Exclusive breastfeeding and infant colic: a systematic review and meta-analysis.

BACKGROUND

The benefits of exclusive breastfeeding for infant health outcomes have been widely reported; however, its association with infant colic remains unclear. This systematic review and meta-analysis aimed to examine whether exclusive breastfeeding is associated with lower odds of infant colic.

METHODS

We searched MEDLINE via OVID, EMB Reviews, Embase, MIDIRS, and Global Health for relevant publications up to March 8, 2026. We included observational studies reporting infant colic among exclusively breastfed infants compared with infants receiving other types of feeding (mixed feeding, formula feeding, or non-exclusive breastfeeding) in children under 12 months of age. Two authors independently screened studies using Covidence, assessed risk of bias, and extracted data using Excel. Overall pooled estimates were obtained using multilevel random-effects meta-analysis, and subgroup analyses were conducted using multilevel meta-regression models, with additional stratified random-effects models for comparator-specific estimates.

RESULTS

Of 13,349 articles identified, 15 studies involving 216,314 infants were included in the meta-analysis. Exclusively breastfed infants had 19% lower odds of colic than non-exclusively breastfed infants (pooled OR = 0.81, 95% CI: 0.67-0.97, p = 0.021). Substantial heterogeneity was observed across studies (I² = 92.6%). Additional analyses suggested that the pooled estimate was robust and unlikely to be substantially affected by publication bias or small-study effects. In subgroup analyses, exclusive breastfeeding was associated with a significantly lower likelihood of infant colic relative to mixed feeding (OR = 0.72, 95% CI: 0.57-0.93; p = 0.01). However, the association was weaker and not statistically significant when exclusive breastfeeding was compared with formula feeding (OR = 0.92, 95% CI: 0.71-1.17; p = 0.470).

CONCLUSIONS

Exclusive breastfeeding was associated with lower odds of infant colic. Further high-quality studies are needed to address limitations in the existing evidence and to better understand the mechanisms underlying this association.

CLINICAL TRIAL NUMBER: PROSPERO 2025 CRD420251051099. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251051099.