Treatment of Infantile Colic in a 2-Month-Old
The first-line treatment for this 2-month-old with infantile colic is parental reassurance combined with gentle motion, rhythmic movement, white noise, and avoiding overstimulation—while explicitly counseling parents about safe strategies to prevent abusive head trauma during this peak crying period. 1
Understanding the Clinical Context
This infant is at the exact peak age for infantile colic, which typically begins at 1 month and peaks between 2-4 months of age. 1 The symptoms described—excessive crying, leg raising, and passing gas—are classic for infantile colic, which affects 10-20% of infants and is benign and self-limiting in over 95% of cases. 2 Critically, this 2-month age is also the peak period for abusive head trauma risk, with crying being the most common trigger. 1
Immediate Management Approach
Behavioral and Environmental Interventions (First-Line)
- Use gentle motion and rhythmic movement to calm the overstimulated infant, as these babies have immature neuroregulatory systems that are easily overwhelmed. 1
- Provide white noise for consistent auditory input without overstimulation. 1
- Actively avoid overstimulation from excessive tactile, visual, auditory, and kinesthetic stimuli. 1
Critical Safety Counseling
- Explicitly counsel parents that it is safe to put the baby down in a safe place (crib) and take a break if they feel overwhelmed, as almost 6% of parents admit to smothering, slapping, or shaking their infant because of crying. 1
- This anticipatory guidance is essential at this peak crying period (2-4 months) when abusive head trauma risk parallels the normal developmental crying curve. 1
Dietary Interventions (Second-Line)
For Breastfed Infants
- Consider a 2-4 week trial of maternal dietary allergen elimination (removing milk and eggs) if behavioral interventions are insufficient. 1
For Formula-Fed Infants
- Switch to extensively hydrolyzed formula if cow's milk protein intolerance is suspected. 1
- There is some evidence for specific probiotic strains such as Lactobacillus reuteri DSM 19378, especially in breastfed infants, though this requires further discussion with parents about evidence quality. 3
Medications: What NOT to Use
- Proton pump inhibitors are ineffective for infantile colic and carry risks including pneumonia and gastroenteritis—do not prescribe them. 1
- While simethicone is FDA-approved for relief of gas and bloating 4, and some studies suggest it may reduce bloating 5, there is limited robust evidence for its effectiveness in reducing crying duration in infantile colic. 5
When to Investigate Further
Rule out organic disease if any of these concerning features are present: 1
- Bilious vomiting
- Gastrointestinal bleeding
- Consistently forceful vomiting
- Fever
- Lethargy
- Hepatosplenomegaly
- Abdominal tenderness or distension
If these red flags are absent, extensive workup is not indicated as organic causes account for less than 5% of cases. 2
Common Pitfalls to Avoid
- Do not delay behavioral interventions while pursuing dietary changes—start with reassurance and environmental modifications immediately. 1
- Do not underestimate the impact on parental stress and the mother-infant relationship, as this can create a vicious cycle where parental stress causes more infant crying. 3, 6
- Do not prescribe medications without clear indication, as the placebo effect in infantile colic is estimated at 50%, and most interventions have limited evidence. 3
- Do not forget that this condition is self-limiting—crying typically resolves by 12-16 weeks of age, and the primary goal is helping parents get through this challenging developmental period. 2, 7