For the hard, gassy, very loud weeks
The Gas & Colic Guide
Less guessing. A calmer feed. One thing at a time.
Your baby is crying. You have tried six different burps. The internet has suggested a new bottle and possibly the moon. Before you buy anything else: let's work through this one step at a time. Start with the simple things, know what is worth trying, and know when to call someone.
First, a safety check
Life-threatening emergency → call 112
- Severe breathing difficulty, blue or grey colouring, or your baby is unresponsive.
Call the huisarts or huisartsen-spoedpost directly
- Baby under 3 months + rectal temperature of 38.0°C or higher.
- Green (bilious) vomit or repeated forceful/projectile vomiting.
Last updated: 13 October 2026
First: you are probably not doing this wrong
A baby crying after feeds can make every bottle feel like a test you are somehow failing. Usually, it isn't. Young digestive systems are noisy, immature and surprisingly dramatic. The goal is not a perfectly silent baby. It is a calmer feed, safe comfort and a clear line for medical help.
Crying often increases from about two weeks, peaks around six to eight weeks and eases by three to four months. That pattern is useful context, not a reason to dismiss a baby who seems unwell. This guide is mainly for the first four months; your huisarts or consultatiebureau can help put your own baby's pattern in context.
01 · Watch the baby, not the bottle
Most practical gas fixes start with the feed. Bottle labels are not a reliable measure of flow. The number on the bottle is information. Your baby is better information.
Gulping, coughing or leaking?
The flow may be too fast, or baby may need a pause. Check the teat and feeding position. Repeated coughing or choking deserves a feeding assessment, rather than another bottle experiment.
Every feed is an exhausting project?
Very long feeds, a collapsing teat or obvious frustration mean the setup may need checking. Look for blocked vents and ask your care team to watch a feed if it keeps happening.
Pause when baby asks
Follow breathing, swallowing and pauses. There is no magic number of sucks to count. Offer a break when baby looks overwhelmed, slows down or turns away.
Do not push the last millilitres
Turning away, relaxed hands or pushing the teat away can mean baby is finished. Offer calmly; don't keep putting the teat back to reach the printed number.
A calmer bottle, in practice
- Support baby's head and neck in a comfortable semi-upright position; never prop the bottle.
- Keep the bottle closer to horizontal while keeping milk in the teat. Let baby set the pace.
- Use a flow that allows comfortable feeding. Faster is not automatically better.
- Twins? Same birthday, different stomachs. Don't make them finish matching amounts.
The Teddy rule: one change at a time
Change one thing. Watch the pattern. Then decide what comes next. Formula + bottle + teat + three drops in the same weekend gives your experiment far too many suspects. This rule is for a baby who is otherwise well; warning signs always come first.
About the famous burping marathon
Gentle burping is fine if it clearly helps. You do not need to spend half an hour trying to manufacture a burp that isn't coming. Burping and comfortable upright holding are different things. If baby is more comfortable upright after a feed, especially with reflux or spit-up, keep the cuddle while you are both awake. VeiligheidNL advises upright holding for the first half-hour after feeding for reflux. When sleep starts, use a flat, firm, clear cot or bassinet and put baby on their back. No wedges or inclined sleepers.
02 · A gentle reset, not another treatment
Several studies suggest gentle infant massage may reduce crying, although the research is limited and not all studies are strong. It is gentle, free and easy to stop if baby doesn't enjoy it. Try between feeds, not straight after one. Stop if baby becomes more distressed.
Warm hands, quiet room
Choose a moment when baby is awake and reasonably settled. Reduce noise and bright lights. Watch their face and body; comfort is the test.
Slow clockwise circles
Use light, slow circles on the tummy. No deep pressure. Stop if baby pulls away, stiffens or cries more.
Bicycle legs, gently
Move the legs slowly, then gently bring the knees towards the tummy. Stay within the movement baby allows; never force it.
Walk, hold, breathe
A slow walk and supported cuddle may help settling. If using a carrier, keep the face visible, nose and mouth clear, and chin off the chest. The safest sleep place is baby's own flat bed, on their back.
If you need a minute, take a safe minute
If you feel yourself becoming overwhelmed, put baby on their back in their safe, clear cot and step away briefly to steady yourself. Ask another adult to take over if possible. Never shake a baby. If you are afraid you might hurt your baby, seek help immediately. You can tell the huisarts or consultatiebureau that the crying is becoming too much for you too.
03 · Lactase is a clue, not a diagnosis
“It helped, but not fully” is useful information. It does not prove the cause. Primary lactose intolerance is unusual in young infants. Temporary lactase problems can occur, for example after a tummy illness or in some babies born very early. Gas and crying alone cannot tell you which explanation fits.
Evidence for lactase drops in infant colic is mixed. If your care team agrees on a trial, follow that product's directions and normal hygienic milk preparation. Do not invent extra doses, leave prepared milk waiting longer, or add several remedies at once.
