Treatment of Infantile Colic in a 2-Month-Old
The best initial treatment is soothing techniques like gentle motion and white noise (Option B), as recommended by the American Academy of Pediatrics as first-line management for infantile colic. 1
Why Soothing Techniques Are First-Line
The clinical presentation described—excessive crying for 3 hours, leg raising, and gas passing at 2 months of age—is classic for infantile colic, which peaks between 2-4 months. 1 The American Academy of Pediatrics emphasizes that these infants have an overstimulated neuroregulatory system and are easily overwhelmed by stimuli. 1
First-line interventions include:
- Gentle motion and rhythmic movement to calm the overstimulated infant 1
- White noise to provide consistent auditory input without overstimulation 1
- Avoiding excessive tactile, visual, auditory, and kinesthetic stimuli 1
Why Simethicone Is NOT Recommended
Simethicone drops (Option A) are ineffective for infantile colic. 2 While simethicone is FDA-approved as an antigas agent for relief of bloating 3, multiple studies demonstrate it does not reduce crying time in infants with colic. 2 The gas passing and leg raising are behavioral manifestations of colic, not true gastrointestinal pathology requiring medication. 1
When to Consider Dietary Interventions
If soothing techniques fail after consistent implementation, consider:
For breastfed infants:
- Maternal elimination diet removing milk and eggs for 2-4 weeks 1, 4
- Lactobacillus reuteri (DSM 17938) may reduce crying by approximately 65 minutes per day, though evidence shows insufficient support for routine use 5, 4
For formula-fed infants:
- Switch to extensively hydrolyzed or amino acid-based formula if cow's milk protein intolerance is suspected 1, 6
Why Antibiotics and Ultrasound Are Wrong
Antibiotics (Option C) have no role in infantile colic management, which is a benign, self-limiting condition. 7, 2
Abdominal ultrasound (Option D) is unnecessary if the infant has normal weight gain and a normal physical examination. 7 Red flags requiring investigation include bilious vomiting, gastrointestinal bleeding, consistently forceful vomiting, fever, lethargy, or abdominal tenderness/distension. 1, 6 The described symptoms do not warrant imaging.
Critical Safety Counseling
This is the peak age for abusive head trauma risk. 1 Crying is the most common trigger, and nearly 6% of parents admit to smothering, slapping, or shaking their infant due to crying. 1 Explicitly counsel parents that it is safe to put the baby down in a secure place and take a break if overwhelmed. 1
Common Pitfalls to Avoid
- Do not prescribe proton pump inhibitors—they are ineffective and carry risks including pneumonia and gastroenteritis 1
- Avoid empiric formula switching without evidence of milk protein allergy 6, 4
- Do not order laboratory tests or imaging in an otherwise healthy, thriving infant 7
- Reassure parents this is benign and self-limiting, typically resolving by 3-6 months 2