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Rome IV Diagnostic Criteria for Infant Colic

Symptom-based diagnosis of excessive, unexplained crying in a thriving infant.

Rome IV Diagnostic Criteria for Infant Colic
Symptom onset and resolution occur before the infant is 5 months of age
Recurrent and prolonged periods of crying, fussing, or irritability reported by caregivers, occurring without obvious cause and that caregivers cannot prevent or resolve
No evidence of infant failure to thrive, fever, or illness
ResultCriteria not met

Does not meet Rome IV criteria for infant colic; evaluate for an organic cause of crying, including assessment of growth, feeding, and possible illness.

When to use

  • Caregiver-reported excessive, unexplained crying in an infant under 5 months who is otherwise thriving.

Formula

Diagnosis requires all of: onset and cessation before age 5 months; recurrent, prolonged crying/fussing/irritability without obvious cause that caregivers cannot prevent or resolve; no failure to thrive, fever, or illness.

Pearls and pitfalls

  • Rome IV no longer requires a specific crying-duration threshold (e.g., the Wessel 'rule of three'); caregiver-reported distress without an identifiable cause suffices when growth is normal.

References

  1. Benninga MA, Faure C, Hyman PE, et al. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150(6):1443-1455.