How do I know if my baby has colic or reflux?

Colic is the diagnosis when a baby cries more than 3 hours a day, more than 3 days a week, for more than 3 weeks, and no physical cause is found. Physiological reflux — effortless spitting up after feeds — is entirely normal in healthy, thriving infants. Pathological reflux disease (GORD) involves complications such as poor weight gain, refusal to feed, recurrent aspiration, or painful arching. Most babies labelled as having reflux actually have normal physiological GOR. Your GP can distinguish these by assessing growth, feeding pattern, and your baby's overall wellbeing.

Will my baby grow out of colic?

Yes — infant colic is a self-limiting condition in the vast majority of babies. Most infants see significant improvement by 3 months, and approximately 90% have resolved by 5 months. The peak of crying is typically around 6–8 weeks of life. While this period is exhausting, reassurance that it will end is one of the most valuable things a GP can offer. The PURPLE crying framework helps families understand that this phase is normal, universal, and temporary. If crying continues beyond 5 months or is accompanied by other symptoms, further assessment is warranted.

What actually helps with infant colic?

Reassurance and education (including the PURPLE crying programme) are the foundation of management and the most reliably effective interventions. Lactobacillus reuteri DSM 17938 (BioGaia ProTectis drops) has good evidence specifically in breastfed infants, reducing daily crying time. Optimising breastfeeding technique and latch with a lactation consultant can make a meaningful difference. Safe soothing strategies — skin-to-skin contact, gentle rhythmic motion, white noise, safe swaddling — are worth trying. If cow's milk allergy is suspected based on specific clinical features, a two-week maternal exclusion diet or extensively hydrolysed formula trial can be considered.

Are reflux medications helpful for a crying baby?

No — multiple high-quality trials have found that proton pump inhibitors such as omeprazole do not reduce crying or distress in infants without documented oesophagitis. NICE, ESPGHAN, and the Royal Children's Hospital Melbourne all advise against prescribing PPIs for typical infant colic or physiological reflux. There is also a documented harm signal: PPI use in infancy is associated with increased fracture risk and gastrointestinal infections. These medications treat acid — not crying — and the crying in colic is not caused by acid reflux.

When should I take my baby to the emergency department?

Take your baby to the emergency department immediately for green or bilious vomiting at any age, blood in vomit or stool, persistent vomiting with drowsiness or limpness, breathing difficulties or turning blue, a bulging fontanelle, fever in a baby under 3 months, suspected non-accidental injury, or a suspected hair tourniquet around a finger, toe, or penis. Faltering growth — crossing two or more weight centile lines downward — also requires urgent assessment. HealthDirect (1800 022 222) can help you assess urgency between GP visits.

Infant colic and paediatric GORD

Infant colic and reflux: the Australian general practice guide

By Dr HB Lo, FACRRM Reviewed 2 August 2026 10 min read

Infant colic — inconsolable crying >3 hours/day, >3 days/week, for >3 weeks in an otherwise well baby — affects 10–25% of infants, peaking at 6–8 weeks and resolving in most by 3–4 months.

Physiological regurgitation is normal in over 50% of healthy infants and differs from pathological reflux disease. Management centres on reassurance, PURPLE crying education, lactation support, and L. reuteri DSM 17938 in breastfed infants.

Proton pump inhibitors are not effective for typical infant colic and carry a documented harm signal. Screen both parents for postnatal depression.

Understanding infant colic, reflux, and cow’s milk allergy

Crying is a newborn’s primary communication tool. When it is inconsolable, prolonged, and without obvious cause, it becomes one of the most challenging and emotionally costly presentations in Australian general practice — for families and clinicians alike.

Infant colic is defined by the Wessel “rule of 3s” and codified in the Rome IV functional gastrointestinal disorders framework: crying or fussing for more than 3 hours per day, more than 3 days per week, for more than 3 weeks, in an otherwise well infant under 5 months of age, with no identifiable organic cause. It affects 10–25% of infants across all cultures and socioeconomic groups, peaking at around 6–8 weeks of life and resolving spontaneously by 3–4 months in approximately 60% and by 5 months in around 90% (RACGP AFP 2012).

Physiological gastro-oesophageal reflux (GOR) — effortless posseting after feeds — is entirely normal in over 50% of healthy infants under 6 months of age. It is not a disease and does not require treatment. Pathological GORD (reflux disease) is reflux causing complications: faltering growth, oesophagitis, recurrent aspiration, dystonic posturing (Sandifer syndrome), or significant feeding refusal. Most babies labelled as having “reflux” have normal physiological GOR, not GORD — a distinction that matters enormously for whether treatment is warranted (ESPGHAN/NASPGHAN 2024).

