Abstract
Background
Infantile colic may represent gastrointestinal distress, yet most definitions emphasize excessive crying. Each may have distinct etiologies.
Design/Methods
In a pre-birth cohort, we used maternal reports of infant crying and apparent abdominal discomfort at 6mos to categorize infants as (1) unaffected (no excessive crying or colic), (2) excessive crying only, and (3) colic (abdominal discomfort +/− excessive crying). We examined associations of potential risk factors in separate models with excessive crying and colic (each vs. unaffected) using unadjusted multinomial logistic regression, and associations between count of risk factors and colic using logistic regression.
Results
Of 1403 infants, 140 (10%) had excessive crying, and 346 (25%) colic. Infants that were non-Hispanic white, low birthweight, firstborn, or had a maternal history of atopy, high postpartum depressive symptoms, or persistent prenatal nausea, had a 40–80% higher relative risk of colic. Preterm birth was associated with double the risk. Being firstborn, low birthweight, and preterm birth predicted excessive crying. Infants with ≥four (vs. 0–1) of the seven identified risk factors had 3.9 times (95% CI: 2.6, 6.1) higher odds of colic.
Conclusions
Colic characterized by apparent abdominal discomfort can be phenotypically distinguished from excessive crying only. Multiple risk factors may further increase colic risk.
Impact
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Infant colic characterized by apparent gastrointestinal distress may be phenotypically distinct from excessive crying only.
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Literature that defines colic only based on crying behaviors may miss important predictors.
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Mother-reported colic and excessive crying appear to have overlapping risk factors, with additional risk factors identified for colic.
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The presence of multiple risk factors increases the risk of colic, supporting a multifactorial etiology.
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Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request and approval from the study team.
References
Wessel, M. A., Cobb, J. C., Jackson, E. B., Harris, G. S. & Detwiler, A. C. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics 14, 421–435 (1954).
Steutel, N. F., Benninga, M. A., Langendam, M. W., de Kruijff, I. & Tabbers, M. M. Reporting outcome measures in trials of infant colic. J. Pediatr. Gastroenterol. Nutr. 59, 341–346 (2014).
Zeevenhooven, J., Browne, P. D., L’Hoir, M. P., de Weerth, C. & Benninga, M. A. Infant colic: mechanisms and management. Nat. Rev. Gastroenterol. Hepatol. 15, 479–496 (2018).
Rome IV Criteria. Rome Foundation https://theromefoundation.org/rome-iv/rome-iv-criteria/.
Zeevenhooven, J., Koppen, I. J. N. & Benninga, M. A. The New Rome IV Criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr. Gastroenterol. Hepatol. Nutr. 20, 1–13 (2017).
Sarasu, J. M., Narang, M. & Shah, D. Infantile colic: An update. Indian Pediatr. 55, 979–987 (2018).
Indrio, F., Dargenio, V. N., Francavilla, R., Szajewska, H. & Vandenplas, Y. Infantile colic and long-term outcomes in childhood: a narrative synthesis of the evidence. Nutrients 15, 615 (2023).
Vandenplas, Y. et al. Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J. Pediatr. Gastroenterol. Nutr. 61, 531–537 (2015).
Savino, F. et al. A prospective 10-year study on children who had severe infantile colic. Acta Paediatr. Suppl. 94, 129–132 (2005).
Mai, T., Fatheree, N. Y., Gleason, W., Liu, Y. & Rhoads, J. M. Infantile colic: new insights into an old problem. Gastroenterol. Clin. North Am. 47, 829–844 (2018).
Zeevenhooven, J. et al. Functional gastrointestinal disorders, quality of life, and behaviour in adolescents with history of infant colic. Acta Paediatr. https://doi.org/10.1111/apa.17215 (2024).
Johnson, J. M. & Adams, E. D. The gastrointestinal microbiome in infant colic: a scoping review. MCN Am. J. Matern. Child Nurs. 47, 195–206 (2022).
Ouald Chaib, A., Levy, E. I., Ouald Chaib, M. & Vandenplas, Y. The influence of the gastrointestinal microbiome on infant colic. Expert Rev. Gastroenterol. Hepatol. 14, 919–932 (2020).
Hjern, A., Lindblom, K., Reuter, A. & Silfverdal, S.-A. A systematic review of prevention and treatment of infantile colic. Acta Paediatr. 109, 1733–1744 (2020).
Tyrsin, O. Y. et al. Effect of Lactobacillus reuteri NCIMB 30351 drops on symptoms of infantile functional gastrointestinal disorders and gut microbiota in early infants: Results from a randomized, placebo-controlled clinical trial. Eur. J. Pediatr. 183, 2311–2324 (2024).
Ellwood, J., Draper-Rodi, J. & Carnes, D. Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines. BMJ Open 10, e035405 (2020).
Bell, G., Hiscock, H., Tobin, S., Cook, F. & Sung, V. Behavioral outcomes of infant colic in toddlerhood: a longitudinal study. J. Pediatr. 201, 154–159 (2018).
Oken, E. et al. Cohort profile: project viva. Int. J. Epidemiol. 44, 37–48 (2015).
Wadhwa, P. D., Sandman, C. A., Porto, M., Dunkel-Schetter, C. & Garite, T. J. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am. J. Obstet. Gynecol. 169, 858–865 (1993).
Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines. (National Academies Press (US), Washington (DC), 2009).
