What is the best treatment for a 2-month-old infant with frequent episodes of excessive crying, raising legs, and passing gas?

Treatment of Infantile Colic in a 2-Month-Old

The best initial treatment is soothing techniques including motion and white noise (Option B), combined with parental reassurance about the benign, self-limiting nature of this condition.

Understanding the Clinical Picture

This 2-month-old infant presents with classic infantile colic symptoms:

• Timing is characteristic: Crying begins in the first month and peaks between 2-4 months of age, which matches this infant's presentation 1
• The "Rule of Threes": Paroxysms of inconsolable crying for more than 3 hours per day, more than 3 days per week, for longer than 3 weeks in an otherwise healthy infant 1
• Physical signs: Leg raising and gas passing are typical accompanying behaviors 2

Why Soothing Techniques Are First-Line

Parental support and reassurance with explanatory guidance is the cornerstone of management 3. The American Academy of Pediatrics emphasizes that excessive crying periods should be managed with attention to the infant's behavioral state and neuroregulatory system, as these babies are easily overwhelmed by stimuli 4.

Specific soothing techniques include:

• Gentle motion and rhythmic movement to calm the overstimulated infant 4
• White noise to provide consistent auditory input without overstimulation 4
• Avoiding overstimulation from excessive tactile, visual, auditory, and kinesthetic stimuli 4

Why NOT Simethicone (Option A)

Simethicone has no role in decreasing the symptoms of colic 5. While the FDA labels simethicone as an antigas agent for relief of pressure and bloating 6, multiple studies confirm it is ineffective for infantile colic treatment 5, 2. The placebo effect in colic is estimated at 50%, which explains why some parents perceive benefit 3.

Why NOT Antibiotics (Option C)

Antibiotics have no role in infantile colic management. Colic is not an infectious process, and the condition is benign and self-limiting 7, 2. An underlying organic cause is found in less than 5% of excessively crying infants 7.

Why NOT Abdominal Ultrasound (Option D)

Ultrasound is unnecessary unless warning signs are present. The American Academy of Pediatrics specifies concerning features that would warrant investigation: bilious vomiting, gastrointestinal bleeding, consistently forceful vomiting, fever, lethargy, hepatosplenomegaly, abdominal tenderness or distension 4. This infant has none of these red flags.

Additional Evidence-Based Options If Soothing Fails

If behavioral interventions are insufficient:

For Breastfed Infants:

• Lactobacillus reuteri DSM 17938 is effective, especially in breastfed infants 3, 2
• Maternal dietary allergen elimination (2-4 week trial eliminating milk and eggs) may help 4, 2

For Formula-Fed Infants:

• Switch to extensively hydrolyzed formula if cow's milk protein intolerance is suspected 4, 2
• Partially hydrolyzed formulas with prebiotics/probiotics show promise 3, 8

Critical Safety Point

This is the peak age for abusive head trauma risk 4, 1. Crying is the most common trigger of abusive head trauma, with incidence paralleling the normal developmental crying curve that peaks at 2-4 months 4, 1. Almost 6% of parents of 6-month-old infants admit to smothering, slapping, or shaking their infant at least once because of crying 4.

Counsel parents explicitly:

• This is normal developmental crying that will resolve by 3-6 months 2
• Never shake the baby 4
• It's safe to put the baby down in a safe place and take a break if overwhelmed 4

What NOT to Use

• Proton pump inhibitors: Ineffective and carry risks including pneumonia and gastroenteritis 4, 2
• Dicyclomine: Contraindicated in infants under 6 months 5, 2
• Chiropractic manipulation, acupuncture, herbal supplements: Lack evidence of efficacy 2