that are not [6,15]. The soothing techniques can be tried in any order and/or combination. Caregivers can be instructed to try a technique for several minutes and if it does not work, move on to another soothing technique. The success or failure of individual soothing techniques may vary from one episode of colic to the next. We suggest that families experiment with soothing techniques for several days to weeks before moving on to other interventions. (See 'Unproven interventions' below.)

Using a pacifier.

Taking the infant for a ride in the car or a walk in the stroller/buggy.

Holding the infant or placing them in a front carrier [35].

Rocking the infant.

Changing the scenery (or minimizing visual stimuli).

Placing the child in an infant swing.

Providing a warm bath.

Rubbing the infant's abdomen.

Hip healthy swaddling (ie, with room for hip flexion, knee flexion, and free movement of the legs [36-38]. (See "Developmental dysplasia of the hip: Epidemiology and pathogenesis", section on 'Swaddling'.)

The risk of sudden infant death with swaddling is discussed separately. (See "Sudden infant death syndrome: Risk factors and risk reduction strategies", section on 'Sleep environment'.)

Playing an audiotape of heartbeats.

Providing "white noise" (eg, vacuum cleaner, clothes drier, dishwasher, commercial white noise generator, etc). Commercial white noise generators (sometimes called infant sleep machines) can produce sound pressure levels greater than the recommended noise threshold for infants in hospital nurseries [39]. To minimize potential adverse effects on hearing or auditory development, white noise generators should be placed as far away from the infant as possible, played at a low volume, and used only for short periods of time.

These interventions are suggested by experts [6,15]. They have not been proven effective in randomized trials but are inexpensive, unlikely to be harmful, involve the caregivers, and may help to reduce caregiver or infant anxiety [5,15,16,20]. In a large observational study, holding, walking, and rocking were found to be effective in calming breastfed infants (with or without colic) younger than 16 weeks [40].

Unproven interventions — A number of other interventions for infantile colic have been evaluated in randomized trials with methodologic weaknesses or inconsistent results. Given these limitations, we generally do not suggest these interventions for infantile colic. However, they may be suggested for some patients on a case-by-case basis after a discussion of the potential risks and benefits if first-line interventions have been unsuccessful after several days to weeks. Providing a several week trial of first-line interventions allows time for colic to run its natural course and may avoid unnecessary, costly, or potentially harmful remedies.

Dietary changes — A time-limited trial of dietary interventions may be warranted for infants who do not respond to first-line interventions, particularly if milk protein allergy is suspected. Dietary changes vary depending upon whether the infant is formula-fed or breastfed.

Formula-fed infants

Extensive hydrolysate formula – A one-week trial of an extensive hydrolysate infant formula (eg, Alimentum, Nutramigen, Pregestimil) is an option for formula-fed infants with colic who have not responded to first line-interventions. A subgroup of infants with colic may have an allergy or intolerance to cow's milk formula, although infants with allergy or intolerance usually have associated clinical features (eg, bloody stool, vomiting, rash, etc). (See "Milk allergy: Clinical features and diagnosis", section on 'Clinical features' and "Food protein-induced enterocolitis syndrome (FPIES)", section on 'Clinical features' and "Introducing formula to infants at risk for allergic disease", section on 'Types of formulas'.)

Hydrolysate formula may be continued if there is a decrease in crying/fussiness. The response usually occurs within 48 hours [41]. The original formula is resumed if there is no change in the infant's symptoms (hydrolysate formulas are more expensive than cow's milk-based formulas).

Systematic reviews of small randomized trials with methodologic limitations suggest that hydrolysate formulas may reduce distress in some infants with colic [17,19,42]. Additional studies are necessary to confirm these results.

Soy protein formula – We do not suggest changing from cow's milk to soy protein formula for formula-fed infants with colic. The benefits of soy versus cow's milk protein in the prevention and management of colic are unproven [43]. Studies comparing the effects of soy and hypoallergenic formulas on the reduction of colicky symptoms are lacking.

Based on four small randomized trials with methodologic limitations (eg, inadequate blinding) [41,44-46], a 2012 systematic review concluded that soy protein formulas may improve colic symptoms, but additional studies are necessary [17].

The American Academy of Pediatrics Committee on Nutrition does not recommend soy protein formula for the treatment of infantile colic [43].

Fiber-enriched formula – We do not suggest fiber-enriched formulas for formula-fed infants with colic. In a randomized crossover trial in 27 term infants in which the investigators were blinded but the caregivers were not, fiber supplementation of soy-protein formula did not affect the average daily duration of crying [47]. However, the caregivers of 18 infants found the fiber-supplemented formula beneficial in alleviating colic symptoms.

