Is It Colic Or Reflux? 5 Silent Signs Your Baby Is In Pain

Understanding Colic: More Than Just Crying

First, let’s talk about the infamous C-word: colic. The classic medical definition is known as the ‘Rule of Threes,’ first coined by pediatrician Dr. Morris Wessel. A baby is considered colicky if they cry for:

• More than 3 hours a day
• More than 3 days a week
• For more than 3 consecutive weeks

But let’s be real, when it’s your baby screaming, you don’t need a calendar to tell you it’s a problem. Colic is less of a ‘disease’ and more of a behavioral pattern—a diagnosis we often reach after ruling out other medical issues. Think of it as unexplained, intense crying in an otherwise healthy, well-fed baby.

What Colic Looks and Sounds Like

A colic episode is unmistakable and heartbreaking to witness. It’s not a ‘I’m a little hungry’ whimper. It’s a full-blown, intense, and often inconsolable shriek. You might notice:

• Predictable Timing: Colic often has a ‘witching hour’ (or three), typically striking in the late afternoon or evening.
• Physical Tension: A colicky baby’s body is rigid with distress. Look for clenched fists, a hard and bloated-looking tummy, curled legs, and an arched back.
• Gas: You may notice your baby is passing a lot of gas, which for a long time led people to believe colic was purely a digestive issue. While it can be a factor, it’s not the whole story.

A Reassuring Thought: Colic is temporary! For most babies, it peaks around 6 weeks of age and magically begins to fade away between 3 and 4 months. This phase will end, I promise.

The exact cause of colic is still one of medicine’s little mysteries. Current theories point to a combination of factors, including an immature digestive system, a developing nervous system that’s easily overstimulated, and possibly an early form of childhood migraine. The key takeaway is that colic is not your fault. It is not a reflection of your parenting. It’s a developmental phase that some babies just have to go through.

Decoding Reflux: From ‘Happy Spitters’ to Painful Episodes

Now, let’s switch gears to reflux. Nearly every baby has some degree of reflux because the muscle at the top of their stomach—the lower esophageal sphincter (LES)—is still immature. It’s like a faulty valve that allows stomach contents (milk and acid) to flow back up the esophagus. This is called Gastroesophageal Reflux (GER).

If your baby spits up frequently but is generally happy, gaining weight well, and doesn’t seem bothered by it, you have what we affectionately call a ‘happy spitter.’ This is a laundry problem, not a medical one! It’s a normal part of infant development that usually improves as they grow and spend more time upright.

When Reflux Becomes a Problem: GER vs. GERD

The issue arises when reflux causes pain and complications. This is when GER becomes Gastroesophageal Reflux Disease (GERD). The ‘D’ for ‘Disease’ is the key differentiator. With GERD, the stomach acid that comes up is causing inflammation and pain in the esophagus. This is what hurts.

Signs that you might be dealing with GERD, not just GER, include:

• Frequent, forceful spitting up or even vomiting.
• Poor weight gain or weight loss because the baby isn’t keeping enough food down or refuses to eat.
• Extreme irritability, fussiness, or crying during and especially after feedings.
• Gagging, choking, or coughing spells.
• Signs of pain, which we’ll dive into next.

Unlike colic, which is often about the time of day, the pain from GERD is directly linked to eating. The act of swallowing and digesting is what triggers the discomfort. This is the single biggest clue to help you start telling the two apart.

The Silent Signals: 5 Overlooked Signs of Pain

Babies can’t tell you, ‘My throat burns!’ or ‘It hurts when I lie down.’ Instead, they communicate through a series of subtle, often silent, physical cues. If you’re seeing these behaviors, especially around feeding times, reflux might be the culprit behind your baby’s distress.

1. Arching the Back During or After Feedings

This is the hallmark sign of reflux pain. When stomach acid splashes into the esophagus, it burns. The baby’s instinctual reaction is to arch their back and neck, sometimes violently. They are trying to lengthen their esophagus to get away from the acid and relieve the pain. This specific type of arching, sometimes called Sandifer’s syndrome when it’s severe, looks like they are trying to push away from you even while they are trying to eat. It’s a confusing ‘stop-start’ feeding behavior that is incredibly frustrating for both baby and parent.

2. Difficulty Sleeping Flat

Does your baby seem to sleep like an angel in your arms or in a carrier, only to wake up screaming the second you lay them flat in their crib? This is a huge red flag for reflux. When a baby is lying flat, gravity isn’t helping to keep the stomach contents down. Acid can wash back up into their throat, causing pain and waking them up. They sleep better upright because gravity is on their side.

