Why Does My Baby Cry for Hours Every Evening? Understanding Colic

Crying for hours every evening in an otherwise healthy, well-fed baby is often colic, a pattern of intense, hard-to-soothe crying that usually begins in the first weeks of life and often eases by around three to four months. Colic describes a pattern, not a single disease, and its cause is not fully understood. This article explains what colic looks like, which factors may contribute, what can help you cope, and which signs call for a same-day visit or 911.

Why does my baby cry for hours every evening? What colic usually looks like

Colic is the word clinicians and parents use for long spells of crying in a baby who is otherwise healthy, feeding well, gaining weight and has a normal exam. The crying often comes in the late afternoon or evening. It can look sudden and intense: a red face, clenched fists, a stiff or arched back, legs pulled up toward the belly, and a cry that sounds louder or more urgent than usual. Feeding, rocking and a clean diaper may not stop it.

Many babies are fussy at the end of the day, and crying is a normal part of early infancy. Colic sits at the intense end of that range. A review titled Three-months' colic in the National Library of Medicine's PubMed Central describes the pattern as one that appears early and settles over the first few months. MedlinePlus lists colic among the common infant and newborn problems that usually pass as a baby grows.

One symptom does not establish a diagnosis. Colic is generally what remains after a clinician has examined the baby and found no other explanation. That is why the exam matters, especially when the crying is new.

What may contribute to evening crying

The mechanism is not fully understood, and several factors probably contribute. None of them has been shown to explain every baby.

• An immature nervous system. Newborns take time to regulate sleep, wakefulness and sensory input. By evening, after a day of light, sound and handling, some babies may become overstimulated and struggle to settle.
• A developing gut. Gas, gut movement and the balance of gut bacteria may play a role in some babies. Researchers have studied whether probiotics help, with mixed and limited results.
• Feeding factors. Swallowed air, a fast milk flow or feeding while very upset may add to discomfort in some babies.
• Food protein sensitivity. In a minority of babies, cow's milk allergy may be involved. A PubMed Central article on when to suspect cow's milk allergy in infantile colic discusses clues such as eczema, blood or mucus in the stool, or poor weight gain alongside the crying.
• Temperament and parent perception. Babies differ in how easily they are soothed. Research on maternal perceptions of infant crying and colic suggests that how a parent experiences the crying may influence whether it is called colic, which may be one reason the label varies between families.

Colic is not caused by anything you did. It does not appear to reflect poor parenting, and a baby with colic is not being spoiled by being held.

Is it colic, reflux, or something else?

Evening crying can overlap with other common infant problems, so it helps to notice the details.

Reflux

Many babies spit up. Spit-up in a baby who is comfortable and growing is usually not a problem. MedlinePlus explains that reflux in infants becomes a concern when a baby has poor weight gain, refuses feeds, vomits forcefully or has breathing symptoms. Our article on spit-up and reflux covers this in depth.

Hunger, tiredness and overstimulation

Before assuming colic, check the basics: a feed due, a wet or dirty diaper, a baby who is too warm or too cold, or a baby who has been awake for a long stretch. Evening crying that improves once a baby sleeps or feeds is less likely to be colic.

Hidden sources of pain

A clinician may look for causes that can be missed at home. These include a hair or thread wrapped tightly around a finger, toe or genitals (sometimes called a hair tourniquet), an eye scratch, a diaper rash, an ear infection, a urinary infection, or a bulge in the groin that may be a hernia. A hair tourniquet, or a hernia that becomes firm, painful or discolored, can reduce blood flow and needs emergency care, as described in the emergency box below. A soft groin bulge that goes away when your baby is calm should be seen by a pediatrician the same day. Undress your baby fully and look from head to toe if the crying seems different from usual.

Serious conditions that look like colic

Much less common than colic, some serious problems can first appear as bouts of crying. An intestinal blockage or a bowel that folds into itself (intussusception) may cause severe crying that comes and goes, with drawn-up legs, repeated vomiting, a swollen belly or bloody stool. Infection of the brain or its lining may cause a high-pitched cry, unusual sleepiness, poor feeding or a bulging soft spot. MedlinePlus describes encephalitis and its warning signs. These conditions are uncommon, and crying alone does not point to them. The accompanying symptoms are what matter, and they are listed in the emergency box below.

Ways to soothe a baby with colic

No single method works for every baby, and what helps one night may not help the next. Many families rotate through a few approaches. Some ideas that are generally low risk:

• Reduce stimulation. A dim, quiet room can help a baby who is overwhelmed by the end of the day.
• Add steady, rhythmic input. Gentle rocking, walking, a baby carrier, a stroller ride, or a car ride with someone else driving may help. Steady background sounds such as a fan or a white-noise machine can calm some babies.
• Try swaddling while the baby is awake. A snug swaddle may help some newborns feel settled. Stop swaddling once your baby begins to show signs of rolling, and ask your pediatrician when that applies.
• Use a hold that puts gentle pressure on the belly. If you use a face-down hold along your forearm, keep your baby awake and supervised, and put them on their back to sleep as soon as they are calm or drowsy. A baby should be placed on their back, on a firm, flat, empty sleep surface, whenever they sleep.
• Check the feeding routine. Burping during and after feeds, keeping the baby more upright, and slowing a fast flow may reduce swallowed air. Ask your pediatrician before changing formula or your own diet while breastfeeding.
• Offer skin-to-skin contact or a pacifier if your baby takes one.

