Medical Professional Publications

Infant Colic: An Update for the Pediatric Specialist

(From the November 2014 Issue of PediatricsOnline)

For many years, medical and parenting communities alike have supposed that extended bouts of infant crying and distress in infants, called colic, can be attributed to gastrointestinal disturbance and pain. To help examine evidence regarding the true cause of colic and review the science that is available regarding GI disorders and pain in infants and very young children, the Journal of Pediatric Gastroenterology and Nutrition developed a supplemental issue on the topic.

“Colic is a vastly understudied topic in pediatrics,” says Carlo Di Lorenzo, MD, chief of the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s Hospital and one of the two coordinators of the collection of publications. “Despite the high prevalence of conditions such as chronic regurgitation, unexplained crying and difficulty stooling without underlying organic diseases in infants and toddlers, very little is known about their pathophysiology and appropriate treatment. That is why we wanted to create an educational piece that helps medical providers understand the current state of the art of these functional disorders.”

Key findings regarding colic featured in the journal’s special issue include the following:

  • As many as 20 percent of infants cry for prolonged periods of time; these cases usually resolve in a few months without medical or dietary intervention.
  • Gastroesophageal reflux rarely causes colic, and there is no indication that medications prescribed for reflux improve colic.
  • Parents may need better support for coping with colicky infants, as well as information demonstrating that medical treatment is not typically helpful.
  • A very small number of infants with colic (likely less than 5 or 10 percent) have true medical problems, including GI disorders. These infants often have other clear indicators of health problems, such as failure to thrive, vomiting, diarrhea or eczema.
  • Cow’s-milk allergy may cause colic in 1 to 2 percent of all infants with extended periods of crying. Dietary changes are helpful in these cases but can be difficult to implement and sustain.
  • Prolonged crying in infants over 4 months of age is associated with poorer developmental outcomes. Prolonged crying may be indicative of a more serious illness in infants over 4 months old, as may severe regurgitation in infants over 10 months old.
  • More research is required regarding the use of probiotics for colicky infants; existing evidence indicates L reuteri supplements are promising, but the literature does not yet support their routine use for colic.
  • Diagnostic criteria in existence for infant colic may be flawed; more research is needed to improve diagnostic assessments and guidelines.

Non-colic functional GI disorders in infants and young children — such as infant regurgitation, rumination, dyschezia and functional diarrhea — are also important for GI specialists to consider, Dr. Di Lorenzo says. Although they are common in children and adults, their proper recognition in infants could prevent infants from being needlessly subjected to extensive and costly medical workups and therapies, he says.

“It is possible to use clusters of symptoms in the absence of alarm signs to identify these non-colic functional problems using the Rome III criteria for infants and toddlers, due to the lack of biological markers,” says Dr. Di Lorenzo, who also published an article on infant functional GI disorders in the supplement. He also serves as medical director of the Rumination Team and the director of the Motility Center at Nationwide Children’s. “Colic should be treated with empathy and reassurance to the parents instead of prescription and nonprescription medications that are of questionable benefit for reducing crying. The condition, although very frustrating, is benign and often transient.”

Uncovering the impact of early life events on future functional GI disorders in children holds an interesting future line of inquiry for understanding the cause of colic, Dr. Di Lorenzo says. His review of this health continuum, included in the supplement, offers support for the concept of genetic predisposition and environmental impact on GI outcomes. Further research in this and other GI specialties may clarify some of the field’s remaining questions regarding infant colic.

“Certain research will be critical to our understanding of colic and GI complaints in infants and young children moving forward,” says Dr. Di Lorenzo, who also is a professor of Pediatrics at The Ohio State University College of Medicine. “We need a better understanding of normal developmental processes in newborns and infants; clarification of brain-gut pathways and the role of emotions and stress on the GI tract; and a better understanding of how the microbiome affects GI functioning and how manipulations of the microbiome may provide benefits to patients.”


St James-Roberts I, Di Lorenzo C. Background and scope. Journal of Pediatric Gastroenterology and Nutrition. 2013 Dec, 57(Suppl 1):S2-S3.

Di Lorenzo C. Impact of early life events on pediatric functional gastrointestinal disorders. Journal of Pediatric Gastroenterology and Nutrition. 2013 Dec, 57(Suppl 1):S15-S18.

Di Lorenzo C. Other functional gastrointestinal disorders in infants and young children. Journal of Pediatric Gastroenterology and Nutrition. 2013 Dec, 57(Suppl 1):S36-S38.

Di Lorenzo C, St James-Roberts I. Summary and conclusions. Journal of Pediatric Gastroenterology and Nutrition. 2013 Dec, 57(Suppl 1):S42-S45.

myChildren’s mobile app

iPhone and Android.

Download Today! »

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000