Tiny tummies, big feelings: how can we support our little ones with colic?

Your baby has been fed, changed, and cuddled, but the crying continues. Minutes stretch into hours, and nothing you try seems to soothe them. You might find yourself pacing the room, second-guessing everything, wondering what you’re missing. For many parents, this is the reality of colic.

Colic affects up to 1 in 4 infants under 3 months (1), making it a common part of early parenthood. Despite this, it can feel unpredictable and difficult to manage, particularly when there is no clear cause and usual soothing techniques don’t seem to help. 

In this article, we review the exciting research on the role of the gut microbiome in colic, offering a new perspective on how to better understand and support both infants and caregiver wellbeing.

What is colic?

‘Colic’ is a descriptive term for prolonged periods of excessive or unexplained crying that begins during the first 6 weeks after birth in an otherwise healthy baby (2). These episodes can occur even when your baby has been fed, changed, and comforted, and often feel difficult to resolve.

When describing colic, healthcare professionals often use the 333 rule:

• Crying for more than 3 hours a day

• Occurring on 3 or more days per week

• Lasting for at least 3 weeks
  

Crying episodes often follow a pattern, commonly appearing in the late afternoon or evening. During these periods, babies may draw their legs up, clench their fists, and appear flushed, which can suggest underlying discomfort.

There is no single identified cause of colic. Instead, it is thought to be multifactorial, with several potential factors working together. These may include:

• An immature or developing digestive system

• Difficulty digesting milk

• Trapped gas or altered gut motility

• Food sensitivities or allergies

• Environmental influences, such as exposure to cigarette smoke

• Parental stress or anxiety

It is important to note that whilst colic is common, persistent distress in babies should always be taken seriously and explored holistically. If something doesn’t feel right, or you’re worried about your baby, that instinct alone is enough reason to seek support or a second opinion. 

Whilst crying can be developmentally normal, prolonged or intense distress can sometimes sit alongside underlying physical, emotional or sensory discomfort. This may include:

• Feeding difficulties such as tongue tie

• Reflux or gastrointestinal discomfort

• Allergy or intolerance considerations

• Eczema or atopic presentations

• Overstimulation or nervous system dysregulation

• Feeding dynamics

• Parental mental health and stress within the caregiving environment

What is the gut microbiome?

More recently, research has begun to explore the microbiome differences associated with colic.

The gut microbiome refers to the trillions of bacteria that live throughout the gastrointestinal tract. Far from being freeloaders, our microbes are deeply involved in keeping us healthy. In fact, we likely couldn’t survive without them. 

In early years, a healthy gut microbiome helps protect against pathogens, aids in the digestion and metabolism of breast milk and weaning foods, breaks down toxins, synthesises vitamins, and supports the lining of the gut.

How does the gut microbiome develop in infancy?

Your baby’s gut microbiome develops from the moment they are born. In fact, the first 1000 days are a critical window for your baby’s microbiome development. If your baby was born via vaginal delivery, they received a healthy dose of your beneficial microbes as they passed through the birth canal. It’s the first and probably most important birthday present you’ll ever give your little one! 

Babies born via Caesarean (C-section) will also acquire beneficial microbes, just through slightly different and often slower routes than vaginally delivered babies. This may include through breast milk, skin-to-skin contact with mum and other caregivers, and the home environment. 

In the first year of life, Bifidobacteria becomes one of the dominant bacterial species in the gut. These bacteria help to: 

• Break down the components of breast milk

• Support immune system development

• Maintain a balanced gut environment

What is the link between colic and the gut microbiome?

Emerging evidence shows that babies with colic may have key differences in their gut microbiome (3-5), including:

• Lower levels of beneficial bacteria, such as Lactobacillus and Bifidobacteria

• Higher levels of gas-producing bacteria, such as Proteobacteria 

• Reduced overall microbial diversity

These differences may influence gas production, gut sensitivity, and inflammation, all of which may contribute to feelings of digestive discomfort for the baby (4-5).

How to support fussy or unsettled babies

While there is no single solution for colic, there are several supportive approaches that may help promote digestive comfort. These include:

Offer comfort and closeness

Holding your baby close can be calming. Your warmth, touch, and heartbeat may help regulate their nervous system and support the gut-brain connection. It’s important to note that you cannot “spoil” a distressed baby through responsiveness and closeness, comforting your baby is supportive and developmentally appropriate.

Try a warm bath and tummy massage

A warm bath can help relax your baby’s body. A gentle, circular tummy massage may help move trapped gas and ease discomfort.

Optimise feeding position

Sit your baby up as straight as possible while feeding to help minimise the amount of air they swallow. If breastfeeding, check that your baby is properly attached (latching on). If they are bottle-fed, a fast-flow teat might be helpful, again to minimise the amount of air they swallow (6).

Create a calming atmosphere

Babies can become overstimulated with lots of noise and activity around them. Try to quieten your surroundings – switch the TV off, dim the lights and try to take some deep breaths yourself to help relax your own gut:brain connection.