Soothing attempts do not always stop the crying. A baby who keeps crying after you have tried everything is not a sign that you are failing.

What the evidence says about remedies

A systematic review of treatments for infantile colic in PubMed Central found that the evidence behind many popular remedies is limited or inconsistent. That is a common finding in colic research, partly because colic improves over time on its own, which can make a remedy look more effective than it is.

• Probiotics. Some small trials of Lactobacillus strains have reported benefit, while others have not. Results vary by strain, and outcomes vary between babies. Probiotics are sold as supplements rather than approved medicines, and they may not be appropriate for premature or seriously ill infants. Ask your pediatrician before giving one.
• Formula or diet changes. These may be considered if a clinician suspects cow's milk allergy. Changing them without guidance can delay finding another cause.
• Gripe water, herbal teas and over-the-counter gas drops. Products differ in ingredients, and the evidence for benefit is limited. Do not give gripe water, herbal teas or other unregulated herbal products to a baby under 12 months. Do not use any medicine or gas drop to treat colic without asking your pediatrician or pharmacist first. Follow the product label and your pediatrician's instructions, and do not work out a dose by weight yourself.
• Medicines meant for older children or adults. Do not give these to a baby to calm crying. Sedating products and sleep aids can be dangerous for infants, and cough and cold medicines are not appropriate for babies. Do not give honey to a baby before age 1. Do not give ibuprofen to a baby under 6 months. Do not give acetaminophen to a baby under 3 months unless a clinician directs it, and a fever at that age needs emergency evaluation first, as described in the emergency box below. Check the label and ask your pediatrician or pharmacist before giving either medicine at any age.

Hydration also matters. If a baby cries hard and feeds poorly, it is worth knowing the signs of dehydration described by MedlinePlus, such as fewer wet diapers, a dry mouth, no tears when crying and a sunken soft spot.

Taking care of yourself when the crying will not stop

Hours of crying every evening are exhausting, and many parents feel anxious, angry, guilty or hopeless at times. These feelings are common. They also carry a safety risk, because frustration at a crying baby is a recognized setting for harm.

• Put your baby down safely. If you feel yourself losing control, lay your baby on their back in the crib, walk to another room, and take a few minutes to breathe. A baby who cries alone in a safe crib for a short time is safer than a baby held by an overwhelmed adult.
• Do not shake a baby. Shaking can cause serious brain injury and death.
• Hand off the baby. Ask a partner, relative or friend to take a shift, even for a short walk outside.
• Tell your clinician how you are doing. Persistent sadness, anxiety, trouble sleeping when the baby sleeps, or loss of interest in daily life may be signs of postpartum depression or anxiety, which can be treated. Tell your clinician so they can decide what support is appropriate.
• If you are overwhelmed or having thoughts of harming yourself or your baby, you can call or text 988, the Suicide and Crisis Lifeline, at any hour. If you think you may act on those thoughts and cannot stay safe, call 911.

How colic is evaluated and how long it lasts

At a visit, a pediatrician usually asks when the crying starts, how long it lasts, how feeding and diapers are going, whether there is vomiting, fever or blood in the stool, and what has helped. They examine the baby from head to toe, check growth on a chart, and may order tests only if something does not fit. Clinicians combine history, examination and, when needed, testing. A video or a diary of crying times and feeds can make the visit more useful.

Researchers are also studying whether recorded cry sounds can help spot colic, but this is research and not a home test. For most families, colic improves gradually over the first few months, and many babies are calmer by around three to four months. Outcomes vary, and a baby whose crying does not improve or changes in character should be re-evaluated.

When to call the pediatrician and when to call 911

The crying itself does not decide urgency. The features around it do. Fever in a baby under 3 months, a limp or hard-to-wake baby, trouble breathing, a seizure, green vomit, or a firm or discolored bulge need emergency care, as listed in the emergency box below. Fever in an older baby, poor feeding, fewer wet diapers, blood in the stool or a sudden change in the crying pattern call for a same-day call to your pediatrician, as listed in the second box. A rectal temperature is the usual way to check a young infant, and your pediatrician can show you how. If a possible swallowed substance or medicine is involved, call Poison Control at 1-800-222-1222.

You know your baby. A parent's sense that something is wrong is a valid reason to seek care, even when the baby's crying fits the usual evening pattern.

When to Seek Medical Care