| When the crying peaks | AAP HealthyChildren: the length of this regular fussing “usually peaks at about 3 hours a day by 6 weeks old”. RCH clinical guidance: crying “typically peaks at 6-8 weeks of age, averaging 2-3 hours/day”. The Period of PURPLE Crying: starts at about 2 weeks, “peaks at about two-months”. The 2022 cross-country meta-analysis found “no statistical evidence for a universal crying peak at 6 weeks of age across studies” and modelled the cry-curve peak at 3.97 weeks (95% credible interval 2.64-5.50 weeks). | AAP HealthyChildren; RCH CPG; NCSBS; Child Development 2022 meta-analysis |
| Fuss/cry duration in the first 6 weeks | “the mean fuss/cry duration across studies was stable at 117-133 minutes (SDs: 66-70) in the first 6 weeks”. The pooled highest single estimate sat at 5-6 weeks: 126 minutes (SD 61). | Journal of Pediatrics 2017 (Wolke et al.), 28 diary studies, 8,690 infants |
| Fuss/cry duration by 10-12 weeks | “dropped to a mean of 68 minutes (SD: 46.2) by 10-12 weeks of age”. | Journal of Pediatrics 2017 (Wolke et al.) |
| The decline from 3-4 months | AAP: fussing “then declines to 1 or 2 hours a day by 3 to 4 months of age”. RCH: “improves by 3-4 months”. St James-Roberts: “infants cry around half as much in months 4 to 12”. | AAP HealthyChildren; RCH CPG; Archives of Disease in Childhood 1996 |
| Where the crying sits in the day | AAP: the regular fussy period “tends to happen between 6 p.m. and midnight”. RCH: “Often worse in the late afternoon/evening, may last hours, can be resistant to soothing”. St James-Roberts: “crying between 1800 hours and midnight makes up about 40% of the daily total”. | AAP HealthyChildren; RCH CPG; Archives of Disease in Childhood 1996 |
| The threshold the word “colic” uses | Modified Wessel criteria: the infant has fussed or cried “for more than 3 hours a day, on at least 3 days in any 1 week”. The same meta-analysis reports colic was “much more frequent in the first 6 weeks (17%-25%)” compared with 11% by 8-9 weeks of age and 0.6% by 10-12 weeks of age. | Journal of Pediatrics 2017 (Wolke et al.) |
| How long a normal baby may cry | AAP: “Healthy babies, even those who are well cared for and loved, may cry for 1 to 2 hours every day, and some babies cry even longer.” The Period of PURPLE Crying tells parents “Some normal babies may cry as long as 5 hours a day, some less.” | AAP HealthyChildren; NCSBS Period of PURPLE Crying |
| How long the period lasts | The Period of PURPLE Crying “starts at about 2 weeks, peaks at about two-months, and usually comes to an end by about 4-5 months, and often earlier”. The meta-analysis notes that colic by the modified Wessel criteria is “rare in infants older than 9 weeks”. | NCSBS; Journal of Pediatrics 2017 |
| The word “colic” is now considered unhelpful | RCH: “The term 'infant colic' has traditionally described excessive crying but is now considered unhelpful, as it inaccurately implies an abdominal cause.” | RCH CPG: Unsettled or crying babies |
| Straining and grunting that is not colic | RCH: “Some babies strain, cry, grunt and go red in the face, before passing soft stools (also known as infant dyschezia). This is a common and self-resolving difficulty in coordinating increased intra-abdominal pressure with relaxation of the pelvic floor required to pass stool.” | RCH CPG: Unsettled or crying babies |
| What is not effective, and what can harm | RCH on medication and supplements: “Often these are not indicated, have no evidence and can cause harm.” Simethicone: “Not effective, possibly harmful”. Herbal 'colic' mixtures such as gripe water: “Not effective, possibly harmful”. Acid suppression medication: “Not effective for infants with physiological reflux, irritability or unsettled behaviours”. Spinal manipulation: “Not effective, risk of significant harm”. | RCH CPG: Unsettled or crying babies |
| Crying and the risk it creates | RCH: “Excessive crying is a risk factor for abusive head trauma (previously known as shaken baby syndrome)”, and “the peak period of infant crying is strongly linked to an increased risk of abusive head trauma”. | RCH CPG: Unsettled or crying babies |
| What to do when it gets too much | AAP: place your baby in a safe place, such as a crib or playpen without blankets and stuffed animals, “leave the room and let your baby cry alone for about 10 to 15 minutes”; if you have not calmed after 10 to 15 minutes, check on your baby but do not pick them up until you feel you have calmed down. PURPLE: “If the crying becomes too frustrating, put your infant in a safe place, walk away and take a break for 5-10 minutes.” | AAP HealthyChildren; NCSBS Period of PURPLE Crying |
| The one rule with no exception | AAP: “it is never safe to shake, throw, hit, slam or jerk any child—and it never solves the problem!” | AAP HealthyChildren: Shaken Baby Syndrome |