Oken, E. et al. Sex-specific associations of maternal gestational glycemia with hormones in umbilical cord blood at delivery. Am. J. Perinatol. 33, 1273–1281 (2016).
Oken, E., Kleinman, K. P., Rich-Edwards, J. & Gillman, M. W. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr. 3, 6 (2003).
Turner, R. J., Grindstaff, C. F. & Phillips, N. Social support and outcome in teenage pregnancy. J. Health Soc. Behav. 31, 43–57 (1990).
Faleschini, S. et al. Women’s perceived social support: associations with postpartum weight retention, health behaviors and depressive symptoms. BMC Women’s Health 19, 143 (2019).
Cheng, E. R. et al. The influence of antenatal partner support on pregnancy outcomes. J. Women’s Health 25, 672–679 (2016).
Cox, J. L., Holden, J. M. & Sagovsky, R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br. J. Psychiatry 150, 782–786 (1987).
Matthey, S., Henshaw, C., Elliott, S. & Barnett, B. Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale: implications for clinical and research practice. Arch. Women’s Ment. Health 9, 309–315 (2006).
Evans, J., Heron, J., Francomb, H., Oke, S. & Golding, J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323, 257–260 (2001).
Levis, B. et al. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ 371, m4022 (2020).
Despriee, Å. W. et al. Prevalence and perinatal risk factors of parent-reported colic, abdominal pain and other pain or discomforts in infants until 3 months of age - A prospective cohort study in PreventADALL. J. Clin. Nurs. 31, 2784–2796 (2022).
Phelan, A. L., DiBenedetto, M. R., Paul, I. M., Zhu, J. & Kjerulff, K. H. Psychosocial stress during first pregnancy predicts infant health outcomes in the first postnatal year. Matern Child Health J. 19, 2587–2597 (2015).
Søndergaard, C. et al. Psychosocial distress during pregnancy and the risk of infantile colic: a follow-up study. Acta Paediatr. 92, 811–816 (2003).
van den Berg, M. P. et al. Paternal depressive symptoms during pregnancy are related to excessive infant crying. Pediatrics 124, e96–e103 (2009).
Korja, R. et al. Preterm infant’s early crying associated with child’s behavioral problems and parents’ stress. Pediatrics 133, e339–e345 (2014).
Gardner, F. C., Adkins, C. S., Hart, S. E., Travagli, R. A. & Doheny, K. K. Preterm stress behaviors, autonomic indices, and maternal perceptions of infant colic. Adv. Neonatal Care 18, 49–57 (2018).
Pärtty, A., Kalliomäki, M., Salminen, S. & Isolauri, E. Infantile colic is associated with low-grade systemic inflammation. J. Pediatr. Gastroenterol. Nutr. 64, 691–695 (2017).
Brett, B. E., Vacaru, S., Beijers, R. & de Weerth, C. Infant colic and HPA axis development across childhood. Psychoneuroendocrinology 164, 106965 (2024).
Baldassarre, M. E. et al. Birth weight and the development of functional gastrointestinal disorders in infants. Pediatr. Gastroenterol. Hepatol. Nutr. 23, 366–376 (2020).
Salvatore, S. et al. Neonatal antibiotics and prematurity are associated with an increased risk of functional gastrointestinal disorders in the first year of life. J. Pediatr. 212, 44–51 (2019).
Aydemir, Y. et al. Screening for functional gastrointestinal disorders in preterm infants up to 12 months of corrected age: a prospective cohort study. Eur. J. Pediatr. 183, 2091–2099 (2024).
Castro-Rodríguez, J. A. et al. Relation between infantile colic and asthma/atopy: a prospective study in an unselected population. Pediatrics 108, 878–882 (2001).
Talachian, E., Bidari, A. & Rezaie, M. H. Incidence and risk factors for infantile colic in Iranian infants. World J. Gastroenterol. 14, 4662–4666 (2008).
Crowcroft, N. S. & Strachan, D. P. The social origins of infantile colic: questionnaire study covering 76,747 infants. BMJ 314, 1325–1328 (1997).
Fazil, M. Prevalence and risk factors for infantile colic in District Mansehra. J. Ayub. Med. Coll. Abbottabad 23, 115–117 (2011).
Funding
Supported by the US National Institutes of Health (Grants R01 HD034568, UH3 OD023286, R24 ES030894. Sources of support had no involvement in the study design; collection, analysis or interpretation of data; or writing of the manuscript.
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Author contributions were as follows: K.M.S., E.O. and J.R.L.: research conception and design; E.O.: data acquisition; K.M.S.: analysis and interpretation of data and drafting manuscript; E.O., J.R.L., K.C.N., E.M.S. and S.R.S.-L.: revising the manuscript for important intellectual content. All authors read and approved the final manuscript.
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Karen M. Switkowski, no competing interests. Emily Oken, no competing interests. Elisabeth M. Simonin, no competing interests. Kari C. Nadeau, no competing interests. Sheryl L. Rifas-Shiman, no competing interests. Jenifer R. Lightdale serves as a consultant to Reckitt Mead-Johnson, Perrigo, and ByHeart and has received research funding from AbbVie.
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Switkowski, K.M., Oken, E., Simonin, E.M. et al. Early-life risk factors for both infant colic and excessive crying without colic. Pediatr Res 97, 1537–1545 (2025). https://doi.org/10.1038/s41390-024-03518-4
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DOI: https://doi.org/10.1038/s41390-024-03518-4
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