Breastfed infants — A time-limited trial of a decrease in maternal milk product consumption or a hypoallergenic maternal diet (eg, no milk, eggs, nuts, wheat) is an option for breastfed infants with colic who have not responded to first-line interventions and whose caregivers have difficulty coping. A subgroup of infants with colic may have food allergy or allergy to cow's milk, although infants with allergy usually have associated clinical features (eg, rash, wheezing). Maternal dietary changes may be particularly beneficial if the mother is atopic or the baby has symptoms of cow's milk allergy (eg, eczema, wheezing, diarrhea, or vomiting) [48]. (See "Milk allergy: Clinical features and diagnosis", section on 'Clinical features'.)

Several systematic reviews of small randomized trials with methodologic limitations suggest that a hypoallergenic diet may reduce distress in infants with colic [17,19,42]. Additional studies are necessary to confirm these results.

Probiotics

Management

Lactobacillus reuteri – We do not suggest L. reuteri for the routine management of colic in breastfed or formula-fed infants. However, for breastfed infants whose caregivers prefer to try probiotics, it may be reasonable to offer L. reuteri DSM 17938 (but not other species or strains) after a discussion of the potential benefits, risks, and uncertainties.

Although there is evidence from randomized trials that treatment with L. reuteri DSM 17938 is associated with decreased crying time [49,50], the evidence of benefit is inconsistent and must be weighed against the natural history of improvement over time [51,52]. Additional factors affecting our suggestion include the cost of probiotics, which are not typically covered by commercial insurance, and uncertain safety of commercially available products. The US Food and Drug Administration does not evaluate probiotic products, which may contain unlabeled ingredients or species that differ from those indicated on the label or be contaminated with fungi or other pathogens) [53-55]. In addition, the reporting of harms in randomized trials of probiotics is often inadequate or lacking [56].

In an individual patient data meta-analysis of four randomized trials (345 infants) [57-60], L. reuteri DSM 17938 100 million colony-forming units per day decreased crying/fussing time on Day 21 compared with placebo (adjusted mean difference in change from baseline -25 minutes [95% CI -47 to -4 minutes]) [49]. The use of nonvalidated diaries in which caregivers estimated duration of crying/fussing at the end of the day in two of the included trials limits confidence in the magnitude of this effect. When analyzed according to feeding method, the benefits were limited to breastfed infants. However, the benefit for breastfed infants is inconsistent and may vary geographically [52,59]. Whether the different outcomes in breastfed and formula-fed infants or the inconsistent outcomes in breastfed infants from different countries are related to the gastrointestinal microbiome remains uncertain [61,62]. All of the trials included in the meta-analysis reported no adverse effects.

Other probiotics – We do not suggest probiotics other than L. reuteri for the routine management of colic in formula-fed or breastfed infants.

A 2013 systematic review of five randomized trials (271 infants) evaluating probiotics (various strains) in reducing crying found inconsistent results depending upon probiotic species and feeding method [57,58,63-66]. Subsequent trials have focused on L. reuteri, as discussed in the previous bullet.

Prevention – We do not suggest probiotics (including L. reuteri) for the prevention of colic. Although they appear to be safe and may reduce crying time, clear evidence that they are effective in preventing colic is lacking [67].

A systematic review identified six heterogeneous trials that compared prophylactic probiotics in infants <1 month of age without colic at baseline [67]. Meta-analysis of three trials (1148 participants) [68-70] found no difference in the proportion of new cases of colic in infants <1 month of age without colic at baseline (4.9 versus 8.9 percent), risk ratio 0.46, 95% CI 0.18-1.19). However, in meta-analysis of three trials (707 participants) [71-73], crying time at the end of the study was decreased in the probiotic group (mean difference of 33 minutes, 95% CI 56-10 minutes). Meta-analysis of the six trials found no difference in the risk of serious adverse events between the probiotic and placebo groups.

Lactase — We do not suggest lactase for the treatment of infantile colic. The benefits of lactase remain unproven. Randomized trials of lactase treatment for infantile colic have conflicting results [42,74-78].

Sucrose — We do not suggest sucrose for the treatment of colic. Although oral sucrose appears to reduce some types of pain in neonates, the evidence that it is beneficial in reducing crying in colicky infants is limited [78,79]. (See "Management and prevention of pain in neonates".)

In a randomized crossover trial in 19 infants, 12 improved subjectively with sucrose [80]. However, the effect was short-lived (30 minutes to 1 hour maximum). A separate case-control study found that the duration of response of colicky infants to sucrose was ≤3 minutes [81].

Infant massage — We do not suggest infant massage for the treatment of infantile colic. A 2010 systematic review found no evidence of benefit and the potential harm of unsettling or overstimulating colicky infants [20].

In a randomized trial comparing four weeks of treatment with infant massage and a crib vibrator, crying decreased from baseline in both groups [82]. The authors attributed the decrease in crying to the natural course of colic (ie, resolution by three to four months of age) rather than to the specific interventions.

