Infantile colic is defined as repeated episodes of excessive and inconsolable crying in an infant that otherwise appears to be healthy and thriving.

• Reassure the parents that their baby is well, they are not doing something wrong, the baby is not rejecting them, and that colic is common and is a phase that will pass within a few months.
• Holding the baby through the crying episode may be helpful. However, if there are times when the crying feels intolerable, it is best to put the baby down somewhere safe (e.g. their cot) and take a few minutes' 'time out'.
• Other strategies that may help to soothe a crying infant include:
• Gentle motion (e.g. pushing the pram or a ride in the car).
• 'White noise' (e.g. vacuum cleaner, hairdryer, running water).
• Bathing in a warm bath.
• Encourage parents to look after their own well-being:
• Ask family and friends for support — parents need to be able to take a break.
• Rest when the baby is asleep.
• Meet other parents with babies of the same age.
• CRY-SIS is a support group for families with excessively crying, sleepless, and demanding children. Their helpline is available every day from 9 a.m. to 10 p.m. Tel: 08451 228 669. The CRY-SIS website (www.cry-sis.org.uk) also contains useful information.

In depth

• The most useful intervention is support for parents and reassurance that infantile colic will resolve.
• Only consider trying medical treatments if parents feel unable to cope despite advice and reassurance. The options for medical treatments are:
• A 1-week trial of simeticone drops (breastfed or bottle-fed).
• A 1-week trial of diet modification to exclude cow's milk protein:
• Breastfed babies: dairy-free diet for the mother.
• Bottle-fed babies: hypoallergenic formula.
• A 1-week trial of lactase drops (breastfed or bottle-fed).
• Only continue treatment if there is a response (i.e. the duration of crying shortens).
• If there is no response to one medical treatment, consider trying another.
• Breastfeeding mothers should take a calcium supplement if they are going to remain on a dairy-free diet long term.
• If the baby does respond to lactase or hypoallergenic diet, reassure the parents that this does not necessarily mean that they are lactose intolerant or allergic to cow's milk. These are rare conditions that affect very few babies with infantile colic.

In depth

• If there is no response to the trial of treatment stop it.
• If there is a response to treatment: after the age of 3 months (and by 6 months of age at the latest), wean off treatment over a period of about 1 week.

In depth

• Seek advice from a paediatrician if:
• The parents are not coping despite advice, reassurance, and primary care interventions.
• There is diagnostic doubt (e.g. the baby is not thriving; crying is not starting to get better or is getting worse after 4 months of age; significant gastro-oesophageal reflux is suspected).
• Unable to wean off treatment by the age of 6 months.

In depth