Cow’s milk allergy (CMA) affects approximately 2–3% of infants. IgE-mediated CMA causes immediate reactions (urticaria, vomiting, anaphylaxis within 2 hours); non-IgE-mediated CMA causes delayed reactions (eczema, mucus or blood in stool, food protein-induced allergic proctocolitis, FPIES) (ASCIA).

A. Core clinical — the AU general-practice framework

Red flags — escalate immediately

Royal Children’s Hospital Melbourne criteria for urgent assessment or emergency department referral:

Bilious (green) vomiting at any age — surgical emergency; midgut volvulus until proven otherwise
Fever in an infant under 3 months — full septic workup required in hospital
Currant-jelly stool with lethargy and paroxysmal screaming — intussusception (peak 3–12 months)
Faltering growth — crossing 2 or more centile lines downward on the WHO growth chart
Persistent projectile non-bilious vomiting at 3–6 weeks — pyloric stenosis; hypochloraemic metabolic alkalosis
Apnoea, cyanosis, or brief resolved unexplained event (BRUE)
Bulging fontanelle — raised intracranial pressure, meningitis
Suspicious bruising, torn frenulum, or inconsistent history — non-accidental injury; mandatory notification; emergency department
Hair tourniquet around a digit, toe, or penis — inspect between every toe and at the penis on every screaming infant
Incarcerated inguinal hernia

History

A structured history for the crying infant covers:

Crying pattern: onset age, timing, duration, evening clustering (typical of colic), inconsolability, what partially helps
Feeding: breast or formula, volumes and frequency, latch quality, nipple pain (maternal), vomiting character (effortless vs forceful, bilious, bloody)
Stooling: frequency, consistency, blood, mucus
Growth: all weights plotted on the WHO growth chart in the Personal Health Record (blue or red book)
Family history: atopy — asthma, eczema, food allergy — raises suspicion of CMA
Parental mental health: ask both parents explicitly about mood, sleep, supports, and intrusive thoughts; screen with the Edinburgh Postnatal Depression Scale (EPDS); postnatal depression affects 10–15% of new parents (COPE)
Household stressors: finances, domestic violence (screen sensitively), isolation, substance use

Examination

Vital signs, temperature, growth (weight, length, head circumference plotted), general alertness and tone, anterior fontanelle (flat vs bulging vs sunken), cardiorespiratory examination, abdominal palpation and hernial orifices, inspection between all toes and the penis for hair tourniquet, skin for bruising and eczema, ear examination for otitis media. Neurological assessment including posture — dystonic neck extension may indicate Sandifer syndrome from oesophagitis.

Investigations

For typical colic in a thriving infant with a normal examination: no routine investigations are required. Investigations are guided by red flags and clinical findings:

Urinalysis ± clean-catch midstream urine for fever or unexplained vomiting in infants under 3 months
FBC, UEC, CRP, blood culture if unwell or febrile
Faecal occult blood if FPIAP (food protein-induced allergic proctocolitis) is suspected
Abdominal ultrasound if intussusception or pyloric stenosis is clinically suspected
Specific IgE or skin prick testing only for suspected IgE-mediated CMA (not useful for non-IgE-mediated forms)

B. Evidence — what helps, what does not

Evidence-supported interventions

Reassurance and PURPLE crying education forms the cornerstone of management for every family (RACGP 2012; RCH Melbourne CPG). The PURPLE crying programme — named for the phases: Peak of crying, Unexpected episodes, Resists soothing, Pain-like facial expression, Long duration bouts, Evening clustering — is evidence-based for reducing shaken-baby syndrome risk by reframing normal infant behaviour. The central reassurance message: this is not a parenting failure, the baby is not broken, and this resolves.

Lactobacillus reuteri DSM 17938 (BioGaia ProTectis drops) — Sung et al. 2018 individual-patient-data meta-analysis of 6 RCTs (n=589) showed clear reduction in daily crying time in breastfed infants (mean approximately 25–40 minutes per day at 21 days). Benefit is specific to breastfed infants; evidence in formula-fed infants is inconsistent and the ESPGHAN endorses use in breastfed colicky infants only. Cost approximately $25–30/month (OTC); not PBS-listed.

Lactation support addresses the root cause of feeding-related distress. Poor latch, oversupply, forceful letdown, and ineffective milk transfer all contribute to crying, wind, and regurgitation. Australian Breastfeeding Association (ABA 1800 686 268, 24-hour peer support) and International Board Certified Lactation Consultant (IBCLC) referral should be offered early.

Safe soothing strategies — skin-to-skin contact, kangaroo care, rhythmic gentle motion, white noise, safe swaddling per Red Nose Australia guidelines (hip-safe, supine, no overheating), pacifier once breastfeeding is established (around 4 weeks) — all have observational support and plausible biological mechanisms. No single strategy is universally effective; parental trial and error with the safety net of education is appropriate.

