“My baby screams inconsolably for hours every evening, pulling his legs up — I’m exhausted and worried something’s wrong”

INFANTILE COLIC is excessive, paroxysmal, often EVENING crying in an otherwise WELL, THRIVING infant — often described by Wessel’s "rule of 3s" (>3 hours/day, >3 days/week, for >3 weeks), a research definition rather than a diagnostic threshold (the Rome IV criteria, international, require no set number of hours) — with drawing up of the legs, typically beginning in the early weeks and resolving by ~3–4 months; it is a clinical diagnosis of EXCLUSION in an otherwise healthy baby. The key task is to EXCLUDE red flags/other causes by history and a full undressed examination face to face (temperature, weight on the chart, skin for bruising): poor feeding or faltering weight, fever/sepsis (NICE NG143: 38 °C or more under 3 months is a red feature needing same-day paediatric assessment; NICE NG254 if sepsis is possible), vomiting (especially bile-stained — obstruction), blood in stool, lethargy/floppiness, a bulging/tense fontanelle, an incarcerated hernia or testicular torsion, a hair-tourniquet (finger/toe/penis), corneal foreign body, cow’s-milk protein allergy (only with other features, NICE CG116) and GORD (no acid suppression for crying or regurgitation alone in an otherwise healthy infant, NICE NG1) — a thriving, well, examined baby with no red flags supports colic. Once red flags are excluded, REASSURE that colic is benign and self-limiting, usually settling by 3–4 months and not the parent’s fault, which directly addresses the fear that "something is seriously wrong". Give practical soothing/feeding advice (holding/rocking, white noise, movement, winding, a calm environment), while noting that evidence for specific treatments (simethicone, lactase drops, probiotics, formula/dietary changes) is limited — avoid routine medications or formula changes unless a specific cause (e.g. CMPA) is suspected and then trial appropriately. Crucially, SUPPORT the exhausted, anxious PARENT: acknowledge the enormous toll, validate distress, ask about parental coping, low mood and anxiety (NICE CG192), mobilise support (partner/family/health visitor), and give the ICON ("Babies cry, you can cope") safety advice that it is okay to place the baby safely down and take a break if overwhelmed and to NEVER shake the baby; any unexplained bruise in a non-mobile baby needs safeguarding action (Working Together to Safeguard Children 2023). The skill is red-flag exclusion + reassurance + parental support, with safety-netting and follow-up.