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Increased crying in the first 3 to 5 months of life has been the cause of parental frustration, stress, and anger for generations. In clinical terms, it is usually referred to as colic. Practically, it includes all infants brought to clinicians for concerns about crying, usually in the first 4 months of life. Based on varying clinical definitions, clinicians then decide whether an infant has or does not have colic, undertake many (or no) investigations, and may or may not recommend therapies.

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In the last 30 years, clinical and nonclinical studies, including both experimental and naturalistic observational ones, have provided a more complete understanding of the nature and functions of early crying and its clinical manifestations. This has led to a reconceptualization of increased excessive crying and colic.1 Current evidence supports 2 concepts as important to our understanding of this behavior.

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The first is that early increased crying in the first 4 months (including most cases of colic) is a manifestation of normal behavioral development rather than an indication of abnormalities in either the infant or their caregivers.2 Essential to this concept is that all infants manifest a similar pattern and similar forms of distress along a spectrum of quantity and intensity, from fussiness to inconsolable crying, or colic. Those infants at the higher end of the spectrum are more likely to present due to a clinical concern.2,3 Since virtually any illness will increase crying, a small number of infants (probably less than 5%) that present with crying complaints are also found to have abnormal cries and/or pathogenetic processes associated with this crying.3-5 However, these abnormalities are superimposed on a normal developmental increase in crying common to all infants. The vast majority (over 95%) of infants with increased crying and colic are healthy infants with normal behavioral development.

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The second concept is that, developmentally, there are 3 primary age-related patterns of early increased crying (see Figure 83-1). The typical and most well-known pattern includes an increase in overall distress (fussiness, crying, and inconsolable crying together) that begins at about 2 weeks of age, peaks sometime in the second month, and then decreases by 3 to 5 months to lower and more stable levels. This pattern is typical of all normal infants, and the amounts vary widely among infants.2,6,7 However, in those in whom some defined threshold is exceeded (often called the Wessel criteria; crying for >3 hours per day, for >3 days per week, for >3 weeks2,8), this is most often referred to as typical colic. In the second pattern, crying increases into the second month but continues after 4 months at previously high levels, usually accompanied by loss of positive caregiver-infant interactions and continuing distress for both (see dotted line [B] in Fig. 83-1B). This pattern may occur in about 3% of infants.9,10 It has been referred ...

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