Simethicone — We do not suggest simethicone for the treatment of infantile colic. Simethicone is a medication that causes gas bubbles to coalesce, facilitating expulsion [22]. However, two 2016 systematic reviews of small randomized trials with conflicting results [63,83,84] found little evidence to support its use in the treatment of infantile colic [78,79]. Simethicone is generally considered to be safe, but it may interact with levothyroxine in infants being treated for congenital hypothyroidism resulting in undertreatment [85].

Herbal remedies — We do not suggest herbal remedies (eg, herbal teas, fennel seed, gripe water [a mixture of herbs and water]) for the treatment of infantile colic. Although a few randomized trials suggest that specific herbal remedies may be beneficial in reducing crying compared with placebo [42,86-88], the benefits are largely unproven [79]. Given the lack of standardization and regulation of herbal products, the benefits do not outweigh the potential risks (eg, contamination with bacteria, toxins, or particulate matter; unlabeled ingredients, such as alcohol) [89-91]. Prolonged ingestion of herbal teas may lead to decreased milk intake [88].

Homeopathic remedies — We do not suggest homeopathic remedies for the treatment of colic. They have not been proven to be effective.

Homeopathic remedies often are considered nontoxic because of the low concentrations of active ingredients. However, the labels of homeopathic products may not report all of the ingredients, some of which may have toxic effects [92]. As an example, gas chromatography-mass spectrometry analysis of a homeopathic remedy for colic that was associated with an increased risk of apparent life-threatening events found that it contained ethanol, propanol, and pentanol, in addition to three potentially toxic substances that were listed as active ingredients (Citrullus colocynthis [bitter apple], Veratrum album [white hellebore], and Strychnos nux-vomica [strychnine tree]) [93]. C. colocynthis is also found in Cocyntal and Hyland colic tablets.

Manipulative therapies — We do not suggest manipulative therapies (eg, chiropractic, osteopathy, cranial manipulation) for the treatment of colic. A 2012 meta-analysis of six randomized trials (325 infants) concluded that methodologic limitations preclude definitive conclusions about the effectiveness or safety of manipulative therapies for infantile colic [18].

Acupuncture — We do not suggest acupuncture for the treatment of colic. The potential benefits are unproven [94].

Although a systematic review concluded that acupuncture is safe when performed by appropriately trained providers [95], there is limited evidence of benefit for infants with colic. An individual patient data meta-analysis that included 307 infants from three heterogeneous randomized trials [96-98] did not find clinically important differences between acupuncture and no acupuncture [94]. In the only study that compared crying during acupuncture and control treatments, crying for >10 seconds was more common during acupuncture (74 versus 37 percent) [97]; crying resolved within two minutes for all infants.

Follow-up — The frequency of follow-up for colicky infants is individualized. Some infants and caregivers may require frequent follow-up (by phone or in person) and re-examination to be reassured that the infant is continuing to do well and growing normally [6]. Other infants whose caregivers are coping well and have strong support networks can be seen less frequently (eg, at regularly scheduled health maintenance visits). In all cases, caregivers should be counseled to return if the infant develops symptoms that were not present during the initial evaluation (eg, vomiting, rash).

INDICATIONS FOR REFERRAL — Most infants with colic can be managed by the primary care provider. Referral to a developmental behavioral pediatrician or mental health provider may be warranted for caregivers who are extremely anxious or in need of additional reassurance [33].

OUTCOMES — Caregivers of colicky infants experience stress, fatigue, guilt, and depression [99]. Some researchers have postulated that colic may disturb the child-caregiver interaction and thus have long-term effects on the family and child [100]. However, the data on the sequelae of colic are conflicting.

Temperament and behavior — Several studies show that temper tantrums are more common among formerly colicky infants. In two follow-up studies, caregivers of formerly colicky infants reported more frequent temper tantrums at three and four years of age than caregivers of control children [100,101]. In a meta-analysis of longitudinal studies, the risk of behavior problems in later childhood was increased when colic persisted at five months of age [102]. The risk was greatest when persistent colic was accompanied by other regulatory problems (eg, feeding, sleeping) and psychosocial risk factors, which makes it difficult to establish a causal relationship [3]. However, in a subsequent prospective study, colic that self-resolved before age six months was not associated with difficult temperament or behavior problems at age two to three years [103].

Caregivers of formerly colicky children perceive their toddlers' temperaments as more difficult than caregivers of noncolicky children. In a follow-up study, caregivers described their formerly colicky children as more emotional at age four years (eg, "cries easily" or "tends to be somewhat upset") than noncolicky infants [101]. Caregivers in another one-year follow-up survey also rated their formerly colicky children as more difficult [104]. However, these children did not differ from control children according to the Toddler Temperament Scale. The discrepancy between the caregiver's perception of the child's temperament and the child's actual temperament may reflect the long-term effects of colic on caregiver-child interaction [105]. Another possibility is that factors that predispose an infant to colic also cause problems with caregiver-child interactions.