04 · Milk protein and milk sugar are different things
Cow's-milk protein allergy (CMPA) is often overdiagnosed. Colic alone is a poor clue. The question becomes more useful when symptoms cluster — for example eczema, persistent vomiting, feeding refusal, blood or mucus in poo, poor growth or other allergic symptoms. Even a cluster needs clinical assessment; it is not a home diagnosis.
Lactose = milk sugar
- Lactase is the enzyme that breaks down lactose.
- Lactose intolerance is a digestion problem.
- Lactase does not remove milk protein.
CMPA = milk protein
- An allergy involves the immune system.
- Lactose-free cow's milk can still contain the relevant proteins.
- Different problem, different clinical plan.
There is no useful home test for delayed/non-IgE CMPA. Commercial IgG “intolerance” panels do not diagnose it.
The allergy pathway needs a beginning and an end
A clinician checks the whole picture
Bring feeding notes, crying and stool patterns, skin changes, growth concerns and everything already tried. The huisarts can assess illness and arrange referral; the consultatiebureau can support feeding and growth monitoring.
A short, supervised elimination
If appropriate, the clinician defines a diagnostic trial, commonly two to four weeks. Formula-fed babies may need an extensively hydrolysed formula; breastfeeding families need individual advice. Do not switch every unsettled baby to specialist formula. A practical bit before you buy a whole tin: in the Netherlands, formula for suspected milk-protein allergy is generally not reimbursed during the elimination-and-reintroduction trial. Ask your clinician and insurer what is covered. These formulas taste and smell different. Younger babies often accept the change; if your baby struggles, ask your clinician or dietitian about introducing it over a few days.
Review, then a planned re-challenge
Improvement alone does not confirm CMPA. Reintroduction helps confirm whether milk protein really caused the symptoms. Your clinician decides when, where and how; do not try this at home after an immediate or severe reaction.
Do not improvise an allergy switch
Goat or sheep milk is not a safe substitute for CMPA. Do not introduce soy formula to a young baby without clinical guidance. Repeated formula switches or an indefinite dairy-free diet without review can obscure the cause and affect nutrition.
05 · The baby aisle sells a lot of hope in tiny bottles
Here is where we'd spend our energy. Don't stack five products at once. If trying something with your clinician, change one variable and agree when to review it.
Worth trying safely
- Calmer feeds: position, teat flow, pauses and following fullness cues.
- Gentle comfort: massage between feeds if baby enjoys it, carrying and a slow walk.
- A careful discussion: lactase or a specific probiotic may be worth discussing for your baby's situation. Probiotic evidence depends on the strain and feeding group; it is not a recommendation for every baby.
Pause before you buy
- Simethicone / gas drops: have not consistently beaten placebo for infant colic.
- Comfort formulas: limited evidence; they are not a treatment for suspected CMPA.
- Acid suppressants: not a treatment for crying alone. Medicines need an appropriate diagnosis and clinician advice.
Skip for babies
- Gripe water and herbal teas: unreliable evidence; can displace milk and carry dosing or contamination risks.
- Star anise and essential oils: do not give them to babies. No honey before age one.
- Manipulation: skip chiropractic or spinal/neck manipulation for colic; no forceful tummy work.
For the evidence nerds (or your pharmacist)
What about using lactase and simethicone together?
One 2024 retrospective observational study reported a lower response to lactase when simethicone was also used. That is interesting, but it does not establish a universal rule or prove a drug interaction. If combining products, mention them to your clinician or pharmacist. This single study is not a reason to reorganise treatment by yourself.
06 · When gas is not just gas
If your baby seems unwell, call. Do not wait for a remedy to work or for two days of diary notes.
Life-threatening emergency → call 112
- Severe breathing difficulty, blue or grey colouring, or your baby is unresponsive.
- Sudden swelling of the mouth or tongue with breathing difficulty or collapse.
Call the huisarts or huisartsen-spoedpost directly
- Baby under 3 months + rectal temperature of 38.0°C or higher.
- Green (bilious) vomit or repeated forceful/projectile vomiting.
- Very sleepy, floppy or hard to wake; new breathing difficulty.
- A markedly swollen or hard tummy, or bouts of severe pain with blood or mucus in the poo.
- Drinking much less than usual, markedly fewer wet nappies, or signs of dehydration such as a dry mouth and increasing sleepiness.
- New wheezing, widespread hives or facial swelling around a feed. If breathing is severely affected, call 112.
Ask the huisarts for a prompt assessment
- Blood in the poo: contact the huisarts today, even if baby otherwise seems well. With severe pain or illness, call directly.
- Persistent vomiting or feeding refusal, poor weight gain, or eczema/mucus in poo alongside ongoing feeding problems.
- Crying that is severe, changing, or continues beyond the usual early-months pattern. You can ask for help before that point too.
Before bottle number six, collect two days of clues
A simple record can tell your care team more than another product. Copy it into your phone notes, download a blank text template, or print the two-day worksheet. Keep one record per baby.
Only collect notes while baby is otherwise well. If you see a warning sign or are worried, call now — the diary can wait.
