INFANT COLIC

BACKGROUND

Colic is the term used to describe infants who cry excessively for no apparent reason during the first three months of life.

Colic is one of the most distressing problems of infancy. It is distressing for the infant, the parents, and for the healthcare provider. The cause of colic is not well understood, but it resolves in most infants by three to four months of age.

Colic is defined as “excessive crying”. An infant with colic usually cries for more than three hours per day on more than three days per week.

DISEASE OCCURRENCE IN POPULATION:

Estimates of the prevalence of colic in infants range from 8 to 40 percent. The incidence of colic does not appear to differ among males and females, breast- and formula-fed infants, or full-term and preterm infants.

RISK FACTORS:

Risk factors for infantile colic are poorly understood. The condition does not appear to be related to gender or gestational age at birth and is not a sign of lactose intolerance, though cow's milk proteins may play a role. The following list identifies possible risk factors that have emerged in research studies:

• Parental smoking, which is associated with increased risk
• Stressful home environment, including maternal prenatal anxiety and depression
• Caucasian race
• Feeding practices, which include swallowing of air, excessive feeding, and underfeeding
• First-born birth order

SIGN AND SYMPTOMS:

Fussing and crying are normal for infants, and a fussy baby doesn't necessarily have colic. In an otherwise healthy, well-fed baby, signs of colic include:

• Predictable crying episodes: A baby who has colic often cries about the same time every day, usually in the late afternoon or evening. Colic episodes may last from a few minutes to three hours or more on any given day. Your baby may have a bowel movement or pass gas near the end of the colic episode.
• Intense or inconsolable crying: Colic crying is intense, sounds distressed and is often high pitched. Your baby's face may flush, and he or she is extremely difficult, if not impossible, to comfort.
• Crying that occurs for no apparent reason: It's normal for babies to cry sometimes. But, crying usually means your baby needs something, such as food or a clean diaper. Crying associated with colic occurs with no clear cause.
• Posture changes: Curled up legs, clenched fists and tensed abdominal muscles are common during colic episodes.

DIAGNOSTIC TEST:

A presumptive diagnosis of infantile colic can be made in an otherwise healthy infant <3 months of age who cries for no apparent reason for ≥3 hours per day on ≥3 days per week. Other causes of crying generally are excluded by the history and physical examination.

HOME MONITORING: You can monitor your infant's crying by keeping a written record of the following information. You can share this information with your child's doctor or nurse to help determine the cause of crying as well as the best ways to manage it.

• When does crying occur and how long does it last? Crying that occurs directly after feeding may be caused by gastroesophageal reflux (heartburn) or swallowed air.
• Does the crying begin at the same time every day? Does the infant cry at other times of the day?
• What seems to trigger an episode of crying? What helps to stop crying?
• What do you do when the baby cries? You can hurt your child if you yell, shake, or hit.
• What does the cry sound like? Infants with colic often have a higher pitched, louder, and more intense sounding cry.
• How and what do you feed the baby? Overfeeding, underfeeding, and feeding inappropriate foods can cause colic.
• Is the crying getting better, worse, or is it about the same?
• How do you feel when the baby cries? Living with a colicky infant is hard; some parents feel overwhelmed and incapable of caring for their infant, while others blame the infant for being difficult.
• How has colic affected your family? Colic affects all members of a household, and it is important to consider input from everyone.
• Why do you think the baby cries? Discuss your thoughts and concerns about your infant with your child's doctor or nurse.

TREATMENT OPTIONS:

Colic improves on its own, often by age 3 months. Unfortunately, there are no proven treatments that consistently help every baby. Treatments that have been tried include:

