Colic, Reflux, Baby Crying: Between Business and Parental Distress

A baby who cries after a bottle and squirms. A baby who grunts, cries, squirms as soon as you put them in the cot. A baby who makes noises in their sleep and whose "milk you can hear coming back up". A baby who wakes up the moment you put them down and takes 20-minute naps. A baby who cries for several hours a day but calms down when carried in their parents' arms.

These situations are now massively present on social media, with an alarming narrative, systematically accompanied by an invitation to "comment REFLUX to receive the special ebook" => the free ebook leads to a paid programme, book purchase, or specialist consultation.

We are witnessing the emergence of a genuine "colic / reflux / silent reflux / baby crying" business that uses both high-level scientific studies and expert recommendations alongside low-quality evidence, creating confusion about the validity of the arguments presented.

What the HAS Says About Reflux (Scoping Document, February 2024)

France's Haute Autorité de Santé has clearly positioned the issue, with the explicit aim of reducing antisecretory prescriptions. The key points are:

Simple regurgitation is a very common physiological phenomenon, affecting up to 70% of 4-month-old infants, with no serious character, resolving spontaneously by around 1 year.

It must be distinguished from pathological GORD, defined by persistent distressing symptoms or complications, whose true prevalence remains low and difficult to estimate.

Warning signs requiring urgent management include projectile or bilious vomiting, and a bulging fontanelle.

Irritability or isolated crying, even associated with visible regurgitation, justifies neither further investigation nor antisecretory treatment.

First-line management of simple regurgitation is based on parental reassurance, maintenance of breastfeeding, postural measures (upright position after feeds, back-sleeping) and assessment of food intake.

If there is no improvement after two weeks, thickening of formula may be proposed, followed if necessary by a trial elimination of cow's milk protein in cases of suspected allergy.

Proton Pump Inhibitors are not recommended in the presence of isolated reflux signs in a normally developing child: outside their licensed indication before one year of age, not superior to placebo in this indication, and associated with a significant increase in infectious risk. Their use is reserved for pathological GORD confirmed by pH-metry or oesophagitis confirmed by endoscopy.

This document therefore constitutes a strong institutional framework against the over-medicalisation of the crying infant.

What Do "Anti-Reflux Methods" Offer?

These methods, spread online under various names, attribute the "problematic signs" ( presented in an alarming manner ) to pathological GORD or "silent reflux", triggered by various factors.

The frequency and quantity given by bottle. The HAS does indeed recommend splitting feeds in cases of regurgitation: a baby taking 120 ml every 3 hours might take 60 ml every 1.5 hours and be more comfortable.
The question of "digestive rest" (often cited as a reason to space out feeds) is not relevant. Bottle-feeding technique can also play a role in overfeeding that generates regurgitation. Giving the bottle more slowly, horizontally, with more appropriate quantities, can ease feeding: this is what has been known for several years as paced-bottle feeding. But this is digestive discomfort linked to overfeeding, not pathological GORD.
Hyperlactation. A generous milk supply with strong milk flow (forceful let-down reflex) can indeed generate lactose overload, an agitated feed, a baby arching backwards, regurgitating after a feed, crying and having gas. These methods again draw on a well-documented issue in breastfeeding.
Cow's milk protein allergy, a recognised differential diagnosis of GORD, with an incidence of around 2 to 3%.

Up to this point, these methods are simply repackaging HAS recommendations that are freely available online, and which parents therefore purchase at varying prices.

Things become more complicated with the following explanations:

the observed symptoms are said to be caused by muscular tension, a posterior tongue-tie, or sucking disorders.
Each of these diagnoses would justify management by a specialist, as well as intra-oral massages to be performed by parents.

However, as we recalled in other articles, manual therapies and massages have not been shown to be effective in this context. A recent meta-analysis (Cabanillas-Barea et al., 2023) confirms that osteopathy and chiropractic do not improve crying time or sleep time in infants with colic, with a quality of evidence judged very low.

But then, how can we explain the success of these methods?

