10 myths about colic — and what you really need to know

Colic is a topic that many parents worry about, and there is so much conflicting information out there that it is hard to know where to start. Having a baby with colic can be very upsetting — and exhausting — for parents, who can easily feel helpless in supporting their baby.

Here are the ten myths practitioners meet most often, and what the evidence actually says.

Myth 1"Colic means pain"

Infantile colic was defined in 1954 by paediatrician Dr Morris Wessel as "crying lasting 3 hours per day, on more than 3 days per week, for at least 3 weeks". This same definition was used fairly universally until very recently, and is known as the Rule of Three.

More recently a new definition has been proposed, referring to a clinical condition of fussing and crying for at least one week in an otherwise healthy infant. Rome III — the diagnostic tool for functional gastrointestinal disorders — now includes infantile colic, with diagnostic criteria requiring all of the following in infants from birth to four months: paroxysms of irritability, fussing or crying that starts and stops without obvious cause; episodes lasting three or more hours per day, occurring at least three days per week for at least three weeks; and no failure to thrive.

As you can see, these definitions don't mention pain — or even the abdomen.

Watch: why the definition of colic has changed, and what that means for how you assess a crying baby.

Myth 2"It's just crying"

Babies cry for all kinds of reasons, but mostly to communicate a need. They might be hungry, tired, cold, lonely, or have tummy ache. They might feel poorly, be over-stimulated, or be telling you something else entirely.

A parent or carer who is really tuned in to their child might be able to recognise what the communication means — and hold the baby in a certain way, or avoid doing certain things. But even on our best days, babies' clues are tricky to read, and we may feel nothing but helpless while holding a red-faced, screaming child.

And a baby's crying is upsetting for the parents as well as the baby: studies show elevated levels of cortisol, the stress hormone, in both.

Myth 3"Baby will grow out of it"

There's a common tendency among medical professionals to reassure parents that colic is normal — when actually what it is, is common — and that it will stop by the time the baby is three months old.

If the cause really is immaturity of the gut, the gastro-oesophageal valve or another part of the digestive system, or frustration at being unable to communicate or regulate feelings of over- or under-stimulation, then this may well be true: baby gets used to it, and by 12–13 weeks will often have settled down.

But if the issue is an allergy or intolerance to something in the milk, or painful trapped wind, or something seemingly small like discomfort from seams or tight clothing, then it will not magically end at the three-month mark.

Myth 4"Baby has been diagnosed with colic"

Colic is a word used to describe seemingly inexhaustible and frequent crying. It is not a diagnosis in and of itself. What it tells us is that there is colicky crying as a symptom of a cause — or perhaps causes plural — in the baby. The baby is trying to communicate with us about what's going on for them.

Colic has many causes, some of them complex and not all of them fully understood. What we do know is that typically the baby experiences some sort of tummy pain that makes them cry frequently and often inconsolably, sometimes arching their back and drawing their legs up as they struggle to find relief.

Myth 5"Baby needs medication"

There are a number of medications available over the counter and online. They work in specific ways and address just one potential cause each, so they won't work for everyone.

• Infacol is simeticone, which reduces the surface tension of gas bubbles trapped in liquid so they join together.
• Dentinox is dimethicone, which does the same thing.
• Colief (or Lactaid) is lactase drops, which help break down lactose — a milk sugar — if the body has a lactase shortage or the milk has more lactose than the body can handle. It splits lactose into glucose and galactose.

Gripe water has different ingredients depending on the brand. The UK's most-sold brand, Woodwards, contains dill oil, which they say "warms and relaxes the tummy, breaking down trapped air bubbles", and sodium hydrogen carbonate — bicarbonate of soda — which they dubiously claim "neutralises acid in the baby's tummy".

These are non-evidenced claims. 5ml of drinkable liquid does not contain enough of anything to change the temperature or pH of the stomach. And the sodium bicarbonate works on the hydrochloric acid in the stomach, forming sodium chloride (salt), carbon dioxide (gas) and water — so gripe water can actually cause the formation of gas.

