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

Treatment Recommendation for Infantile Colic

Swaddling and rocking (Option B) is the recommended first-line approach for this 2-month-old infant with symptoms consistent with infantile colic, as gentle motion, rhythmic movement, and avoiding overstimulation are evidence-based behavioral interventions, while simethicone drops are ineffective for colic treatment. 1, 2

Why Swaddling and Rocking Over Simethicone

Simethicone is Ineffective

• Simethicone has been proven ineffective for the treatment of infantile colic despite being marketed as an antigas medication 2
• While the FDA labels simethicone for "relief of pressure and bloating commonly referred to as gas," this does not translate to efficacy in infantile colic 3
• The American Academy of Pediatrics guidelines do not recommend simethicone for colic management 1

Behavioral Interventions Are Evidence-Based

• Gentle motion and rhythmic movement can calm the overstimulated infant, which is the cornerstone of colic management 1
• White noise provides consistent auditory input without overstimulation 1
• Avoiding overstimulation from excessive tactile, visual, auditory, and kinesthetic stimuli is specifically recommended by the American Academy of Pediatrics 1
• Swaddling combined with establishing regularity in daily infant care helps infants develop stable sleep-wake rhythms and self-regulating ability 4

Clinical Context at 2 Months

• This infant is at the peak age for colic symptoms (2-4 months), when crying duration is maximal 1
• The behavioral signs described (leg raising, gas passing) are typical manifestations of the gastrointestinal dysfunction seen in colic 1
• Approximately 10-40% of infants experience colic, with symptoms typically resolving by 3-6 months 2

Critical Safety Counseling

This is the peak age for abusive head trauma risk, with crying being the most common trigger 1

• Almost 6% of parents of 6-month-old infants admit to smothering, slapping, or shaking their infant at least once because of crying 1
• Explicitly counsel parents that it's safe to put the baby down in a safe place and take a break if overwhelmed 1

If First-Line Behavioral Interventions Fail

For Breastfed Infants:

• Consider maternal dietary allergen elimination (2-4 week trial eliminating milk and eggs) 1
• Lactobacillus reuteri DSM 17938 probiotic has evidence of effectiveness specifically in breastfed infants 5, 2

For Formula-Fed Infants:

• Switch to extensively hydrolyzed formula if cow's milk protein intolerance is suspected 1, 2

Medications to Avoid:

• Proton pump inhibitors are ineffective and carry risks including pneumonia and gastroenteritis 1
• Dicyclomine is contraindicated in infants 2

Reassurance and Parental Support

• Parental reassurance with explanatory guidance is the cornerstone of management 1, 5
• The placebo effect in colic interventions is estimated to be as high as 50% 5
• Parental stress creates a vicious cycle where babies cry more, making support imperative 5