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Colic: who to see and what helps

Colic · Kitchener, Waterloo & Cambridge

Colic is frequent, hard-to-soothe crying in a young baby who is otherwise healthy and growing. It is usually over by three to four months of age, and no drop, diet change or hands-on treatment has strong evidence behind it. The first step is a check of your baby by a physician or nurse practitioner. At CARESPACE that is a Nurse Practitioner, with a Registered Dietitian when feeding is in question. Neither replaces your baby’s regular medical care.

What colic is

All babies cry, and some cry much more than others. In the Canadian Paediatric Society’s guide for parents, a baby with no health or developmental concerns who tends to cry a lot may be called colicky. One common yardstick is the “rule of three”: crying about three hours a day, at least three days a week, for at least three weeks. Estimates of how many babies are affected run from about 5% to 25%.

Signs of colic

  • Frequent, intense crying that is hard or impossible to soothe
  • Crying that is worst in the late afternoon or evening
  • Clenched fists and a red face
  • Knees pulled up to the tummy, or an arched back
  • Arms and legs stretched out and stiffened, then pulled in tight
  • A rumbling tummy, or a lot of wind

The crying usually starts at two to four weeks of age.

What causes colic

The cause is not known. Many experts think colicky babies are at one end of the normal range of infant crying, more a stage of development than a matter of what the baby eats. Gas, digestion and food allergies have not been proven to cause it, and it is just as likely in breastfed babies as in bottle-fed ones. The NHS does mention a food allergy, such as to cow’s milk, as a possibility.

How colic is diagnosed

Colic is the name used when a baby cries this much and is otherwise healthy, so the diagnosis starts with a physician or nurse practitioner looking for other causes, such as hunger, reflux or constipation. Toronto’s SickKids hospital advises having a baby who cries often and intensely, and cannot be soothed, seen to rule out a health problem.

When crying is not colic: emergency and urgent signs

Nobody at CARESPACE can rule out an emergency in a baby. These signs come from the Public Health Agency of Canada’s guide for new parents, the Canadian Paediatric Society and the NHS, put into Ontario terms. The lists are not complete: when in doubt, consult your health care provider or get emergency medical care.

Call 911 if your baby has trouble breathing or swallowing; is choking; is pale blue or grey, or has a very pale face or lips; has a swollen tongue, mouth or throat; has a hoarse voice or cry; has fainted or passed out; is not reacting to you when awake; or may have swallowed poison, alcohol, medication or drugs. Call 911 as well if your baby is working harder to breathe (shortness of breath, flaring nostrils, skin drawn in between the ribs, wheezing or gasping), is breathing quickly even when calm and not crying (more than 60 breaths a minute), looks pale or greyish, reacts little to you when awake, or is hard to wake. The federal guide lists those under “consult your health care provider”, but they are hard to tell apart from the signs above, and the NHS tells parents in the UK to call an ambulance or go to emergency for very fast or difficult breathing, for blue, grey or pale skin, and for a baby who is difficult to wake. The NHS list is longer than the one here: it also has a seizure, a rash that does not fade when you press it, and skin that feels cold or clammy. For any of those, call 911 or go to an emergency department right away.

Go to an emergency department right away if your baby is under three months old and has a fever (a rectal temperature of 38°C or higher, or an armpit temperature of 37.6°C or higher), has blood in the stool, or has a cry that is weak, high-pitched or does not sound like their normal cry.

If you have thoughts of harming your baby or yourself, put your baby down in a safe place, such as the crib, and call 911. If you are afraid that someone else might hurt your baby, get help right away, and call 911 if your baby is in danger. Never shake, smother, hit or throw a baby: it can cause lifelong injury or death.

If you are in crisis or thinking about suicide, help is available right now.

  • Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
  • Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
  • Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

If you cannot tell whether a sign belongs on the 911 list above, call 911. Otherwise, call your baby’s physician or nurse practitioner without delay, and go to an urgent care clinic or an emergency department if you cannot reach them, if your baby: has frequent projectile vomiting; is not drinking much and is unusually sleepy; is irritable and crying all the time and cannot be consoled; has not peed in 24 hours; or is more than three days old and has orange crystals in the diaper. The federal guide adds that crying is normal, and that the time to call is when your baby is inconsolable and has other symptoms that worry you.

Make an appointment with your baby’s physician or nurse practitioner if you are worried about the crying, or about any part of your baby’s health or development, or if your baby is not behaving as usual (sleeping more or less than usual, for example), is not eating or growing normally, is vomiting or has diarrhea, could have been hurt in a fall or injury, or has cried excessively for more than three months. The NHS adds three reasons: nothing you try seems to work, you are finding it hard to cope, or the colic is still there after four months of age.

What the evidence says about treating colic

  • Time ends colic. None of the sources behind this list found a treatment with strong evidence.
  • Changing how you feed rarely helps. Stopping breastfeeding, or switching formula (hypoallergenic and soy formulas included), has not been shown to help. A Cochrane review of 15 small trials with 1,121 babies rated the evidence on diet changes as very low quality and was unable to recommend any of them.
  • Probiotics: the advice differs. The Canadian Paediatric Society’s 2022 statement says Lactobacillus reuteri “can be considered” for reducing colic symptoms. The same statement notes safety concerns for at-risk children: sepsis has been reported, particularly in children who are immunocompromised, have an active cancer or were born prematurely. The NHS says probiotic supplements are not recommended. Ask your baby’s physician or nurse practitioner before giving one.
  • Drops, gripe water and herbal remedies are not supported. A Cochrane review found no evidence to support simethicone, and concluded that herbal agents, sugar and the medicines dicyclomine and cimetropium bromide cannot be recommended for colic. Gripe water has shown no benefit. Talk to your baby’s physician or nurse practitioner before using any over-the-counter or “natural” product.
  • Chiropractic, osteopathy and other manual therapy: the NHS says do not try it. The UK’s NHS tells parents: “do not try putting gentle pressure to your baby’s spine (spinal manipulation) or skull (cranial osteopathy)”, because “there is little evidence this works, and it may hurt your baby”. In Cochrane’s review of six small trials with 325 babies, the five that could be pooled showed about an hour and 12 minutes less crying a day, but in the trials where parents did not know whether their baby had been treated the difference was not statistically significant. A 2018 review pooled four studies and reported a similar drop in crying (about 1.3 hours a day), rated moderate-strength evidence, with no effect on overall improvement. Its authors called the benefits small, said it is unclear whether they are meaningful to parents, and wrote that manual therapy “appears relatively safe” on the few adverse events reported, while asking for a dedicated study of adverse events in children. Cochrane’s reviewers were more cautious: harms were recorded in only one of their six trials, and they judged a definitive conclusion about effectiveness impossible and the data inadequate for any definitive conclusion about safety.

How each CARESPACE service helps with colic

Nurse Practitioner

In Ontario a Nurse Practitioner can take a full health history, examine, make a diagnosis, order tests and refer to specialists, and Nurse Practitioners work across age groups. For a baby who cries a lot, that is the check that comes first: an examination that looks for a cause other than colic. When you book, ask which Nurse Practitioners see babies.

See our nurse practitioner team →

Nutrition & Dietitian

A Registered Dietitian can go through how feeding is going and what you have already changed, so that you do not give up foods, or breastfeeding, without a reason the evidence supports. A cow’s milk protein allergy is a separate medical diagnosis, treated with a supervised change to the mother’s diet or the baby’s formula. For breastfed babies with one form of it (allergic proctocolitis), the Canadian Paediatric Society strongly recommends counselling by a qualified paediatric dietitian, so that the baby’s nutritional needs are met and hidden sources of the allergen are avoided, and says a dietitian can help see that the mother’s needs are met too. When you book, ask who works with babies and breastfeeding parents.

