Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

breastfed

1st line – appropriate feeding + upright position while feeding + adequate burping post-feed

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ACUTE
|
breastfed
1st line – 

appropriate feeding + upright position while feeding + adequate burping post-feed

This approach should be continued until the colic has subsided.

Plus – eliminate cow's milk and potential allergens from the maternal diet

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ACUTE
|
breastfed
|
severe colic or with personal/family history of atopy
Plus – 

eliminate cow's milk and potential allergens from the maternal diet

Treatment recommended for ALL patients in selected patient group

Breastfeeding mothers of infants with severe colic or evidence of atopy may be advised to eliminate cow's milk from their own diet and avoid potentially allergenic substances.

Potentially allergenic substances include caffeine, chocolate, eggs, and nuts.[32][35]​​

formula-fed

1st line – mechanical bottle factors

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ACUTE
|
formula-fed
1st line – 

mechanical bottle factors

The hole in the bottle teat should be the correct size for the infant's feeding speed.

Bottles containing collapsible bags may decrease air swallowing.[21]

Plus – appropriate feeding + upright position while feeding + adequate burping post-feed

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ACUTE
|
formula-fed
Plus – 

appropriate feeding + upright position while feeding + adequate burping post-feed

Treatment recommended for ALL patients in selected patient group

This approach should be continued until the colic has subsided.

Plus – use of hypo-allergenic formulae

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ACUTE
|
formula-fed
|
severe colic or with personal/family history of atopy
Plus – 

use of hypo-allergenic formulae

Treatment recommended for ALL patients in selected patient group

Temporary use of hypo-allergenic formulae such as whey hydrolysates or casein hydrolysates should be considered for infants with severe colic, especially for those with atopic features or a strong family history of atopy.[26][35]

The use of soya formulae in the treatment of infantile colic should generally be avoided because soya protein is an important allergen in infancy, and its use might have long-term harmful effects on reproductive health.[35][36][37] In addition, there are concerns regarding the phyto-oestrogen content of soya-based formulae and the potential risks for those infants who receive their sole sources of nutrition from them. In particular, the use of soya-based formulae should be avoided in premature infants and infants with congenital hypothyroidism.

Periodic food challenges at monthly intervals should be done to ensure that the improvement is related to dietary modification and not a result of natural resolution.[35]

ONGOING

persistent colic despite behavioural and dietary modifications

1st line – parental reassurance

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ONGOING
|
persistent colic despite behavioural and dietary modifications
1st line – 

parental reassurance

Parents should be reassured by the physician that the infant will outgrow the condition and will continue to thrive.[21][32]

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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