Management of Infantile Colic in Formula-Fed Babies

5 mins
Mother watching over sleeping baby
A stepped care approach for managing colic in formula-fed infants

Colic is common in newborns and affects 20% of babies in the first few months of life.1 This can be distressing for parents and their babies and it is a frequent contributor to the need for healthcare professional consultations. The continuous inconsolable crying of an infant without obvious cause can be very difficult for parents to manage and 1 in 6 families seek help and advice on how to deal with colic.2

This stepped care approach is designed to help healthcare professionals support parents and manage their baby’s colic.

1. Identifying the signs of colic

Following the ROME IV criteria, a diagnosis of colic can be made when all the following are present:3

  • An infant aged <5 months when the colic symptoms start and stop
  • Recurrent and prolonged periods of crying, fussing or irritability reported by parents (caregivers) that occur without obvious cause and cannot be prevented or resolved by parents or caregivers
  • No evidence of infant faltering growth, fever or illness
2. Offer parental reassurance and advice

In >90% of cases, treatment consists of helping the parent/caregiver get through this challenging period in the babies development.3 Reassure them that newborn colic is a common issue that should resolve by 6 months of age.4

Recommend these techniques that may help soothe the crying infant:4

Soothe baby:

  • Hold the baby through the crying episode
  • Gentle motion like pushing a pram or rocking the crib
  • Create ‘White noise’ like the sound of a vacuum cleaner or hairdryer
  • Give the baby a warm bath

Encourage parents/caregivers to look after their well-being

  • Ask family and friends for support and take time to look after themself
  • Rest when the baby is asleep
  • Access peer support by meeting parents/carers with babies of the same age
  • Allow themself time out for a few minutes by putting baby down in a safe place like their cot if you feel unable to cope with the crying
3. Take a nutritional approach

There are specialist products designed to help manage colic in babies. If the above interventions have not helped reduce colic in formula-fed infants and parents/carer are still struggling to cope then a comfort formula can be a useful option to consider.5

Colic is multifactorial4,5 and comfort formulas have been designed to help manage the various possible causes:

Possible causes of colic Comfort formula features How this helps with colic and associated symptoms of the crying baby

Intestinal microflora imbalance which influences gut motility and causes trapped wind6

Alterations in faecal microflora7

GOS and FOS*

An increase in beneficial bacteria in the infant gut microbiome8

Immaturity of the digestive system9

100% whey, Partially hydrolysed protein

Supports easier digestion and accelerates gastric emptying10

Lactose intolerance11

Reduced lactose content

In those infants where lactose intolerance is a cause of the colic, helps with symptoms of lactose intolerance and leads to a reduced crying time in infants with colic11.

Not all Comfort formulas are the same. SMA® Comfort is a unique formulation that contains an increased Magnesium** content which supports significant improvement in stool consistency12-14

4. Arrange for follow-up
  • Arrange follow-up to reassure parents if symptoms persist.
  • It may take up to 2 weeks to see an improvement in symptoms while using a Comfort formula so it is important to encourage parents to continue.
  • Comfort formulas are thickened formulas so advise parents to use a fast flow teat.
  • There may be a change in stool colour, this is normal, and parents should be advised not to be concerned.

Click to access resources you can use with parents.

Click the link below to download an infographic for managing colic in formula fed infants.

* GOS and FOS, Galacto-oligosaccharides and Fructo-oligosaccharides

**Magnesium content of new SMA® Comfort is 8.1mg/100ml compared to SMA® PRO First infant Milk which contains a magnesium level of 5.7mg,100ml.

References Show all Hide all
  1. Vandenplas Y et al. JPGN 2015 (61); 5: 531–537

  2. Drug and Therapeutics Bulletin. Management of Infantile Colic [Online]. 2013. Available at: http://dtb.bmj.com/content/51/1/6.full.pdf+html (Accessed June 2021)

  3. Benninga M et al. Gastroenterology 2016;150: 1443–1455.

  4. NICE (2017) scenario: Management of infantile colic. Available at https://cks.nice.org.uk/topics/colic-infantile/management/management/ (Accessed June 2021)

  5. Vandenplas Y, Alarcon P. Updated algorithms for managing frequent gastro-intestinal symptoms in infants. Benef Microbes. 2015;6(2):199-208.

  6. Savino F, Cordisco L, Tarasco V, Calabrese R, Palumeri E, Matteuzzi D:Molecular identification of coliform bacteria from colicky breastfed infants. Acta Paediatr 2009, 98(10):1582–8.

  7. de Weerth C, Fuentes S, de Vos WM: Crying in infants: on the possible role of intestinal microbiota in the development of colic. Gut Microbes. 2013;4(5):416–21. 10.4161/gmic.26041

  8. Moro G, et al. Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in formula-fed term infants. J Pediatr Gastroenterol Nutr. 2002 Mar;34(3):291-5

  9. Pärtty A, Kalliomäki M, Salminen S, et al. : Infantile Colic Is Associated With Low-grade Systemic Inflammation. J Pediatr Gastroenterol Nutr. 2017;64(5):691–5.

  10. Billeaud C et al. Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk. Eur J Clin Nutr 1990; 44: 577–583.

  11. Kanabar D et al. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Dietet 2001; 14: 359-363.

  12. Chao et al. Therapeutic effect of Novalac-IT in infants with constipation. Nutrition 2007;23:469–473.

  13. Infante et al. Modification of stool’s water content in constipated infants: management with an adapted infant formula. Nutrition Journal 2011; 10:55-8.

  14. Benninga MA; MENA Infant Constipation Study Group, Vandenplas Y. The Magnesium-Rich Formula for Functional Constipation in Infants: a Randomized Comparator-Controlled Study. Pediatric Gastroenterology Hepatology and Nutrition 2019 May;22(3):270-281.

