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Health condition · Clinically reviewed

Infant colic, the witching hour, red flags and what actually helps.

Up to a quarter of babies have colic. It is common, self-limiting and not your fault. This guide explains what it is, how to spot the red flags and which treatments actually help.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, RCPCH and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including Rome IV criteria, probiotic evidence and safeguarding priorities.

Key facts

Colic at a glance.

The essentials in plain English. What colic is, how it is defined, how common it is and what actually helps.

  • What it is

    Recurrent, prolonged crying in an otherwise healthy, well-fed infant under 5 months of age with no apparent medical cause.

  • Rome IV criteria

    Crying or fussing for 3 or more hours a day, 3 or more days a week, for at least 3 weeks in a baby under 5 months.

  • How common

    Affects up to 20 to 25% of infants. Equally common in boys and girls, and in breast and formula-fed babies.

  • Typical timing

    Usually starts at 2 to 6 weeks, peaks around 6 weeks and resolves by 3 to 4 months of age.

  • The pattern

    Intense evening crying (the "witching hour"), legs drawn up, red face, clenched fists, arching back and passing gas.

  • The reassurance

    Self-limiting and not caused by anything parents did wrong. Feeding, weight and development stay on track.

Why this guide matters

A calm plan for a hard few weeks.

Colic is common, exhausting and short-lived. The three points below shape everything else on this page and the plan we suggest with your GP or health visitor.

  • Rule out serious causes first

    Most crying babies have colic, but a small number have reflux, cow milk protein allergy, infection or surgical illness. Red flags come first.

  • Reassurance is the treatment

    Colic resolves by 3 to 4 months. Parental support, sleep, soothing and safety matter more than medication for most families.

  • Never shake a baby

    Overwhelm is common. Put the baby down safely in the cot, step out and call for help. Shaking causes life-changing brain injury.

How the diagnosis is made

From first bouts to a clear plan.

The steps a UK GP, health visitor or paediatrician will normally follow to confirm colic and rule out anything else.

  1. 01

    Assessing

    Detailed feeding and crying history

    Type of feed, volumes, latch, winding, timing and pattern of crying, sleep, family stress and parental mental health.

  2. 02

    Assessing

    Growth and development check

    Weight, length and head circumference plotted on the personal child health record chart. Normal growth is reassuring.

  3. 03

    Assessing

    Head-to-toe examination

    Hydration, fontanelle, skin, abdomen, hernial orifices, testes and hair around fingers and toes (tourniquet syndrome).

  4. 04

    Confirming

    Selective investigations

    Not routine. Urine dipstick if unwell, stool for blood if cow milk protein allergy suspected, FBC and inflammatory markers if concerns.

  5. 05

    Confirming

    Rule out serious causes

    Exclude reflux, cow milk protein allergy, pyloric stenosis, volvulus, intussusception, UTI, testicular torsion and safeguarding concerns.

  6. 06

    Support

    Parental wellbeing screen

    PHQ-9 and Edinburgh Postnatal Depression Scale where appropriate. Coping capacity is a clinical priority.

  7. 07

    Support

    Referral if red flags or persistent

    Health visitor, GP or paediatric referral if red flags, no improvement by 4 months, or safeguarding concerns.

Typical timeline: a first visit to a settled plan within one to two weeks.

Symptoms

What colic looks like at home.

A specific mix of intense evening crying with a well, growing baby between bouts. And the features that mean it is time to seek review.

  • Inconsolable crying

    Intense, sudden-onset crying that is hard to soothe. Often lasts hours and clusters in the late afternoon or evening.

  • Legs drawn up and arched back

    The classic posture during a bout, with clenched fists, red face and passing gas.

  • Evening "witching hour"

    Symptoms typically peak between 5pm and midnight, then settle. Days between episodes look normal.

  • Normal feeding and weight gain

    A baby with colic feeds and grows normally. Poor feeding or weight loss points to another diagnosis.

  • Well between bouts

    Between episodes the baby is alert, interactive and content. This is a key diagnostic clue.

  • High parental stress

    Exhaustion, frustration, guilt, low mood and relationship strain are extremely common and deserve support.

  • Resolves by 3 to 4 months

    For most families, bouts fade as the infant matures. Persistence beyond 4 months prompts a fresh look.

  • Red flag - unwell or not feeding

    Fever, poor feeding, vomiting, blood in stool, lethargy, apnoea or a change in cry needs urgent medical review.

Treatment

How colic is managed in the UK.

Reassurance, soothing and feeding review first. Targeted trials for cow milk protein allergy or probiotics where appropriate. Medications play a small role.

  • Reassurance and education

    Explain that colic is self-limiting, resolves by 3 to 4 months and is not the parents fault. The baby is usually not in pain.

  • Soothing routines

    Swaddling, white noise, rocking, upright holding, tummy massage, warm baths, walks in the pram and skin-to-skin contact. Karp's "5 S's" bundle helps many babies.

  • Feeding review

    Optimise latch, position and winding. Slow-flow teat, paced bottle feeding and smaller more frequent feeds where appropriate.

  • Trial for cow milk protein allergy

    If CMPA is suspected, a 2 to 4 week trial of maternal dairy exclusion (breastfed) or an extensively hydrolysed formula. Amino acid formula if severe. Reintroduce if no benefit.

