Colic vs Reflux: How to Tell the Difference and What to Do

Why This Gets Confusing

Few things are more stressful than a baby who cries and cries—and you don’t know why. Parents often ask me: “Is this colic? Or could it be reflux?” Both can cause fussiness, crying, and sleepless nights, but they aren’t the same thing. Knowing the difference helps you respond in the best way for your baby (and for your peace of mind).

What Is Colic?

Colic is defined less by cause and more by pattern: crying for more than 3 hours a day, 3 days a week, for at least 3 weeks in an otherwise healthy baby. It usually starts around 2–3 weeks of age, peaks at 6–8 weeks, and resolves by 3–4 months.

Key signs of colic:

• Predictable crying spells (often in the late afternoon or evening).

• Intense, hard-to-soothe crying, sometimes with clenched fists or arched back.

• Baby is otherwise healthy, feeding well, and gaining weight.

Colic is thought to be related to immature digestive or nervous systems—but there’s no single cause. Importantly: it’s temporary.

What Is Reflux?

Reflux (also called GER—gastroesophageal reflux) happens when stomach contents flow back into the esophagus. It’s very common in infants because their digestive systems are still developing.

Key signs of reflux

• Frequent spit-up or vomiting after feeds.

• Fussiness or discomfort when lying flat.

• Arching of the back during or after feeding.

• Poor weight gain (in severe cases).

Most babies “outgrow” reflux by 12–18 months as their digestive tract matures.

How to Tell the Difference

• Cry timing: Colic tends to follow a daily pattern; reflux fussiness often happens around or after feeds.

• Spit-up: Common with reflux; not a hallmark of colic.

• Weight gain: Babies with colic grow normally; reflux may affect growth if severe.

• Soothe response: Colic crying is often hard to soothe; reflux fussiness may improve when held upright.

Sometimes, babies have both—colic-like crying and mild reflux.

What Parents Can Do

For Colic

• Hold and comfort your baby: rocking, swaddling, or using white noise may help.

• Try motion: stroller walks, car rides, or a baby carrier.

• Offer a pacifier—sucking can soothe.

• Take shifts with a partner or caregiver to give yourself breaks.

For Reflux

• Keep baby upright for 20–30 minutes after feeds.

• Feed smaller amounts more frequently.

• Burp often during feeds.

• Elevate the head of the crib slightly (with pediatric guidance).

• Talk with your pediatrician if spit-up is forceful, green/bloody, or if baby isn’t gaining weight.

When to Call the Pediatrician

• Crying feels constant and overwhelming.

• Vomit is green, bloody, or projectile.

• Baby isn’t gaining weight as expected.

• You’re concerned about feeding, growth, or your own ability to cope.

Clinician’s Note

As a pediatrician and parent, I know how exhausting this stage can feel. The important thing to remember: colic ends, reflux improves, and you are not alone. Neither condition is your fault. Sometimes, the best medicine is reassurance—and knowing this tough season won’t last forever.

Key Takeaways

• Colic: intense, predictable crying in an otherwise healthy baby; peaks at 6–8 weeks, resolves by 3–4 months.

• Reflux: spit-up and fussiness tied to feeding; usually improves by 12–18 months.

• Colic doesn’t affect growth; reflux sometimes does.

• Comfort, upright positioning, and patience are key tools.

• Talk to your pediatrician if symptoms seem severe or you’re worried.

Final word: Whether it’s colic, reflux, or a bit of both, your baby’s fussiness is temporary. With time, growth, and support, the crying fades—and calmer days (and nights) return.