Colic and PURPLE crying: what's normal and how to cope

Colic is when an otherwise healthy baby cries a lot and there's no obvious cause. The NHS colic page says your baby may have colic if they cry more than 3 hours a day, 3 days a week, for at least 1 week. It usually starts when a baby is a few weeks old and stops by around 3 to 4 months. The Period of PURPLE Crying is a way of describing this same normal phase, developed to help parents cope and to prevent shaken baby injuries.

Long, hard-to-soothe crying is exhausting, and it is not your fault. This guide explains what's normal, a plan for the hardest hours, and which signs mean your baby needs a doctor. For everyday soothing, see soothing a crying baby.

What is colic?

"Colic" is a description, not a diagnosis of a specific illness. The NHS says the cause is unknown. During a crying spell, a colicky baby may:

• be very hard to soothe
• clench their fists
• go red in the face
• draw their knees up to their tummy or arch their back
• have a rumbling tummy or seem windy

Crying is often worse in the afternoon and evening. The AAP's colic page says about one in five babies develop colic, usually between the second and fourth weeks. The Royal Children's Hospital Melbourne (RCH) prefers to talk about "excessive crying", saying the word colic can be unhelpful.

Before deciding it's colic, ask your GP or child-health nurse to check your baby. The NHS suggests ruling out other causes such as hunger, a dirty nappy, wind, reflux and constipation.

What is the Period of PURPLE Crying?

The Period of PURPLE Crying is a shaken baby prevention programme from the National Center on Shaken Baby Syndrome, which describes it as evidence-based and available since 2007. It explains the crying that is normal in early infancy so parents know what to expect. The Hull University Teaching Hospitals NHS leaflet explains the letters this way:

The word "period" is there to remind you that this phase ends. The National Center's FAQ for parents says soothing will work some of the time, but nothing will work all of the time, and that even parents who do everything "just about perfect" still see these crying bouts.

When does colic start, peak and stop?

The RCH's Community Paediatric Review describes crying bouts at this stage lasting 35 to 40 minutes on average, sometimes one to two hours or more, and clustering in the late afternoon and evening. Sources give ranges rather than a fixed end date, and every baby is different.

How can you soothe a colicky baby?

The NHS suggests:

1. holding or cuddling your baby when they cry a lot
2. sitting or holding them upright during feeds, and winding them after feeds (see burping and wind)
3. gently rocking them over your shoulder, in a bassinet or in a pram
4. a warm bath
5. gentle background white noise
6. carrying on feeding as usual

The AAP adds walking your baby in a carrier, steady motion and sound, offering a dummy, gentle back rubs while they lie tummy-down across your knees (moving them onto their back in the cot if they fall asleep) and swaddling in a thin blanket. The Hull leaflet suggests skin-to-skin contact, smaller and more frequent feeds, and pram walks. A structured approach like the 5 S's gives you a sequence to follow.

What about feeding changes?

The NHS says breastfeeding mothers don't need to change their diet. The AAP suggests that, after talking with your paediatrician, some breastfeeding mothers may try cutting out one food at a time, such as dairy or caffeine, for about 2 weeks. It also says fewer than 5% of colicky crying is caused by food sensitivity. Talk to your GP or child-health nurse before changing your diet or your baby's formula.

Which colic remedies don't help?

• Anti-colic drops, herbal supplements and probiotics. The NHS says these are not recommended because there's no evidence they help. The RCH notes one probiotic strain, Lactobacillus reuteri DSM17938, may help some exclusively breastfed babies, but it won't stop crying entirely and studies suggest it makes no difference for formula-fed babies.
• Medicines. The RCH says medicine is not usually recommended for excessive crying and should only be given on a doctor's or nurse's advice.
• Spinal manipulation and cranial osteopathy. The NHS says there's little evidence these work, and they may hurt your baby.
• Other colic products. The RCH says many have no evidence of benefit and some can be harmful.

Our colic remedies guide looks at specific products in more detail.

What is a good coping plan for colic?

Having a plan before the evening starts makes the hard hours easier.

1. Rule out the basics. Feed, burp, change the nappy and check your baby isn't too hot or cold.
2. Pick one or two soothing methods and give each a few minutes before switching.
3. Share the load. Take shifts with a partner or support person, so each of you gets some unbroken rest (see partner support).
4. Know your limit. If you feel tense, angry or panicky, it's OK to put your baby down on their back in their cot, close the door and step away for a few minutes. The NHS suggests a time limit, such as 10 minutes, before you go back.
5. Check on your baby while you take a break. The National Center on Shaken Baby Syndrome suggests checking about every 10 to 15 minutes.
6. Never shake a baby. The RCH says shaking can cause brain damage and lifelong disability.

The RCH also suggests reducing other demands where you can, such as pre-made meals, and asking family and friends for practical help.

When is crying more than colic?

Trust your instincts. Colic is a diagnosis for a baby who is otherwise well.

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now if your baby:

• has a weak or high-pitched cry, or a cry that doesn't sound like their normal cry (NHS)
• is floppy, unresponsive or not waking as easily as usual
• has difficulty breathing, or blue, grey, pale or blotchy skin, lips or tongue
• has a fit (seizure) or a rash that doesn't fade when pressed
• is under 3 months old with a temperature of 38°C (100.4°F) or higher, which the NHS urgent-help guide lists among reasons to call an ambulance
• has a bulging soft spot on their head
• has not had a wet nappy in the past 8 hours
• has green or yellow vomit, which the Sydney Children's Hospitals Network says can mean a twisted or blocked bowel and needs an ambulance or the nearest emergency department
• is vomiting blood, which the NHS vomiting guide lists among reasons to call an ambulance or go to A&E

Get an urgent appointment the same day (GP, a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US) or after-hours service) if your baby:

• is refusing to feed, or has signs of dehydration such as fewer wet nappies than usual
• is projectile vomiting
• has blood in their poo
• has a swollen or tender tummy
• won't stop crying and is very distressed

The same-day list follows the NHS reflux page, which lists these as urgent. The NHS page also lists green or yellow vomit and vomit with blood in it there, but this guide follows the stricter emergency advice above. If your baby also seems very unwell, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US).

Talk to your GP or child-health nurse soon if:

• you're worried about the crying, or nothing seems to help
• your baby isn't growing or putting on weight as expected
• crying is still intense after 4 months
• you're finding it hard to cope

Where can parents get support?

Colic can wear down anyone. Contact a parenting support service (Tresillian or Karitane in Australia, your health visitor in the UK, your pediatrician's office in the US) for advice and a listening ear. If you often feel low, anxious or unlike yourself, talk to your GP or call a perinatal support line (PANDA on 1300 726 306 in Australia, Samaritans on 116 123 in the UK, the National Maternal Mental Health Hotline on 1-833-852-6262 in the US) (see postnatal mood). The RCH says that if you're worried you may harm yourself or your baby and can't keep yourselves safe, put your baby somewhere safe and call your local emergency number (000 in Australia, 999 in the UK, 911 in the US), or call a crisis line (Lifeline on 13 11 14 in Australia, Samaritans on 116 123 in the UK, 988 in the US).

A simple diary of when crying starts and stops, feeds and what helped can show whether crying clusters in the evening, and gives your GP or child-health nurse a clear picture.