What is the best approach to treat a 2-month-old infant with frequent episodes of excessive crying, drawing up legs and passing gas, suggestive of infantile colic?

Treatment of Infantile Colic in a 2-Month-Old

The best initial approach is soothing techniques including gentle motion and white noise (Option B), as recommended by the American Academy of Pediatrics for managing excessive crying in infants with colic. 1

First-Line Management: Behavioral Interventions

The American Academy of Pediatrics emphasizes that infants with colic are easily overwhelmed by stimuli and require management focused on their neuroregulatory system rather than medications. 1 The evidence-based first-line treatments include:

• Gentle motion and rhythmic movement to calm the overstimulated infant 1
• White noise to provide consistent auditory input without overstimulation 1
• Avoiding overstimulation from excessive tactile, visual, auditory, and kinesthetic stimuli 1

These behavioral interventions address the underlying issue of an infant who cannot self-regulate when overwhelmed, which is the core problem in colic at this peak age (2-4 months). 1

Why Not Simethicone (Option A)?

Simethicone is ineffective for infantile colic. 2 While the FDA labels simethicone as an antigas agent for relief of pressure and bloating 3, research demonstrates it does not work for colic. 2 The gas passing and leg raising are symptoms of colic, not the cause—treating the gas does not resolve the excessive crying.

When to Consider Other Interventions

If behavioral interventions fail after consistent implementation, consider:

• Dietary modifications for breastfed infants: Maternal elimination of milk and eggs for 2-4 weeks may help 1, 2
• Formula change for formula-fed infants: Switch to extensively hydrolyzed formula if cow's milk protein intolerance is suspected 1, 2
• Lactobacillus reuteri DSM 17938: May reduce crying by approximately 65 minutes per day in breastfed infants, though evidence is insufficient for routine use 1, 2, 4

Why Not Antibiotics (Option C)?

Antibiotics have no role in treating infantile colic and are not indicated. 2 Colic is not an infectious process.

Why Not Abdominal Ultrasound (Option D)?

Imaging is not indicated unless concerning features are present. The American Academy of Pediatrics specifies red flags that would warrant investigation: bilious vomiting, gastrointestinal bleeding, consistently forceful vomiting, fever, lethargy, hepatosplenomegaly, or abdominal tenderness/distension. 1 The described symptoms (excessive crying, leg raising, gas passing) are typical manifestations of colic, not concerning features requiring imaging. 1

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 is safe to put the baby down in a safe place and take a break if overwhelmed. 1 This anticipatory guidance is essential at this age when crying peaks. 1

Clinical Timeline

Crying in colic begins in the first month, peaks between 2-4 months (exactly where this infant is), and typically resolves by 3-6 months of age. 1, 2 Reassuring parents about this natural timeline while providing behavioral strategies is the cornerstone of management. 2, 4