Day 1 — date: __________
- Feeds
- time; breast/bottle; note each feed
- Amount
- amount taken, if known — no need to measure breastfeeds
- How the feed went
- calm, gulping, coughing, leaking, refusing
- Crying
- when; how long; relation to feeds
- Spit-up / vomiting
- small spit-up or vomiting; colour; force
- Poo
- frequency; consistency; anything unusual
- Wet nappies
- number; any change from baby's usual pattern
- Skin
- eczema, rash or changes around feeds
- Sleep
- sleep periods; settling; unusual sleepiness
- What helped
- comfort; one change tried; what happened
Day 2 — date: __________
- Feeds
- time; breast/bottle; note each feed
- Amount
- amount taken, if known — no need to measure breastfeeds
- How the feed went
- calm, gulping, coughing, leaking, refusing
- Crying
- when; how long; relation to feeds
- Spit-up / vomiting
- small spit-up or vomiting; colour; force
- Poo
- frequency; consistency; anything unusual
- Wet nappies
- number; any change from baby's usual pattern
- Skin
- eczema, rash or changes around feeds
- Sleep
- sleep periods; settling; unusual sleepiness
- What helped
- comfort; one change tried; what happened
Note each feed and anything unusual. Add lines on paper or in your own notes. Twins? Same birthday. Separate diary.
You do not have to troubleshoot this alone
Consultatiebureau / JGZ
Feeding and growth supportFor a baby who is otherwise well: ask someone to watch a feed, discuss weight and crying, and help you make one sensible change. Bring your diary. The consultatiebureau is not the urgent-care service.
Huisarts / huisartsen-spoedpost
Illness or warning signsCall your huisarts in opening hours, or the huisartsen-spoedpost (huisartsenpost) outside them. Explain baby's age, symptoms and feeding. Do not wait until morning for an urgent warning sign.
112
Life-threatening emergencyFor severe breathing difficulty, blue/grey colouring, unresponsiveness or another life-threatening emergency, call 112.
Sources & evidence — open the engine room
Source-checked on 13 October 2026. We keep claims cautious: colic studies often measure crying, not proven gas pain. Dutch guidance informs care pathways and safe sleep; systematic reviews and European guidance inform treatment claims. The simethicone/lactase observation is kept separate from stronger guidance.
- Thuisarts — fever and when to call (Dutch)
- VeiligheidNL — safe sleep, reflux and upright holding (Dutch)
- Voedingscentrum — responsive bottle feeding (Dutch)
- ESPGHAN position paper — cow's-milk allergy, diagnosis and re-challenge (2024)
- Cochrane — pain-relieving agents for infant colic, including simethicone
- Lactase supplementation for infant colic — systematic review of randomised trials (2024)
- Infant massage — systematic review; limited colic evidence (2022)
- Lactase and simethicone — retrospective observational study (2024)
- NHS — colic and support for parents
- University Hospitals Sussex — crying patterns and colic
- Dutch insurers (ZN) — formula reimbursement during allergy trials
- NHS Kingston and Richmond — milk allergy formula and taste transitions
The questions that arrive at 03:00
Why is my baby so gassy after a bottle?
Fast flow, swallowed air and feeding pressure can contribute, but gas does not prove the cause of crying. Check position, teat flow and baby's cues first. If feeds remain difficult, ask someone to observe one. A baby who seems unwell needs medical assessment.
Do I need to burp my baby for 30 minutes?
No need to keep trying to force a burp. Gentle burping is reasonable if it helps. Comfortable upright holding is different: for reflux, VeiligheidNL advises holding baby upright for the first half-hour after a feed while awake. For sleep, use a flat safe bed, on the back, without wedges.
Does lactase help infant colic?
Research is mixed. A carefully agreed trial may help some babies, but improvement does not establish lactose as the cause and partial improvement does not diagnose CMPA. Follow the product instructions and discuss a review date with your care team.
What is the difference between lactose intolerance and CMPA?
Lactose is milk sugar; lactase helps digest it. CMPA is an immune reaction to milk protein. Lactose-free cow's milk may still contain those proteins. They need different assessment and management.
When should I call a doctor for baby gas?
Call the huisarts or huisartsen-spoedpost directly for a baby under 3 months with a rectal temperature of 38.0°C or higher, green vomit, repeated projectile vomiting, unusual sleepiness, a hard swollen tummy or dehydration concerns. Blood in poo deserves contact today. For a life-threatening emergency, call 112.
Can I use gripe water or herbal tea?
We would skip them for babies. Evidence is unreliable, they can displace milk, and ingredients or dosing may create risks. Do not give star anise, essential oils or honey under age one. Ask about any product before using it.
When does infant colic usually improve?
Crying commonly peaks around six to eight weeks and usually eases by three to four months. The timeline is not a diagnosis. Ask for help if crying is severe, changes, affects feeding or growth, or persists beyond that period.
A little more company for the next chapter
A guide beside you, not a diagnosis
Educational information for parents, not individual medical advice. Your own care team knows your baby and should guide diagnosis, products and diet changes. Sources and local processes can change. Seek help whenever your baby seems unwell or you are worried.