Use a targeted probiotic

International guidelines recommend specific probiotic strains, including Bifidobacterium lactis BB-12®, at a daily dose of 1 billion CFU⁷⁻⁸. BB-12® is one of the most well-documented Bifidobacteria strains, with over 400 scientific publications. Clinical studies in infants with colic (7-8) have shown that it can:

• Reduce crying and fussing time

• Decrease the number of crying episodes

• Improve sleep duration

• Support quality of life for parents and caregivers

These effects may be linked to its role in increasing beneficial bacteria, such as Bifidobacteria, supporting immune function, and promoting the production of butyrate, a compound that improves gut motility and reduces inflammation (3,6).

You know your baby best

Ultimately, you know your baby best. We encourage you to seek assessment if symptoms feel severe, persistent, or are accompanied by red flags such as:

• Poor weight gain

• Vomiting

• Blood or mucus in stools

• Feeding refusal

• Fever

• Lethargy

• Significant eczema or allergic symptoms

• Inconsolable crying that feels unusual for your baby

How to support your mental health as a parent and caregiver

Caring for a baby with colic can be incredibly demanding. It’s no surprise that colic can have a significant impact on parents and caregivers, and has been associated with parental stress, frustration, guilt, sleep disruption, post-natal depression, and reduced quality of life (6).

The relationship between caregiver wellbeing and unsettled infant behaviour is complex and deeply interconnected. Stress and anxiety are often a natural result of caring for a distressed baby, while babies can also be highly sensitive to the emotional state of those around them through the close, bidirectional connection between parent and baby nervous systems.

Which is why looking after yourself is just as important, including:

Share the load

If possible, take turns with a partner, family member, or friend. Even short breaks can help.

Adjust expectations

This phase can be unpredictable. It is okay if routines shift or plans change. Be kind to yourself.

Talk about it

Speaking with healthcare professionals or connecting with other parents can provide reassurance and support.

Resting where possible

Taking opportunities to rest, even in short periods, can support your overall wellbeing.

Support matters not only for babies, but for parents too. Families coping with excessive crying are often functioning in survival mode and deserve compassionate, non-judgemental support.

References

1. Wolke D, Bilgin A, Samara M. Systematic Review and Meta-Analysis: Fussing and Crying Durations and Prevalence of Colic in Infants. J Pediatr. 2017 Jun;185:55-61.e4. doi: 10.1016/j.jpeds.2017.02.020. Epub 2017 Apr 3. PMID: 28385295.

2. Rome IV Criteria for Infant Colic available at https://theromefoundation.org/rome-iv/rome-iv-criteria/ (accessed December 2024)

3. de Weerth C, Fuentes S, Puylaert P, de Vos WM. Intestinal microbiota of infants with colic: development and specific signatures. Pediatrics. 2013 Feb;131(2):e550-8. doi: 10.1542/peds.2012-1449. Epub 2013 Jan 14. PMID: 23319531.   

4. Johnson JM, Adams ED. The Gastrointestinal Microbiome in Infant Colic: A Scoping Review. MCN Am J Matern Child Nurs. 2022 Jul-Aug 01;47(4):195-206. doi: 10.1097/NMC.0000000000000832. PMID: 35352686.

5. Rhoads JM, Collins J, Fatheree NY, Hashmi SS, Taylor CM, Luo M, Hoang TK, Gleason WA, Van Arsdall MR, Navarro F, Liu Y. Infant Colic Represents Gut Inflammation and Dysbiosis. J Pediatr. 2018 Dec;203:55-61.e3. doi: 10.1016/j.jpeds.2018.07.042. Epub 2018 Aug 31. PMID: 30177353; PMCID: PMC6669027.

6. NHS. (n.d) https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/breastfeeding-challenges/colic/

7. Nocerino R, De Filippis F, Cecere G, Marino A, Micillo M, Di Scala C, de Caro C, Calignano A, Bruno C, Paparo L, Iannicelli AM, Cosenza L, Maddalena Y, Della Gatta G, Coppola S, Carucci L, Ercolini D, Berni Canani R. The therapeutic efficacy of Bifidobacterium animalis subsp. lactis BB-12^® in infant colic: A randomised, double blind, placebo-controlled trial. Aliment Pharmacol Ther. 2020 Jan;51(1):110-120. doi: 10.1111/apt.15561. Epub 2019 Dec 3. PMID: 31797399; PMCID: PMC6973258.

8. Chen K, Zhang G, Xie H, You L, Li H, Zhang Y, Du C, Xu S, Melsaether C, Yuan S. Efficacy of Bifidobacterium animalis subsp. lactis, BB-12^® on infant colic - a randomised, double-blinded, placebo-controlled study. Benef Microbes. 2021 Nov 16;12(6):531-540. doi: 10.3920/BM2020.0233. Epub 2021 Sep 22. PMID: 34550055.