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What to Know About Infant Fussiness and Colic

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Check out the PedsDocTalk YouTube video: Fussy Newborns and Colic for more on what colic is and management strategies.

It can be a disheartening, frustrating, and exhausting experience when your baby has been crying and crying, but you can’t figure out how to comfort them. It can be helpful to know what is considered normal fussiness in babies, what colic is, and tips for managing colic.

Infant fussiness vs. colic

Many parents notice an increase in fussiness in their newborn, usually starting around 2-7 weeks of age, with a peak at 6 weeks. One reason is that the honeymoon period is over and infants are waking up to their surroundings. For the first 2-4 weeks, many babies can sleep anywhere and haven’t realized there’s a whole new world out there. Shortly after that time, they become more alert and aware that they are not in a dark womb anymore – there are noises, lights, temperature irregularities, and they have to work to feed!

When they are more alert and aware, they are more easily overstimulated.

Another reason is thought to be the developing gut. Healthy bacteria colonize the microbiome of the newborn every day, and this can potentially lead to more gas. This is a vicious cycle – more gas can lead to more crying, and more crying can lead to more swallowed air, which leads to more gas.

All infants cry, but when a healthy, well-fed infant cries for more than three hours per day, for more than three days a week, and for longer than three weeks, they are considered to have colic.

Colic is a self-limited condition that babies will outgrow, typically by 3-4 months, but it can still be a very distressing experience for parents.

It’s important to acknowledge that colic is NOT reflux. Colic is NOT a milk protein allergy. Colic is a diagnosis of exclusion, which means other reasons for fussiness have been excluded.

Colic is not a baby who is fussy all day, every day. The baby usually has a specific time or times they are fussy and crying – whether it’s in the evening or in the middle of the night at 2:00 AM.

Symptoms of colic

Babies with colic often have periods of inconsolable fussiness with a clear start and finish. These periods often seem to start without a known trigger. The quality of the cry is typically higher pitched and louder than a non-colicky cry. Parents often report that their cry sounds like they are in pain and is often described as more urgent sounding and distressing than non-colicky cries. This can be an overwhelming feeling as a parent, but it’s important to be a calm and soothing presence for your baby.

Management of colic

Typically, management will focus on finding soothing strategies – which can be different for each baby! Some will work well for one baby but not another, so try several and see if your baby responds best to a certain one.

It’s also key to be a calm presence during these times since our children can feel our emotions. Sometimes it’s helpful to pause before reacting or picking up your crying infant – give yourself a moment to calm yourself down.

Check out this PedsDocTalk podcast for more about colic, soothing a fussy baby, and tips to help get you through those tough moments.

Before trying soothing strategies, make sure their basic needs are met.

  • Check their diaper to see if it needs to be changed
  • Look for feeding cues to see if they’re hungry
  • Do a scan to make sure medically they’re okay—if the back of their neck feels burning hot, it may be best to remove clothing layers and check a rectal temp to confirm the fussiness is not due to a fever
  • Also, check their extremities for hand tourniquets or pieces of hair wrapped around their finger or toes.

This is a basic needs and health assessment. When all this is good, take that deep breath, regulate yourself, and say, “My baby is safe. I’m safe.”

Now try a few soothing techniques that work for YOUR baby. Here are a few soothing tips to consider:

  • Swaddle
  • Suck
  • Skin-to-skin
  • Side rock
  • Swing or bounce
  • Shush (sound machine)

Download this PedsDocTalk Fussy Baby Checklist for more guidance and tips to soothe a fussy baby.

Beyond soothing strategies, there is minimal evidence to support the use of other methods to reduce crying in infants with colic. There has been some evidence that supplementing babies with a probiotic containing Lactobacillus reuteri, like Gerber Soothe drops, can reduce time spent crying, but the evidence is inconsistent.

Check out this PedsDocTalk YouTube video on Probiotics in Infants: Research Behind Use and Different Types

Similarly, gripe water and gas drops, like Simethicone or Mylicon drops, have not shown consistent evidence of reducing symptoms in babies with colic. Therefore, it’s best to start with all the previous interventions before trying these medications. Also, only continue to use them if you notice a benefit. As always, discuss with your child’s pediatrician before starting any new medications.

If spit-up or excessive gas is present, some clinicians may consider switching an infant’s diet if other symptoms are present (such as to a more gentle or hydrolyzed formula if formula feeding), but please speak to a clinician before making too many changes. As for breastfeeding mommas, there is no elimination diet recommended, but if you notice a strict correlation between certain foods you eat and gassiness in the baby, you can choose to eliminate those certain foods.

Because a gassy baby and colic can go hand in hand, using anti-colic bottles can help if bottle feeding, feeding baby in an upright position or 45-degree angle, burping in the middle of feedings to alleviate gas, and ensuring proper latch with breastfeeding can help to reduce gas. Also, gently massaging your baby’s belly in a circular motion or pumping their legs back and forth can help alleviate the gas.

Download this PedsDocTalk Gas and Poop Survival Guide for help on how and when to intervene and when to talk to your child’s pediatrician.

When should you seek medical care?

Seek care for the following:

  • Your baby under three months has a fever over 100.4 Fahrenheit taken rectally
  • If your baby seems to be fussy the whole day without chances of sleep stretches at all
  • If your baby is also spitting up with the fussiness
  • There is blood in the stool
  • They are not feeding and making at least 4 wet diapers in a day 

Colic and significant infant fussiness can contribute to family stress, postpartum anxiety, and depression. It’s an important time to utilize your support system – take some alone time away from your baby, if possible to recharge. Remember if you’re feeling consistently sad, overwhelmed, disconnected, or just feeling unlike yourself, seek help from a professional, such as a therapist.

Watch the PedsDocTalk YouTube Video HERE!

P.S. Stay up to date on the latest news on all things child health and parenting with the PedsDocTalk newsletter!

Dr. Mona Admin

Hi there!

I’m a Board Certified Pediatrician, IBCLC, and a mom of two.

I know the ups and downs of becoming a mom and raising kids.

I help moms ditch the worry and second-guessing so you can find more joy in motherhood.


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