It's thought a possible action of the dill is as an oligosaccharide — a complex carbohydrate that feeds the so-called friendly bacteria — and that the reason gripe water seems to work is that it tastes nice, so baby is simply happier. Of course, when we were babies, gripe water contained alcohol.

Myth 6"Baby needs comfort formula"

Experts believe some colicky symptoms are feeding-related, triggered by the milk itself or the way the baby drinks. Some parents try a so-called "comfort" milk, marketed as "for colic and constipation".

These milks are still based on cows' milk protein, but the protein has been slightly broken down — partial hydrolysation — and they have a lower level of lactose, some of which has been replaced by glucose. There is no robust evidence that these milks prevent or relieve colic. If a baby is suffering from a mild form of cows' milk protein allergy they may be effective versus standard infant formula, but they are unlikely to be gentler than breastmilk, and may actually trigger a reaction in a sensitive child who had previously been breastfed.

Diet may well affect the intestinal comfort of the baby, though. A Cochrane systematic review of dietary modifications to manage infantile colic (Gordon et al., 2018) found that removing cows' milk protein from the baby's diet if formula fed, or from the mother's diet where the baby is breastfed, was in some cases able to reduce colicky crying — which suggests that for some babies the cause is a cows' milk protein allergy.

But the wider finding matters more: the review failed to show that any single dietary modification works across all cases of infantile colic. Many of the trials were small and of poor quality, which tends to exaggerate reported effects. Where benefit was found, it was often marginal and of uncertain clinical relevance. The practical conclusion is not "try this diet" — it is work out what is actually causing this baby's symptoms, and address that. Removing cows' milk protein may be the answer if the cause is allergy; it will do nothing if the cause is trapped gas.

Myth 7"Baby has trapped wind"

Working out where the gas is coming from — how it's getting down there to begin with — is a good place to start. Usually it's from crying, from issues with the latch to the breast, or from air swallowed when bottle feeding. Sometimes it comes from fermentation in the gut, because of intolerance or allergy triggered by something in the milk. If you cannot figure it out, expert and experienced infant feeding support is the best bet.

There are ways of holding a baby that help, both during and after feeding, but they need to be taught to the individual. What works best immediately after a feed is the technique we call "wonky winding": baby upright, facing you, with their tummy pressed against you, their bottom half in the middle of your body, and their head on your right shoulder. This places any air bubbles in the stomach directly under the gastro-oesophageal valve — the valve between the stomach and the food pipe — so the air can easily get up and out.

Myth 8"Baby needs anti-colic bottles"

Bottle-fed babies can most easily suffer from trapped wind, often because air is incorporated into the milk or drawn through the teat. After adding powder to the extremely hot water, swirl rather than shake the bottle. If you have shaken it, let it stand for 20 minutes to allow the bubbles to disperse. Babies are often less colicky on liquid ready-to-feed formulas, although these are considerably more expensive.

Frequently, using a similar feeding position to the breastfed baby works: the bottle should follow the same line the breast would, so aim the teat at the pointy part at the back of your baby's head rather than at their ears. That's what the baby expects, and how their anatomy works best. Keep the teat full and maintain the angle as the bottle empties. You may need to start the feed with baby relatively upright, before reclining them a little so the bottle and head stay in a straight line.

A range of bottles is available featuring different valves, vents, air systems and shaped or angled teats, claiming variously to mimic breastfeeding and prevent colic. The best advice is to buy a bottle and teat that are easy to thoroughly clean and sterilise, and make sure milk is made up with very hot water — 70°C minimum — because one of the biggest contributors to a baby's crying is gastroenteritis from bacterial infection via the bottle or milk.

Too much milk, too fast, can give a baby a bloated, colicky feeling. It's a tendency with bottle feeding, whether with breast or formula milk, but can be avoided by responding to the baby's cues. Paced or responsive feeding means offering baby a break from the bottle after every ounce or two, rather than trying to be efficient with time or with the milk.

