Does Your Baby Have Colic or Acid Reflux? Here’s the Difference

Babies do not come with instructions. Sometimes, new parents need to learn on the fly, and it’s scary when something seems wrong with your baby. Some babies suddenly start crying nonstop, while others may spit up a lot. This article tackles two common conditions: colic and baby reflux. We explain the differences, signs to look for, and some common treatments.

All newborns cry when hungry and usually cry for another one to two hours throughout the day. Babies communicate their needs, like hunger, dirty diapers, and needing comfort by crying.³ However, colic is different and typically defined as prolonged crying for more than three hours a day, three or more days a week for at least three weeks.^1,3 Although crying episodes can happen at any time of the day, they often occur in the evening.⁴ Colicky babies are difficult to console, and crying may last a few minutes to hours.²

In an otherwise healthy baby, common colic symptoms include:^1,2,3

• Their face may turn red when crying
• They may make fists with their hands
• They may bring their legs up to their abdomen
• They may appear to be in pain
• Their belly may be slightly swollen
• Crying that begins suddenly for no apparent reason

Doctors do not know precisely what causes newborns to have colic, and a lack of answers to explain your baby’s nonstop crying can be frustrating.¹ The good news is colic typically resolves by about 3 to 4 months of age. Symptoms usually begin around two to three weeks after birth and peak when your baby is 4 to 6 weeks old.²

Many believe gas is at least partly to blame for colic, but according to the American Academy of Pediatrics, this is a common myth. Babies can swallow air that passes through their bodies as gas when they cry. However, this is a normal process and should not be painful. So, when considering whether your baby may have colic vs. gas, remember that all babies pass a lot of gas. Since colicky infants have increased crying (and therefore swallow more air), they may pass more gas.³ Other sources, such as the American Academy of Family Physicians, still list “gas pains” as a potential contributing factor to colic.^1,2

Other possible factors include:²

• Feeding too much or too little
• Overstimulation
• Intolerance to formula or breastmilk
• Immature gastrointestinal system
• Emotional response to their surroundings

Although there is no test to diagnose colic, your doctor will complete a physical exam and health history. They may order diagnostic work like lab tests or X-rays to rule out a more severe diagnosis, as colic is a diagnosis of exclusion.¹

Baby colic is common, but because the cause is unknown and likely multifactorial, treatment consists of avoiding potential triggers and comforting your baby.² Parents may experiment with trial and error to determine what works best. However, despite a parent’s best efforts, a baby is sometimes inconsolable. If there is no other medical reason for the crying, a colicky baby can rock any parent’s nerves, leaving them exasperated and exhausted. Babies who cry a lot are at risk for shaken baby syndrome; never shake a baby. If you become overwhelmed, ask for help or place your infant safely in a crib without extra blankets or toys and walk away (to another room) for 10 minutes. Shaking a baby can lead to death or life-long disability.⁵

To help a colicky baby, you can try:^1,2,3

• Skin-to-skin contact or swaddling your baby
• Rocking or singing to your baby
• Walking your baby in a stroller
• Going for a drive with your baby in a car seat
• Talking to your provider about feedings, as they may suggest a change
• Using a slow-flow nipple if your baby bottle feeds too fast
• Using white noise and a dimly lit room
• Giving your baby a warm bath or a massage
• Giving your baby a pacifier

Some over-the-counter medicines, such as simethicone drops, may help relieve gas, but always ensure it is okay with your pediatrician first. Colic may be a symptom of baby reflux, and your provider may recommend a different option.^1,2

It is normal for your baby to spit up because their gastrointestinal system is still developing. Some babies spit up more than others. Spitting up is also called baby reflux. Other names include gastroesophageal reflux (GER) and acid reflux. Baby reflux happens when the stomach contents (like milk) come back up the esophagus (feeding tube) and out the mouth or both the mouth and nose as spit-up. Normally, food is kept in the stomach by the lower esophageal sphincter, but when the structure is still developing, sometimes it opens, letting food and stomach acid back up.^6,7,8,10,11

You may notice your baby spitting up at 2-3 weeks old. Reflux is not usually a cause for concern if your baby is otherwise doing well and gaining weight. Most babies will outgrow reflux as their bodies develop by 12 months.^7,11

Gastroesophageal reflux disease (GERD) is different. GERD occurs when a baby’s reflux impacts other areas of their health, like weight gain and breathing. GERD can happen in younger infants and older children.¹¹ GERD in babies may also resolve as they grow and mature, have better head control, and are introduced to solid foods.⁷ If your baby is diagnosed with GERD, you may need to see a specialist. Treatment recommendations can vary depending on the severity of your child’s symptoms.^6,7,11

Spitting up is usually the first symptom of reflux and GERD in babies. GERD can cause other issues. Contact your pediatrician if you notice any of the following symptoms:^6,9,11

• Increased irritability during and after feedings
• Arching their back when crying
• Vomiting
• Gagging
• Coughing
• Difficulty breathing
• Vomit that is green, yellow, red, or brown
• Poor feeding
• Not gaining weight

Silent reflux is aptly named. Babies swallow their regurgitated stomach contents and may not spit up much, if at all. However, symptoms of silent reflux in babies often overlap with GERD symptoms.¹² Talk to your pediatrician if you think your infant may be suffering from silent reflux.

Babies are prone to reflux because they drink an all-liquid diet and spend much of their time lying down. Your health provider may recommend diet changes if your baby’s reflux symptoms are concerning. So you may wonder, does milk help acid reflux? Formula-fed children may do better on another type of formula. Sometimes, doctors recommend adding a little rice cereal to your baby’s milk.⁸

If your baby is not gaining weight or has other complications related to GERD, your provider may consider prescribing a medication for treatment. However, while these medications are available over the counter, parents should not give this medicine to a child without a doctor’s prescription.

Other non-pharmacologic things you can do to combat the symptoms of GERD include:¹¹

• Do not bounce your baby after feeding
• Hold your baby upright for 20-30 minutes after a feed
• Burp your baby after every 1-2 ounces of feed or after each breast
• Do not overfeed your baby

How Can I Tell the Difference Between Colic and Reflux?

When wondering if your baby may have colic vs. reflux, consider the following:

• Babies with colic and GERD are usually otherwise healthy
• Babies with colic cry for no apparent reason
• Babies with GERD may cry because of pain
• Babies with colic may or may not be spitty
• Babies with reflux spit up often
• Babies with colic may or may not have reflux
• Babies with GER or GERD may or may not have colic
• The cause of colic is unknown
• The anatomical cause of reflux is known (poor lower esophageal sphincter tone)
• Colic usually resolves by 3 to 4 months of age
• Reflux may resolve closer to one year

Talk to your provider if you believe your baby may have colic or reflux. Your doctor will want to rule out other conditions. Remember, you are not alone, and your provider should provide a better understanding of your baby’s situation. Some of our suggestions may also help during this challenging time.