  • Probiotic - L. reuteri DSM 17938

    Best-evidenced supplement for breastfed babies with colic per Cochrane review. Evidence in formula-fed infants is weaker.

  • Simethicone (Infacol)

    Widely used and safe but the evidence for benefit is weak. Reasonable to trial for a limited period.

  • Lactase drops (Colief)

    Mixed evidence. Occasionally helpful where transient lactose intolerance is contributing.

  • Parental support and safeguarding

    Health visitor input, Cry-sis and Family Lives helplines, respite from a trusted adult and mental health referral where needed. Never shake a baby.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, health visitor or paediatrician knows your baby and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE Clinical Knowledge Summary. Colic - infantile.

  • RCPCH. Guidance on assessment of the crying infant and safeguarding.

  • Rome IV. Diagnostic criteria for functional gastrointestinal disorders in infants and toddlers.

  • Cochrane Review. Probiotics for infantile colic (Lactobacillus reuteri DSM 17938).

  • iMAP guideline. UK primary-care guideline on cow's milk protein allergy in infants.

Red flags

When a crying baby needs urgent review.

Most crying is colic. These are the features that are not and where medical review is essential.

  • Poor feeding or weight loss

    A baby who is not feeding, not gaining weight or losing weight needs urgent GP review to look for a medical cause.

  • Bilious or projectile vomiting

    Green vomit or forceful vomiting can point to obstruction or pyloric stenosis. Seek urgent care.

  • Blood in stool

    Fresh blood or mucus in the nappy may suggest cow milk protein allergy, infection or, rarely, intussusception. Get seen.

  • Fever, lethargy or a change in cry

    A high-pitched or weak cry, floppiness, poor colour or fever in a young baby is a red flag for sepsis or serious illness.

  • Bulging fontanelle or seizure

    Signs of raised intracranial pressure or neurological illness. Call 999 or attend A&E.

  • Persistent crying beyond 4 months

    Colic typically resolves by 3 to 4 months. Ongoing symptoms deserve fresh assessment for reflux, CMPA or other causes.

  • Hair tourniquet or hernia

    A hair wrapped around a finger, toe or genitalia, or a groin lump, can cause severe pain and needs prompt attention.

  • Parental crisis or exhaustion

    Any thought of harming the baby, shaking, or an unsafe home situation is a safeguarding emergency. Ask for help.

  • Never shake a baby

    Shaking causes abusive head trauma and can be fatal. If overwhelmed, put the baby down safely and take a break.

Living with it

A short season, with real help.

Four things that make the biggest difference for families in the middle of it. Reassurance, a small soothing toolkit, shared rest and a safety plan.

A quiet reminder

Never shake a baby.

If you feel at breaking point, put your baby down safely in the cot, step out of the room and call a family member, friend, Cry-sis (08451 228 669) or your GP.

  1. 01 Reassure

    It is not your fault

    Colic is common and self-limiting. Feeding, growth and development stay on track and it usually resolves by 3 to 4 months.

  2. 02 Soothe

    Build a small toolkit

    Swaddle, white noise, rocking, upright holding, walks and skin-to-skin. Try what works for your baby, one thing at a time.

  3. 03 Rest

    Share the load

    Sleep in shifts. Accept help from family. Health visitor visits, Cry-sis (08451 228 669) and Family Lives are there for the hard nights.

  4. 04 Safety

    If you feel overwhelmed - stop

    Put the baby down safely in the cot, step out for a few minutes and call someone. Never, ever shake a baby.

Frequently asked

Everything parents ask about colic.

Quick answers on timing, feeding, probiotics, red flags and when to worry.

  • What is infant colic?

    Colic describes recurrent, prolonged crying and fussing in an otherwise healthy, well-fed baby under 5 months of age, with no apparent medical cause. The Rome IV criteria define it as crying for 3 or more hours a day, 3 or more days a week, for at least 3 weeks.

  • Is my baby in pain?

    The classic posture (legs drawn up, arched back, red face) looks painful, but babies with colic are usually not in pain in the same way adults are. They are otherwise well between bouts and continue to feed and grow normally. If your baby seems unwell in any other way, seek review.

  • When will it stop?

    Colic usually starts between 2 and 6 weeks, peaks around 6 weeks and resolves by 3 to 4 months. If symptoms persist beyond 4 months, or change in character, ask your GP or health visitor to look again.

  • Does what I eat affect a breastfed baby?

    For most breastfed babies, maternal diet makes little difference and restrictive diets are not recommended without a clear reason. If cow milk protein allergy is suspected, a supervised 2 to 4 week trial of maternal dairy exclusion may be tried and then reintroduced.

  • Do gripe water, Infacol or Colief work?

    Simethicone (Infacol) and lactase drops (Colief) are safe but have limited evidence of benefit. Gripe water and most herbal remedies are not recommended. The best-evidenced supplement is the probiotic Lactobacillus reuteri DSM 17938, mainly for breastfed babies.

  • When should I worry?

    Seek urgent review if your baby has poor feeding, poor weight gain, fever, lethargy, bilious or projectile vomiting, blood in the stool, a bulging fontanelle, apnoea, a seizure or a change in the cry. Never shake a baby - if you feel overwhelmed, put them down safely and call for help.

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