Milk in a bottle is homogenised, unlike milk fed from the breast, so the way the baby suckles makes no difference to the consistency they receive. They can drink too quickly, and won't be getting the natural cues that tell them they are full. It's tempting to want to use every last drop, but take the lead from the baby if it appears they've had enough.

Myth 9"Baby is getting too much foremilk"

During a feed, breastmilk changes from a more watery type to a thicker, fattier substance as the baby drains more from the breast. If positioning, attachment and latch are good, they will get the nourishment they need and be less prone to digestive troubles. The watery milk is thirst-quenching but high in lactose and low in protein; it may temporarily fill the baby but won't satisfy them for long, and can ferment in the gut and cause tummy pain.

These stages are sometimes called "foremilk" and "hindmilk", although many feeding experts feel the terms are misleading, as they suggest a cut-off point where consistency switches. In reality the change is gradual.

If you improve the effectiveness of attachment and baby draws more of the richer, fattier milk, they will often be more contented. It's normal to use just one breast per feed, but let the baby decide: if they come off and don't look finished, try the same one again. If they object, try the other. You'll know they've had their fill of richer milk — they'll look "milk drunk", with a bit of a loll and perhaps some creamy liquid trickling from the side of their mouth. And they'll be satisfied; you won't hear from them for an hour or so.

If you feel a baby is not receiving the milk they need, a breastfeeding counsellor or IBCLC can provide support to enable more effective feeding. What's in the nappy gives further clues: a young baby under six weeks should poo at least twice a day, so speak to their midwife or health visitor if that isn't happening.

Myth 10"Baby needs probiotic powders"

Sometimes families of babies with digestive issues wonder whether so-called "baby probiotics" might help. Given what we know about the microbial flora and fauna of humans in general and babies in particular, and the trend towards supplementing adult diets with healthy bacteria, it's understandable that people draw the two together.

Start with what they are. Probiotics are bacteria. They're described as "friendly", but they are bacteria nonetheless, and too many of any kind can have undesirable effects on the body.

So why deliberately give bacteria to a baby? There is a reasonable argument for supplementing the microbiome of a baby whose own has been compromised — by method of birth, illness in the mother, smoking in the home, formula feeding, or something else.

But to do that properly, you would need to know what was actually missing — not simply add a random couple of strains and hope. It's possible that before long there will be labs offering stool testing to identify which bacteria a baby has too much or too little of, so an unbalanced microbiome can be treated appropriately. Until then, there are good grounds to feel uneasy about giving bacteria to vulnerable babies with no idea what their balance already is.

Some products are marketed specifically at families of breastfed babies. That has drawn criticism, because the mother's milk can already provide the necessary bacteria — and the prebiotics those bacteria feed on — if her milk contains them. So with a breastfed baby, the wiser course is to supplement the mother, not the infant, and with a far broader-spectrum product than the ones usually sold for babies.

Soothing a colicky baby — and does massage help?

Watch: eight practical ways to soothe a baby with colic.

Many parents and practitioners find that baby massage eases colicky symptoms, and it has wider benefits too: it helps babies feel loved, respected and secure, helps strengthen and regulate the digestive, respiratory and circulatory systems, and encourages a baby to settle.

If you want to try it:

• Put a little natural oil on your hands to help them glide — olive, sunflower or grapeseed oil. Always do a skin test first to check the baby doesn't react to the oil.
• Give slow, gentle tummy strokes, moving your hands clockwise. The direction matters: it follows the direction of the baby's intestines, encouraging trapped wind and poo to move the right way.
• Holding the baby's knees together, gently bend their legs at the knee and push them into the tummy. Hold for a count of six.
• Do the tummy massage three or four times a day for two weeks — it can take that long to tell whether it's working. It's fine to carry on after two weeks.
• Laying the baby on their tummy while massaging their back can sometimes help bring up wind.

A gentle massage may ease the crying for a little while. It is not a treatment for an underlying allergy or feeding problem — but as part of a wider picture it is safe, free, and good for both baby and parent.