Home Management of Infantile Colic
For breastfed infants with colic, start with a 2-4 week maternal elimination diet removing cow's milk and eggs, and consider Lactobacillus reuteri DSM 17938 supplementation, which reduces crying time by approximately 55-65 minutes per day at 21 days. 1, 2, 3
Evidence-Based Home Interventions
Feeding Modifications
For Breastfed Infants:
- Implement a strict maternal elimination diet excluding cow's milk and eggs for 2-4 weeks 1
- Small amounts of cow milk protein ingested by mothers can be expressed in breast milk and trigger colic symptoms
- Continue breastfeeding while modifying maternal diet—do not discontinue nursing 1
For Formula-Fed Infants:
- Switch to extensively hydrolyzed protein formula or amino acid-based formula 1, 4
- Partially hydrolyzed formulas may help when cow's milk allergy is not the underlying cause 4
- Avoid soy milk—it is not recommended as a treatment 4
Feeding Technique Adjustments:
- Reduce feeding volume while increasing frequency 1
- Avoid overfeeding 1
- For formula-fed infants, consider thickening with up to 1 tablespoon rice cereal per ounce of formula (increases density from 20 to 34 kcal/oz) 1
- Caution: Thickened feedings are associated with necrotizing enterocolitis risk in preterm infants and should be avoided in babies born before 37 weeks 1
Probiotic Supplementation
Lactobacillus reuteri DSM 17938 is the most evidence-based probiotic intervention:
- For breastfed infants: Reduces crying time by mean difference of -55.8 minutes/day at 21 days (95% CI -64.4 to -47.3) 2
- Specifically recommended for breastfed babies with colic 3
- For formula-fed infants: Evidence is weaker; consider Bifidobacterium breve BR03 and B632 combination instead 5
- Dose: >10^9 CFU/day 3
Positioning and Environmental Modifications
- Keep infants upright or prone only when awake and under direct supervision 6
- Avoid seated and supine positions immediately after feeding 1
- Avoid environmental tobacco smoke 1
- Avoid overheating—dress infant with no more than one layer more than an adult would wear 7
Behavioral Interventions
- Provide reassurance to parents that colic is self-limited with no long-term adverse effects 8
- Use motion/sound to calm the infant 4
- Reduce excessive stimuli 4
- Consider massage, warm washcloth application, or bathing 9
- Avoid overstimulation during crying episodes
Anti-Colic Bottles: Limited Evidence
There is no strong evidence that anti-colic feeding bottles provide meaningful benefit. The guidelines do not specifically address specialized bottle designs, and no high-quality studies demonstrate their effectiveness in reducing colic symptoms. The focus should remain on the interventions listed above rather than purchasing specialized feeding equipment.
What Does NOT Work
- Simethicone: No consistent benefit demonstrated; not recommended routinely 5, 2
- Lactase enzyme: Only helpful if lactose malabsorption is specifically suspected 5
- Commercial devices marketed to reduce colic: No evidence of effectiveness 7
- Written materials alone: Not effective without structured counseling 10
Red Flags Requiring Medical Evaluation
Seek immediate medical attention if the infant exhibits:
- Bilious vomiting
- Gastrointestinal bleeding
- Consistently forceful vomiting
- Fever
- Lethargy
- Poor weight gain
- Abdominal distension or tenderness 6, 1
Practical Algorithm
- Week 1-2: Implement feeding modifications (maternal diet elimination for breastfed OR formula change for formula-fed) + positioning strategies
- Week 2-3: Add Lactobacillus reuteri DSM 17938 if breastfed and symptoms persist
- Week 3-4: Reassess—if no improvement, consider medical evaluation to exclude organic causes
- Throughout: Provide parental support and reassurance about the self-limited nature of colic
Important Caveats
- Most medications available in the United States have not been proven effective 8
- Colic typically peaks at 4 months of age and resolves spontaneously 6
- The evidence for fennel preparations shows some benefit (mean difference -72.1 min/day), but quality is limited 2
- Avoid home cardiorespiratory monitors—they do not reduce risk and are not indicated for colic 7