Infant crying, or fussy baby: "Infant Colics" change name

We recently discussed infant colic in this article on the business of parental distress, and noted that the intestinal origin of the crying has never been demonstrated. A new publication from the Rome V committee has just been released.

The term "infantile colic" is being replaced by "infant distress syndrome," since there is no evidence that the pain originates in the colon.

NB: The Rome criteria are a standardized diagnostic classification system for disorders of gut-brain interaction (DGBI), formerly known as "functional gastrointestinal disorders." They were developed by the Rome Foundation, an international group of experts (gastroenterologists, pediatricians, researchers).

They define clinical diagnoses (such as irritable bowel syndrome, functional constipation, or infant distress syndrome) without requiring invasive testing, based on a precise set of symptoms, their frequency, and their duration. The goal is to allow a positive diagnosis based on reproducible criteria, rather than a diagnosis of "exclusion" after ruling out any organic pathology.

The article emphasizes the infant's visible distress rather than an assumed anatomical location.

On average, crying/fussiness lasts 1–2 hours/day during the first 3 months, then decreases to 30–60 minutes/day. Under the Rome IV criteria, prevalence ranged from 1.9% to 19.2%, peaking between 1 and 2 months, and was more common in the Americas than in Europe or Asia. Rome V removed the strict Rome IV threshold of 3 hours/day on 3 days/week, as well as the "no fever/no growth delay" criterion, which was considered arbitrary.

Diagnostic criteria (clinical use) of this infant distress syndrome (formarly called "infant colics"):

• Onset of symptoms before 5 months of age

• Recurrent and prolonged crying and fussiness, without apparent cause, not relieved by the parents

• No other medical explanation after appropriate evaluation

  
  

Pathophysiology and psychological factors

This syndrome is described as multifactorial, combining digestive, neurological, and psychosocial factors.

• The role of the microbiome is highlighted: infants with this syndrome show more Proteobacteria, fewer Bifidobacteria/Lactobacilli, and reduced bacterial diversity. Early neonatal antibiotic treatment is associated with dysbiosis and an increased risk of crying.

• Neurological factors also appear to play a role, including reduced capacity for crying self-regulation, heightened sensory reactivity, and differences in amygdala development.

• Parental psychological factors are involved as well: maternal anxiety precedes and accompanies excessive crying, while maternal depression appears instead to be a consequence, creating a vicious cycle. Prenatal paternal depression is also associated with excessive crying.

Clinical evaluation includes a thorough history and physical exam; screening for urinary tract infection in febrile or afebrile infants; and watching for red-flag signs (high-pitched/extreme crying, absence of a diurnal rhythm, onset after 4 months, frequent regurgitation/vomiting/diarrhea, weight loss, maternal medication use).

Management

The cornerstone of management is validating both the infant's symptoms and the parents' emotional burden, reassurance about the benign, self-resolving nature of the condition, and education.

• Parental guidance programs (with or without soothing techniques) reduce crying time, though the evidence base remains limited. NB: One example worth mentioning is Dr. Pam Douglas's Possums Program, which we present in the NDC training.

• Probiotics are also proposed: Lactobacillus reuteri is the most studied, with an average reduction of 64.6 minutes/day of crying observed, with no notable adverse effects.

• Dietary modifications: the evidence is weak and at risk of bias; eliminating cow's milk (from the infant's diet or the breastfeeding mother's diet) may be beneficial in certain cases.

• Manual therapies (chiropractic, osteopathy) show controversial results and are not recommended as routine care.

• Other approaches (lactase, simethicone, herbal medicine, acupuncture, PPIs) have very weak evidence and are not recommended.

BIBLIOGRAPHY

Di Lorenzo C, Saps M, Chumpitazi BP, Rajindrajith S, Staiano A, Thapar N, van Tilburg M, Velasco-Benítez C, Vlieger A. Lower and Biliary Disorders of Gut-Brain Interaction: Child and Adolescent. Gastroenterology. 2026 May;170(6):1367-1387. doi: 10.1053/j.gastro.2026.01.036. Epub 2026 Feb 17. PMID: 41713707.