Knowing if a baby is hungry or has colic involves observing crying patterns and body language: Hunger cues include rooting, lip smacking, bringing hands to mouth, and alert fussing (before intense crying), while colic often features loud, inconsolable crying for hours (especially evening), clenched fists, arched back, flushed face, and tense legs, with feeding sometimes not helping and stomach rumbles/gas present. Colic is defined by the "Rule of Threes": 3+ hours/day, 3+ days/week, for 3+ weeks, in a healthy baby.
Colic crying is not like the crying a baby does when hungry or wet. Being fussy even after crying has lessened. Timing you can predict, which is often in the evening. Change of face color, such as skin flushing or blushing.
Crying is a natural part of a baby's communication. It is how they express hunger or discomfort. Sometimes, however, a baby may cry for no clear reason. In some cases, this fussiness can develop into prolonged, intense crying episodes that are difficult to soothe, which may be colic.
[14] Wessel proposed a diagnostic criteria for infantile colic known as the Wessels "Rule of 3," which are still helpful today. Infants affected by colic experience bouts of fussiness and crying that last at least 3 hours a day for 3 or more days a week for over 3 weeks.
Symptoms of colic
Reflux. Reflux and colic are closely related and are often confused. Reflux can also be caused by oversupply and both are more often a problem when a baby is given large feeds with long gaps in between. A baby who has reflux often spits up milk and cries more when he is lying down or is in a car seat.
Colic often begins suddenly, with loud and mostly nonstop crying. This constant, extreme crying can be very stressful and difficult for parents. Babies with colic are often fussy, gassy, and don't sleep well.
Baby colic causes may include: Belly (abdominal) pain or discomfort from gas due to air swallowed while nursing or crying. Reflux (bringing up) of stomach contents. Food allergies.
Possible Causes of Colic
Hunger. Overfeeding. Baby cannot tolerate certain foods or certain proteins in breast milk or formula. Sensitivity to certain stimuli.
Spotting the difference between colic and gas involves paying attention to patterns. Colic tends to show up as intense crying around the same time each day, happening at least three times a week for a minimum of three weeks. Gas, though it may cause fussiness, lacks the predictable rhythm of colic cries.
Stretching, becoming more active, and putting their hand to their mouth are all familiar mid cues or signs that tell they are hungry. Babies will make extreme efforts to let you know they are hungry if these mid-cues don't result in a nursing session. They will scream and cry.
The hardest week with a newborn is often considered the first six weeks, especially weeks 2-3, due to extreme sleep deprivation, constant feeding demands, learning baby's cues, postpartum recovery, and a peak in inconsolable crying (the "witching hour"), making parents feel overwhelmed as they adjust to a new, exhausting routine. While the first week is tough, the challenges often intensify as the baby becomes more alert but still fussy, with major developmental hurdles like cluster feeding and increased fussiness peaking around 6-8 weeks.
Babies with restricted oral movement often swallow air, struggle to feed, and end up with gas and reflux-like symptoms. These can closely mimic colic — leaving parents feeling helpless and frustrated.
Early feeding cues - baby is hungry
Colic episodes often begin around the same time each evening. Each episode may last from a few minutes to a few hours. Babies with colic continue to eat normally and gain weight.
Change your baby's position: Sit them up if they have been lying down, or hold them face-out if they have been facing your chest. Hold your baby near low, rhythmic noises, like the sound of the washing machine or a recording of a heartbeat. The steady hum of a fan or a white noise machine can also be soothing.
The "Colic 333 Rule" is a common guideline for identifying colic in a healthy, well-fed baby: crying for more than 3 hours a day, for more than 3 days a week, for more than 3 weeks. While it's a helpful way to recognize persistent, intense crying spells, it's not a strict diagnosis, and you don't need to wait three weeks to seek help if you're concerned. Colic usually peaks around 6 weeks and lessens by 3-4 months, but it's important to rule out other issues with a doctor.
Babies who have colic may show symptoms, such as:
Signs of overfeeding a baby include frequent spitting up/vomiting, fussiness, gassiness, a tight belly, and changes in stool (loose, green, frothy, or explosive). While babies often know when they're full (turning away, falling asleep), signs of overfeeding often involve discomfort and digestive issues, sometimes with rapid weight gain or a very full, hard tummy, especially if fed past fullness cues.
TAKEAWAY Excessive crying and fussiness can be distressing for both you and your baby. Fortunately, colic symptoms typically improve by the age of 3 months, so it will get better. While gripe water has not been shown to be a definitively effective alternative for soothing colicky babies, it is generally safe.
The discomfort from gas will pass. Gas discomfort from burps and farts typically peaks at six weeks and improves immensely by 3 months of age.
Be guided by your doctor, but there are some things you can do to help ease the pain, including:
Colic and gas are common challenges faced by newborns, often causing significant discomfort and distress. Swaddling, when done correctly, can be a highly effective strategy in alleviating these symptoms by providing comfort, security, and soothing effects.
Best Sleeping Position for a Colic Baby: Flat on Their Back
Colic can sometimes be caused by gas and digestive discomfort, so taking steps to improve your baby's digestion before putting them to sleep on their back can allow for better-quality, longer sleep.
Relieving gas in your baby
Feed your baby in a partially upright position. After feeding, put them in a baby seat for about 15 to 30 minutes. Be sure to burp your baby during and after feeding. Massage your baby.