See our nutrition team →

Other services people ask about

Chiropractic and osteopathy. This page does not recommend either for colic. The NHS’s advice to parents is “do not try” spinal manipulation or cranial osteopathy, because “there is little evidence this works, and it may hurt your baby”, and Cochrane’s reviewers found the data inadequate for any definitive conclusion about safety. A baby who cries a lot needs a medical check by a physician or nurse practitioner. Massage. SickKids says neither baby massage nor chiropractic care has been shown to be effective for colic. Help with breastfeeding. A lactation consultant can check for problems, such as a poor latch, that could leave a baby hungry. Region of Waterloo Public Health runs free Baby Feeding Clinics for babies of any age, led by public health nurses, in person, virtually or by telephone; book online or call 519-575-4400.

Where most people start

With a medical check of your baby, by your own family physician, nurse practitioner or paediatrician or by a Nurse Practitioner at CARESPACE. Add a Registered Dietitian if feeding is the worry.

How your team works together

Colic rarely needs a team. Caring for a crying baby is stressful, though, and feeling sad, anxious, resentful or angry is a reason to talk to someone you trust or a health professional. If low mood or worry is lasting, see Postpartum Depression & Anxiety.

Browse by service: nurse practitioners and registered dietitians.

What to expect at your first visit

  1. The crying. You may be asked when it started, what time of day it is worst, how long it lasts and what settles it.
  2. Feeding and growth. Breast or bottle, how feeds go, and how your baby is growing. Bring any weights you have from check-ups.
  3. An examination. A Nurse Practitioner can examine your baby to look for a cause other than colic.
  4. A plan. You leave the first visit with a plan.

What you can do at home

  • Check the basics first: hunger, a diaper that needs changing, being too hot or too cold, pain or fever.
  • Hold or cuddle your baby. You cannot spoil a baby by picking them up.
  • Try gentle motion: rocking, swaying, a walk in the stroller or a ride in the car.
  • Swaddle safely, dim the lights, and cut the noise or try gentle white noise.
  • Offer a feed or a pacifier, or try a warm bath.
  • Hold your baby upright during feeds, and burp them afterwards.

When you are exhausted or upset, ask someone you trust to take over for a while. If nobody is there, it is all right to put your baby down safely in the crib and take a short break in another room.

How long colic lasts

Usually until three to four months of age, with a peak somewhere between 3 and 12 weeks. If the crying is still excessive after that, see your baby’s physician or nurse practitioner.

Help with colic in Kitchener, Waterloo and Cambridge

Kitchener. Nutrition in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nutrition in Waterloo and Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Nutrition in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is colic a sign that something is wrong with my baby?

No. Colic does not mean that something is wrong with your baby, and colicky babies grow up normally. The signs that crying may be something else are in the urgent section above.

Should I change my diet, or my baby’s formula?

Usually not. The NHS says breastfeeding mothers do not need to change their diet, and switching formula has not been shown to help. A diagnosed cow’s milk protein allergy is different: that change is supervised, and a dietitian can help with it.

Do gripe water, gas drops or probiotics work?

Gripe water and simethicone drops have shown no benefit. On probiotics the advice differs: the Canadian Paediatric Society says Lactobacillus reuteri can be considered, and the NHS does not recommend probiotic supplements. Check with a physician or nurse practitioner first.

Does chiropractic or osteopathy help colic?

The NHS’s advice to parents is “do not try” spinal manipulation or cranial osteopathy for colic: “there is little evidence this works, and it may hurt your baby”. Small trials showed less crying, but not to a statistically significant degree when parents did not know whether their baby had been treated, and the reviewers found too little data for any definitive conclusion about safety.

Where can I get help with a colicky baby in Cambridge?

CARESPACE offers Nutrition in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Postpartum Depression & Anxiety
Postpartum Recovery

The CARESPACE Central Reception Team

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