• Dietary and feeding technique changes:
• Bottle-fed infants: A number of devices (nipples, bottles) have been designed to decrease the amount of air swallowed during feeding. You may try positioning your infant in a vertical (sitting up) position while feeding. You may also try a curved bottle or collapsible bag, in combination with frequent burping. These techniques can reduce the amount of air swallowed, which may reduce colic in some infants.
• Breast-fed infants: Mothers who breastfeed may try consuming a hypoallergenic diet to reduce their infant's colic. A hypoallergenic diet eliminates potentially aggravating food groups, including milk, eggs, nuts, and wheat.
• Carrying: Some parents find that carrying their infant in their arms, a sling, or a front carrier can decrease the infant's and parents' anxiety. Although studies have not proven carrying to be effective for all infants, it is worth trying if your infant has not responded to other treatments. Using a sling or front carrier frees your hands and arms and allows you to move around while monitoring your infant.
• Change in environment: There are many other techniques that may help to reduce crying: a pacifier, ride in the car, change of scenery, infant swing, and warm baths have been suggested and may help to soothe an infant with colic.

Swaddling may be soothing. Placing the infant near a white noise machine or clothes drier may soothe an infant who is sensitive to noise.

• Gas-relief medications: Available over-the-counter, gas-relief medications such as simethicone probably won't do much to ease baby's symptoms. These medications are generally considered safe, except for babies who have to take thyroid replacement medications.

Talk to your doctor or nurse before giving your infant any medication.

• Probiotics: Probiotics are microorganisms that have beneficial properties for the host (sometimes called “good bacteria”). Most commercially available probiotics are prepared from food sources like cultured milk (e.g. Lactobacillus).

Some studies suggest that a particular probiotic, Lactobacillus reuteri, may be helpful in children with colic. However, additional studies are needed to confirm these results and to determine whether other probiotics may be more helpful.

Talk to your doctor or nurse BEFORE giving your infant any probiotic. Probiotics may not be appropriate and could be dangerous in some cases.

• Herbal remedies: Herbs such as chamomile, fennel seed, and balm-mint are thought to have anti-spasmodic properties and have been used in infants with colic. Although a few studies have shown improvement in infants given a tea made with a specific mix of herbs, parents should be cautious about trying this type of treatment.

Gripe water is a mixture of herbs and water that has been promoted for its ability to cure colic. However, various types of gripe water have been found to contain dangerous ingredients, including glass particles and alcohol. A homeopathic remedy, colocynthis was also found to contain dangerous ingredients (including alcohol).

Talk to your doctor or nurse BEFORE giving your infant any herbal remedy; herbal remedies may not be appropriate and could be dangerous in some cases.

• Infant massage: Infant massage has been recommended to parents of infants with colic, although no studies have proven it to be of clear benefit

PRECAUTIONS:

One may lessen the frequency of episodes by trying the following:

• Hold your baby upright when feeding to prevent themswallowing air; wind them often, and especially after a feed.
• After feeding your baby, be sure to burp them over your shoulder or on your knee until they release some gas.
• Feed smaller amounts more frequently.
• Ifbreast-feeding avoid too much caffeine in your
• Try to soothe your baby with movement such as vibration (for example by taking a trip out in the car) or with white noise, for example by placing your baby in a seat near a washing machine or vacuum cleaner.
• Avoid over-stimulating a baby
• Hold your child during a crying episode if this helps.
• Give your baby a warm relaxing bath or try to create a peaceful soothing environment.
• Try giving your baby a gently tummy massage.
  

REFERENCES:

• WESSEL MA, COBB JC, JACKSON EB, et al. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics 1954; 14:421.
• Lehtonen L, Korvenranta H. Infantile colic. Seasonal incidence and crying profiles. Arch Pediatr Adolesc Med 1995; 149:533.
• Wake M, Morton-Allen E, Poulakis Z, et al. Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study. Pediatrics 2006; 117:836.
• Parker S, Magee T. Colic. In: The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed, Augustyn M, Zuckerman B, Caronna EB (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.182.
• Clifford TJ, Campbell MK, Speechley KN, Gorodzinsky F. Infant colic: empirical evidence of the absence of an association with source of early infant nutrition. Arch Pediatr Adolesc Med 2002; 156:1123.
• Reijneveld SA, Brugman E, Hirasing RA. Excessive infant crying: the impact of varying definitions. Pediatrics 2001; 108:893.
• mayoclinic.org/diseases­conditions/colic/basics/symptoms/con­20019091
• uptodate.com