In a prospective study, 48 infants (31 to 87 days of age) who were hospitalized with severe colic and 48 infants without chronic or severe illness who were hospitalized for problems unrelated to colic, gastrointestinal, allergic, or psychological disease were followed up with at 10 years of age [106]. Fussiness, aggressiveness, and feelings of supremacy were reported more often by the caregivers of colicky infants than of controls.

Sleep patterns — Prospective studies regarding the relationship between colic and the development of childhood sleep problems have conflicting results [100,103,106-109]. The conflicting results may reflect differences in caregiver perception or in caregiver-child interaction for caregivers of children with and without histories of colic.

Family functioning — Studies also differ regarding the effects of colic on family functioning. In a case-control study, family functioning was assessed at one year of age in families of infants with and without colic [104]. Families in the severe colic group had more difficulties in communication, unresolved conflicts, dissatisfaction, and lack of empathy and flexibility. However, other observational studies found no effects of colic on family functioning at two to three years of age [103,107]. Perhaps the effects of colic on family functioning are present early on but do not persist to three years of age.

Asthma and atopy — Prospective studies evaluating the development of asthma and atopy among infants with colic have conflicting results. In a study in which 983 infants were followed from infancy through 11 years of age, the prevalence of colic was approximately 9 percent. No association was found between infantile colic and asthma, allergic rhinitis, peak flow variability, or markers of atopy (total serum immunoglobulin E and allergy skin prick test) at any age [110]. In a subsequent smaller study with shorter follow-up, there was an association between infantile colic and allergic disorders (eg, allergic rhinitis, atopic eczema, food allergy) [106].

Cognitive development — Colic does not appear to influence long-term cognitive development. In a prospective study of 327 children, approximately 15 percent had a history of colic (defined as "daily uncontrolled crying without any obvious cause, persisting for at least two weeks"), and 5 percent had a history of prolonged crying (colic-like crying that was reported at both 6 and 13 weeks) [111]. At five years of age, adjusted mean intelligence quotient (IQ) scores were similar among children with and without a history of colic.

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or email these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient education" and the keyword[s] of interest.)

Basics topic (see "Patient education: Colic (The Basics)")

Beyond the Basics topic (see "Patient education: Colic (excessive crying) in infants (Beyond the Basics)")

SUMMARY AND RECOMMENDATIONS

Terminology – We broadly define colic as crying for no apparent reason (eg, hunger, soiled diaper, etc) that lasts for ≥3 hours/day and occurs on ≥3 days per week in an otherwise healthy infant <3 months of age. (See 'Terminology' above.)

Natural history – Colic symptoms resolve spontaneously in 90 percent of infants by eight to nine weeks of age. (See 'Natural history' above.)

Management – Management of colic is individualized based upon the history, examination, and family characteristics. The goals are to help the caregivers cope with the child's symptoms and to prevent long-term sequelae in the caregiver-child relationship. (See 'Overview' above.)

Caregiver support is the mainstay of the management. (See 'Caregiver support and education' above.)

Beyond caregiver support, we suggest changes to feeding technique and/or experimenting with a number of techniques to soothe the infant (eg, rubbing the infant's abdomen, providing "white noise," etc) as first-line interventions (Grade 2C). (See 'First-line interventions' above.)

A time-limited trial of hydrolysate formula for formula-fed infants or hypoallergenic diet for mothers of breastfed infants may be helpful for infants who do not respond to first-line interventions. For formula-fed infants, we suggest not switching from cow's milk formula to soy protein formula or using fiber-enriched infant formulas (Grade 2C). (See 'Dietary changes' above.)

A number of other interventions for infantile colic have been evaluated in randomized trials with methodologic weaknesses or inconsistent results (eg, probiotics, simethicone, herbal teas). Given these limitations, we generally do not use these interventions for infantile colic. However, they may be tried on a case-by-case basis after a discussion of the potential risks and benefits. (See 'Unproven interventions' above.)

Follow-up – The frequency of follow-up for colicky infants is individualized. Some infants and caregivers may require frequent (ie, weekly or biweekly) follow-up for reassurance, whereas other infants whose caregivers are coping well and have strong support networks can be seen less frequently. (See 'Follow-up' above.)

Outcomes – The data on the sequelae of colic with respect to temperament, behavior, sleep patterns, family functioning, asthma, and atopy are conflicting. However, colic does not appear to be related to cognitive development. (See 'Outcomes' above.)

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Topic 612 Version 39.0

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