CRITICAL SAFETY WARNING: Even if your baby sleeps better at an incline, you must NEVER use sleep positioners, wedges, or let your baby sleep in a swing or car seat. These are not safe for sleep and dramatically increase the risk of SIDS and suffocation. The American Academy of Pediatrics is clear: babies should always be placed on their back on a firm, flat surface for all sleep.

3. Fussiness *Specifically* at the Breast or Bottle

A colicky baby is often fussy regardless of what’s happening. A baby with reflux pain associates eating with hurting. They may start a feed hungry and eager, but after a few minutes, they’ll start to pull off, cry, latch back on, and repeat the cycle. It’s as if they’re mad at the very thing that should be comforting them. This is because swallowing can initially soothe the burn, but then more milk enters the stomach, which can lead to more reflux and more pain.

4. A Hoarse Cry, Chronic Congestion, or Coughing

Have you ever had bad heartburn that left you with a sore throat? Imagine that happening all day. When stomach acid travels far enough up, it can irritate the vocal cords and nasal passages. This is sometimes called ‘silent reflux’ because the baby might not be spitting up much. Instead, the signs are more respiratory. You might notice your baby has a consistently hoarse-sounding cry, seems to have a ‘perma-cold’ with a stuffy nose, or has a persistent dry cough, especially after lying down.

5. Frequent, Painful Hiccups or ‘Wet’ Burps

All newborns get hiccups, but reflux hiccups are different. They can be very frequent, forceful, and seem to cause the baby genuine distress. You may also hear ‘wet burps’—a burp where you can audibly hear liquid gurgling up and then being re-swallowed. It’s the sound of reflux in action. While a normal burp is just air, a wet burp is a clear sign that stomach contents are coming up with it.

Colic vs. Reflux: A Side-by-Side Comparison

Okay, that was a lot of information! It can be hard to keep it all straight, especially when you’re sleep-deprived. Let’s put it all into a simple chart to help you see the patterns more clearly. Remember, it’s possible for a baby to have both colic and reflux, but usually, one is the primary driver of their fussiness.

Use this table as a starting point for your detective work. For a few days, try jotting down notes on your phone: When did the crying start? What did it look like? What happened after a feed? These patterns are golden information for your pediatrician.

Actionable Steps: Soothing Your Baby and Seeking Help

Now for the most important part: what can you actually do? Finding what works for your baby might take some trial and error, but there are many strategies you can try at home. And it’s just as important to know when it’s time to call in the professionals.

Home Care and Soothing Techniques

If you suspect COLIC:

• The 5 S’s: Developed by Dr. Harvey Karp, this method can be a lifesaver. It involves Swaddling, holding baby on their Side or Stomach (only while holding them and they are awake), Shushing loudly, Swinging gently, and offering something to Suck on (like a pacifier).
• Motion: Try a walk in the stroller, a drive in the car, or wearing your baby in a sling or carrier.
• Tummy Time: A warm bath followed by a gentle tummy massage can help relieve gas pressure.
• Probiotics: Some studies have shown that the probiotic strain Lactobacillus reuteri can reduce crying time in colicky babies. Always talk to your doctor before starting any supplement.

If you suspect REFLUX:

• Positioning is Key: Keep your baby fully upright during feedings and for at least 20-30 minutes afterward. Let gravity be your friend!
• Feeding Adjustments: Try offering smaller, more frequent meals. This puts less volume in the stomach at one time. If bottle-feeding, ensure the nipple flow isn’t too fast or too slow, as both can cause them to swallow more air.
• Burp Often: Don’t wait until the end of the feed. Burp your baby after every ounce or two (from a bottle) or when switching breasts.
• Dietary Changes (for Mom): If you are breastfeeding, your pediatrician might suggest an elimination diet. The most common culprit is cow’s milk protein in your diet. You’d need to eliminate all dairy for at least two weeks to see if it makes a difference. Always do this under medical supervision.

When to Call Your Pediatrician

Your intuition as a parent is powerful. If you feel something is wrong, it’s always worth a phone call. Please seek medical advice immediately if your baby experiences any of the following:

• Poor weight gain, or is losing weight.
• Projectile vomiting (shoots forcefully across the room).
• Vomit that is green, yellow, or looks like coffee grounds (which can indicate blood).
• Refusing to eat for multiple feedings.
• Signs of dehydration, like fewer than 6 wet diapers in 24 hours, a sunken soft spot, or no tears when crying.
• Any breathing difficulties, such as wheezing or labored breathing.
• You are feeling overwhelmed, anxious, or depressed. Your mental health is just as important.