Several factors may explain a feeling of improvement:

The powerful placebo effect, and the therapeutic effect of active listening. In addition to an explanatory programme, marketing methods often include standardised empathetic emails and a welcoming community of mothers with the same problems: mothers feel understood, listened to, helped by a discourse that legitimises their worry: "you're right to think something is wrong."
The difficulty of objectively assessing crying in a state of exhaustion.
The natural and spontaneous evolution of the situation independently of any specific intervention.
The well-documented "placebo by proxy" effect in paediatrics: parents' beliefs and expectations directly influence their perception of their child's symptoms (Czerniak et al., 2020).

What If It Were Simply Normal Infant Behaviour?

A baby who grunts and squirms when put down. Who sleeps for 20 minutes. A baby who makes noises in their sleep but calms down in their parent's arms. A baby who cries as soon as they are moved away. These behaviours are normal — and yet their pathologisation is a well-documented phenomenon.

Attaching the label "Reflux" increases parents' desire to medicate their baby or find a "therapeutic solution", regardless of the medical explanation: this is the nocebo effect of diagnosis.

It is also observed that parents of children diagnosed with GORD present high rates of anxiety and depression (Aizlewood et al., 2023), which in turn perpetuates the vicious cycle of over-medicalisation.

An article by Dr Pam Douglas (2013) provides the following points:

After a feed (breast or bottle), gastric acid is neutralised for 2 hours: reflux during this period is not harmful to the mucosa.
Infants who cry a lot have an overactivated autonomic nervous system, which causes oesophageal dysmotility and backflow into the oesophagus, not the other way round.
Back-arching, breast refusal and crying when the infant is separated from their mother are normal neurobehavioural signals, not signs of oesophageal pain.
Regurgitation is normal in 40% of babies, peaking at 4 months; its frequency increases with the level of crying.
During breastfeeding, back-arching at the breast signals positional instability or a feeding problem , not GORD.

Vilar-Compte et al. (2022), in a systematic review, also highlight the influence of infant formula marketing in the dissemination of beliefs about supposedly abnormal infant behaviour: "It is important to note that some normal baby behaviours are now considered abnormal, partly due to infant formula industry marketing. These formulas frequently use advertisements that exploit parental concerns, claiming a baby is hungry, might have a digestive problem the formula can solve, or that it can improve sleep (Piwoz & Huffman, 2015). These claims are not supported by scientific evidence, but they influence infant feeding choices and undermine breastfeeding mothers' confidence (Parry et al., 2013)."

Infantile Colic

Colic affects a large number of babies and their families worldwide. According to Wessel's definition (1954), taken up in a 2019 Cochrane review, it corresponds to "episodes of inconsolable crying lasting more than three hours a day, more than three days a week, for at least three weeks" (Ong et al., 2019). According to the Rome IV committee, colic falls under functional gastrointestinal disorders, alongside constipation and regurgitation, and concerns infants aged 1 to 4 months, characterised by recurrent and prolonged periods of crying without a clear cause or evidence of disease (Ellwood, 2020; Zeevenhooven, 2017).

Causes of Colic

The pathophysiological mechanism remains unclear. The term "colic" implies a gastrointestinal origin, but this has not been demonstrated. Several hypotheses coexist in the literature:

Maternal factors: smoking, feeding method (hunger crying due to suboptimal feeding), anxiety, with a vicious cycle established through emotional co-regulation;
Immaturity of the central nervous system;
Infant temperament;
Early form of migraine;
Aerophagia;
Under- or over-stimulation of the infant;
Pathological causes: cow's milk protein allergy, GORD;
Microbiome impact, with possible lesser microbial diversity in colicky infants, and a possible benefit of probiotics in breastfed children (Zeevenhooven, 2017; Daelemans, 2018).

Crying could also simply reflect normal infant development. A specific sensitive period between 1 and 4 months is observed, with notable cultural differences: babies cry more in societies where physical contact is less present (Hunziker & Barr, 1986).