Mother watching over sleeping baby
5 mins

Management of Infantile Colic in Formula-Fed Babies

A stepped care approach for managing colic in formula-fed infants

Colic is common in newborns and affects 20% of babies in the first few months of life.1 This can be distressing for parents and their babies and it is a frequent contributor to the need for healthcare professional consultations. The continuous inconsolable crying of an infant without obvious cause can be very difficult for parents to manage and 1 in 6 families seek help and advice on how to deal with colic.2

This stepped care approach is designed to help healthcare professionals support parents and manage their baby’s colic.

1. Identifying the signs of colic

Following the ROME IV criteria, a diagnosis of colic can be made when all the following are present:3

  • An infant aged <5 months when the colic symptoms start and stop
  • Recurrent and prolonged periods of crying, fussing or irritability reported by parents (caregivers) that occur without obvious cause and cannot be prevented or resolved by parents or caregivers
  • No evidence of infant faltering growth, fever or illness
2. Offer parental reassurance and advice

In >90% of cases, treatment consists of helping the parent/caregiver get through this challenging period in the babies development.3 Reassure them that newborn colic is a common issue that should resolve by 6 months of age.4

Recommend these techniques that may help soothe the crying infant:4

Soothe baby:

  • Hold the baby through the crying episode
  • Gentle motion like pushing a pram or rocking the crib
  • Create ‘White noise’ like the sound of a vacuum cleaner or hairdryer
  • Give the baby a warm bath

Encourage parents/caregivers to look after their well-being

  • Ask family and friends for support and take time to look after themself
  • Rest when the baby is asleep
  • Access peer support by meeting parents/carers with babies of the same age
  • Allow themself time out for a few minutes by putting baby down in a safe place like their cot if you feel unable to cope with the crying
3. Take a nutritional approach

There are specialist products designed to help manage colic in babies. If the above interventions have not helped reduce colic in formula-fed infants and parents/carer are still struggling to cope then a comfort formula can be a useful option to consider.5

Colic is multifactorial4,5 and comfort formulas have been designed to help manage the various possible causes:

Possible causes of colic Comfort formula features How this helps with colic and associated symptoms of the crying baby

Intestinal microflora imbalance which influences gut motility and causes trapped wind6

Alterations in faecal microflora7

GOS and FOS*

An increase in beneficial bacteria in the infant gut microbiome8

Immaturity of the digestive system9

100% whey, Partially hydrolysed protein

Supports easier digestion and accelerates gastric emptying10

Lactose intolerance11

Reduced lactose content

In those infants where lactose intolerance is a cause of the colic, helps with symptoms of lactose intolerance and leads to a reduced crying time in infants with colic11.

Not all Comfort formulas are the same. SMA® Comfort is a unique formulation that contains an increased Magnesium** content which supports significant improvement in stool consistency12-14

4. Arrange for follow-up
  • Arrange follow-up to reassure parents if symptoms persist.
  • It may take up to 2 weeks to see an improvement in symptoms while using a Comfort formula so it is important to encourage parents to continue.
  • Comfort formulas are thickened formulas so advise parents to use a fast flow teat.
  • There may be a change in stool colour, this is normal, and parents should be advised not to be concerned.

Click to access resources you can use with parents.

Click the link below to download an infographic for managing colic in formula fed infants.

References Show all Hide all
  1. Vandenplas Y et al. JPGN 2015 (61); 5: 531–537

  2. Drug and Therapeutics Bulletin. Management of Infantile Colic [Online]. 2013. Available at: http://dtb.bmj.com/content/51/1/6.full.pdf+html (Accessed June 2021)

  3. Benninga M et al. Gastroenterology 2016;150: 1443–1455.

  4. NICE (2017) scenario: Management of infantile colic. Available at https://cks.nice.org.uk/topics/colic-infantile/management/management/ (Accessed June 2021)

  5. Vandenplas Y, Alarcon P. Updated algorithms for managing frequent gastro-intestinal symptoms in infants. Benef Microbes. 2015;6(2):199-208.

  6. Savino F, Cordisco L, Tarasco V, Calabrese R, Palumeri E, Matteuzzi D:Molecular identification of coliform bacteria from colicky breastfed infants. Acta Paediatr 2009, 98(10):1582–8.

  7. de Weerth C, Fuentes S, de Vos WM: Crying in infants: on the possible role of intestinal microbiota in the development of colic. Gut Microbes. 2013;4(5):416–21. 10.4161/gmic.26041

  8. Moro G, et al. Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in formula-fed term infants. J Pediatr Gastroenterol Nutr. 2002 Mar;34(3):291-5

  9. Pärtty A, Kalliomäki M, Salminen S, et al. : Infantile Colic Is Associated With Low-grade Systemic Inflammation. J Pediatr Gastroenterol Nutr. 2017;64(5):691–5.

  10. Billeaud C et al. Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk. Eur J Clin Nutr 1990; 44: 577–583.

  11. Kanabar D et al. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Dietet 2001; 14: 359-363.

  12. Chao et al. Therapeutic effect of Novalac-IT in infants with constipation. Nutrition 2007;23:469–473.

  13. Infante et al. Modification of stool’s water content in constipated infants: management with an adapted infant formula. Nutrition Journal 2011; 10:55-8.

  14. Benninga MA; MENA Infant Constipation Study Group, Vandenplas Y. The Magnesium-Rich Formula for Functional Constipation in Infants: a Randomized Comparator-Controlled Study. Pediatric Gastroenterology Hepatology and Nutrition 2019 May;22(3):270-281.