Interventions to avoid

Proton pump inhibitors and H2 receptor antagonists for typical colic — multiple RCTs have found no clinical benefit for crying, distress, or feeding behaviour in infants without documented oesophagitis. NICE NG1, ESPGHAN/NASPGHAN 2024, RCH Melbourne CPG, and eTG all advise against prescribing acid suppression for colic or uncomplicated physiological GOR. Wang et al. JAMA 2015 demonstrated a harm signal with infant PPI use: increased fracture risk, respiratory infections, and gastrointestinal infections. PPI prescribing in infancy has increased more than tenfold over 20 years with no measurable improvement in outcomes.

Simethicone (e.g. Infacol) — placebo-controlled trials show no efficacy over placebo. It is harmless but ineffective. Parents should be counselled honestly rather than given false reassurance through an inert medication.

Chiropractic, osteopathic, and craniosacral manipulation — Cochrane review (Dobson 2012) found no benefit beyond placebo, and there is a theoretical safety risk from spinal manipulation in infants. Advise against on both efficacy and safety grounds.

Gripe water, fennel oil, and herbal infusions — TGA-restricted (alcohol-containing formulations), associated with hepatic toxicity reports, and not recommended by RACGP or eTG.

C. Cow’s milk allergy trials and feeding considerations

When to consider a CMA trial

A dietary trial for CMA is warranted when specific clinical features are present: persistent colic plus one or more of — bloody or mucus-containing stools, significant eczema, strong family history of atopy, or features of FPIES (profuse vomiting with pallor and lethargy 1–4 hours after feeding) (ASCIA CMA guidelines). A trial is not indicated for uncomplicated crying in a thriving infant without these features.

Breastfed infants with suspected CMA

Maternal cow’s-milk-free diet for two weeks: remove all dairy including hidden sources (check labels for casein, whey, lactose). If the infant improves, reintroduce cow’s milk to the maternal diet to confirm the relationship before committing to long-term dietary restriction. Maternal calcium supplementation (1000–1200 mg/day) is recommended during elimination. Dietitian involvement is helpful for sustained dietary modification.

Formula-fed infants with suspected CMA

Trial an extensively hydrolysed formula (eHF) — such as Aptamil Pepti, Pepti-Junior, or Nutramigen — for two weeks, then reintroduce standard formula to confirm the association. If eHF fails or the presentation was severe (FPIES, significant growth faltering), escalate to an amino acid formula (Neocate, EleCare) and refer to a paediatric allergist. Neither eHF nor amino acid formula is PBS-listed for general practice prescribing; specialist Authority is required for PBS access.

Thickened feeds and anti-reflux formula

Thickened feeds (commercial anti-reflux formula or carob thickener) reduce visible regurgitation in infants with documented GORD and significant spilling. They have no effect on crying and are not indicated for colic. They are appropriate only when regurgitation itself — not crying — is the clinical problem (RCH CPG).

D. Australian operations

MBS billing

Items 23 / 36 / 44 — Level B, C, D consultations; long consultations are appropriate given the complexity and emotional weight of these presentations
Item 16401 — GP postnatal review within 8 weeks of delivery
Items 2715 / 2717 — Mental Health Care Plan for a parent with postnatal depression or anxiety; strongly consider in any persistent colic presentation given the 10–15% postnatal depression prevalence in new parents
Item 715 — Aboriginal and Torres Strait Islander health assessment
Item 73529 — urinalysis when clinically indicated

PBS and OTC

L. reuteri DSM 17938 (BioGaia ProTectis drops) — not PBS; OTC approximately $25–30/month
Simethicone (Infacol) — not PBS; OTC; not clinically endorsed
Extensively hydrolysed formula — not PBS for general practice prescribing; specialist Authority Required via paediatrician or paediatric allergist for PBS access
PPIs — PBS Authority listings exist for paediatric GORD with documented complications, but not appropriate for typical colic without confirmed oesophagitis

Support and referral pathways

Australian Breastfeeding Association 1800 686 268 (24-hour peer support, free) for all breastfeeding-related concerns
IBCLC (International Board Certified Lactation Consultant) — private ($150–250) or hospital outpatient for complex feeding problems
Maternal and Child Health Nurse — state-funded universal service; weight checks, feeding support, EPDS screening
PANDA 1300 726 306 — perinatal anxiety and depression helpline
COPE — perinatal mental health resources for clinicians and families
Tresillian (NSW), Karitane (NSW), Ngala (WA) — early-parenting residential and day-stay services for sleep, settling, and feeding support
Paediatric gastroenterologist for true GORD with faltering growth or aspiration
Paediatric allergist for confirmed or complex CMA requiring amino acid formula

E. Special populations

Aboriginal and Torres Strait Islander families — the 715 health assessment creates an opportunity to address maternal and infant wellbeing in a culturally safe framework; higher rates of postnatal depression and social complexity warrant proactive screening and warm referral.