Management of Colic and Infant Crying

Historically, methods to reduce infant crying are based on massage, upright carrying, rocking and lullabies — in other words, reassuring physical closeness. A 2022 systematic review (Mrljak et al.) reports beneficial effects of massage on pain, with a reduction in crying attributed to colic during full-body massages twice a day, and a positive impact on the creation of the parent-child attachment bond.

Manual therapies, on the other hand, do not benefit from convincing levels of evidence (Daelemans, 2018; Cabanillas-Barea et al., 2023), and their effectiveness and safety are called into question by the French Society of Paediatrics and the Academy of Medicine.

Zeevenhooven et al. note that the impact of these symptoms on parents depends largely on their ability to manage them, their perception, and their experience (first or second child).

Sarasu et al. recall that the first line of management, after excluding pathology, is parental advice and reassurance: a misinterpretation of infant crying leads to an ineffective parental response, which in turn leads to infant dissatisfaction. Behavioural modification is considered a first-line intervention, with no side effects and cost-effective.

Conclusion: Normalise Rather Than Pathologise

In the face of the explosion of online content around "anti-reflux methods", several observations are essential for healthcare professionals.

First, parental demand is real and legitimate. Parents who consult these contents are not credulous: they are exhausted, worried, and looking for answers that the healthcare system does not always offer with sufficient time and attentiveness. These methods fill a gap, that of active, individualised reassurance , which we, as healthcare professionals, have the competence and legitimacy to provide.

These methods are nevertheless deceptive: reassurance is a marketing tool, parents are prospects who enter sales funnels through their email being collected on Instagram. They then receive standardised emails, playing on their anxiety by recalling supposedly pathological signs to trigger a purchase.

Moreover, the main danger of these approaches lies not so much in what they do as in what they induce: they pathologise normal infant behaviour, generate additional parental anxiety, and open the door to over-medicalisation that HAS recommendations are precisely trying to curb.

A diagnosis, even given with the best intentions, can become harmful when not accompanied by a clear and reassuring explanation.

Finally, the role of the healthcare professional is not limited to excluding pathology. It also consists in naming normal behaviour, validating the parental experience, and supporting without alarmism. A baby who cries, regurgitates, squirms in your arms and calms down as soon as you carry them: that baby, very often, is perfectly well. It is their parents who need support, especially in our society where isolation and individualism predominate.

Want to know more about this topic? We discuss it in our training on the Possums approach.

References

Aizlewood EGM, Jones FW, Whatmough RM. Paediatric gastroesophageal reflux disease and parental mental health: Prevalence and predictors. J Health Psychol. 2023;28(7):651–663.
Cabanillas-Barea S, et al. Systematic review and meta-analysis: complementary and alternative medicines were not effective for infantile colic. Acta Paediatr. 2023 Jul;112(7):1378–1388.
Czerniak E, et al. "Placebo by Proxy" and "Nocebo by Proxy" in Children: A Review of Parents' Role in Treatment Outcomes. Front Psychiatry. 2020;11:169.
Daelemans S, et al. Recent advances in understanding and managing infantile colic. F1000Res. 2018.
Douglas PS. Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry a lot in the first few months overlooks feeding problems. J Paediatr Child Health. 2013.
Ellwood J, et al. Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines. BMJ Open. 2020.
HAS. Gastro-oesophageal reflux in children under one year: definitions, management and relevance of pharmacological treatments. March 2024.
Hunziker UA, Barr RG. Increased carrying reduces infant crying: a randomized controlled trial. Pediatrics. 1986 May;77(5):641-8.
Mrljak R, et al. Effects of Infant Massage: A Systematic Review. Int J Environ Res Public Health. 2022;19:6378.
Ong TG, et al. Probiotics to prevent infantile colic. Cochrane Database of Systematic Reviews. 2019, Issue 3.
Sarasu JM, Narang M, Shah D. Infantile Colic: An Update. Indian Pediatr. 2018 Nov 15;55(11):979-987.
Vilar-Compte M, et al. Impact of baby behaviour on caregiver's infant feeding decisions during the first 6 months of life: A systematic review. Matern Child Nutr. 2022.
Zeevenhooven J, Koppen IJ, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017.