Culturally and linguistically diverse families — use qualified interpreters (TIS National 131 450, free for GPs); PURPLE crying education materials are available in multiple languages; avoid assumptions about infant feeding norms or parenting practices.

Premature and late-preterm infants — the developmental milestone of “peak crying” is based on corrected gestational age, not chronological age; parents need this reframing to understand when improvement is expected. Preterm infants also have higher rates of true GORD warranting paediatric review.

Parental mental health as a safeguarding concern — parental depression and infant colic are bidirectionally linked. Identifying and supporting a struggling parent is both a clinical and safeguarding intervention, as significant parental overwhelm is a risk factor for shaken-baby syndrome.

When to escalate

Refer or escalate immediately for any of the red flags listed above. Refer for further assessment when:

Suspected CMA not responding to a time-limited dietary trial — paediatric allergist
Suspected GORD with faltering growth, recurrent aspiration, or oesophagitis — paediatric gastroenterologist
Colic not improving by 5 months of age
Parental mental health crisis or suicidal ideation — PANDA 1300 726 306, Lifeline 13 11 14, or emergency department
Non-accidental injury suspected — mandatory notification per state child-protection legislation; emergency department

What this article is and is not

This is general health information drawn from current Australian general practice guidelines — Therapeutic Guidelines, Royal Children’s Hospital Melbourne Clinical Practice Guidelines, RACGP, NICE NG1, ESPGHAN/NASPGHAN 2024, ASCIA, and Australian Breastfeeding Association resources. It is not personal medical advice and does not create a doctor–patient relationship. Decisions about your baby’s health and management are made with your own GP and paediatric team.

For Australian consumer-friendly resources: HealthDirect — Baby colic (1800 022 222), Better Health Channel, Red Nose Australia, Australian Breastfeeding Association 1800 686 268.

For perinatal mental health: PANDA 1300 726 306, COPE. For crisis: Lifeline 13 11 14.

Sources cited

Frequently asked questions

How do I know if my baby has colic or reflux?

Colic is the diagnosis when a baby cries more than 3 hours a day, more than 3 days a week, for more than 3 weeks, and no physical cause is found. Physiological reflux — effortless spitting up after feeds — is entirely normal in healthy, thriving infants. Pathological reflux disease (GORD) involves complications such as poor weight gain, refusal to feed, recurrent aspiration, or painful arching. Most babies labelled as having reflux actually have normal physiological GOR. Your GP can distinguish these by assessing growth, feeding pattern, and your baby's overall wellbeing.
Will my baby grow out of colic?

Yes — infant colic is a self-limiting condition in the vast majority of babies. Most infants see significant improvement by 3 months, and approximately 90% have resolved by 5 months. The peak of crying is typically around 6–8 weeks of life. While this period is exhausting, reassurance that it will end is one of the most valuable things a GP can offer. The PURPLE crying framework helps families understand that this phase is normal, universal, and temporary. If crying continues beyond 5 months or is accompanied by other symptoms, further assessment is warranted.
What actually helps with infant colic?

Reassurance and education (including the PURPLE crying programme) are the foundation of management and the most reliably effective interventions. Lactobacillus reuteri DSM 17938 (BioGaia ProTectis drops) has good evidence specifically in breastfed infants, reducing daily crying time. Optimising breastfeeding technique and latch with a lactation consultant can make a meaningful difference. Safe soothing strategies — skin-to-skin contact, gentle rhythmic motion, white noise, safe swaddling — are worth trying. If cow's milk allergy is suspected based on specific clinical features, a two-week maternal exclusion diet or extensively hydrolysed formula trial can be considered.
Are reflux medications helpful for a crying baby?

No — multiple high-quality trials have found that proton pump inhibitors such as omeprazole do not reduce crying or distress in infants without documented oesophagitis. NICE, ESPGHAN, and the Royal Children's Hospital Melbourne all advise against prescribing PPIs for typical infant colic or physiological reflux. There is also a documented harm signal: PPI use in infancy is associated with increased fracture risk and gastrointestinal infections. These medications treat acid — not crying — and the crying in colic is not caused by acid reflux.
When should I take my baby to the emergency department?

Take your baby to the emergency department immediately for green or bilious vomiting at any age, blood in vomit or stool, persistent vomiting with drowsiness or limpness, breathing difficulties or turning blue, a bulging fontanelle, fever in a baby under 3 months, suspected non-accidental injury, or a suspected hair tourniquet around a finger, toe, or penis. Faltering growth — crossing two or more weight centile lines downward — also requires urgent assessment. HealthDirect (1800 022 222) can help you assess urgency between GP visits.

Source quality

Sources grouped by evidence tier. AU primary tier first; international where AU is silent or lagging; named-author reconstruction where guidelines have not yet caught up. How tiers work.