Infantile Colic

Introduction

Infantile colic is a benign, self-limited process in which a healthy infant has paroxysms of inconsolable crying. The standard diagnostic criteria - known as the "rule of three" (or Wessel Criteria) is crying more than 3 hours per day, more than 3 days per week, for longer than 3 weeks.

  • Symptoms typically resolve by 3 to 6 months of age.

NOTE: There is some evidence that a woman who smokes is more likely to have a baby with colic.



Symptoms

Colic symptoms may occur in up to 20% of infants. It usually starts between ages 2 and 6 weeks and occurs during the late afternoon or early evening at about the same time each day.

The primary manifestation is recurrent crying episodes where the infant is very difficult to console, with fussiness, and/or irritability.

Other symptoms may include

  • Drawing arms and legs toward body,
  • Turning red with crying,
  • Burping and excessive flatus,
  • Difficulty with passing stools,
  • Tight fists, kicking, and arching of the back.
The infant is normal between episodes and there are no significant findings on physical examination.



    Management

    Because colic is benign, the mainstay of treatment is parenteral support and reassurance.

    • Advise parents to assess for and remedy common causes of crying such as infant discomfort, hunger or extremes of temperature.
    • Reassure that colic is not their fault, is not harmful to the infant, and is common.
    • Their infant will likely grow out of it by age 3-6 months.
    General comfort measures, including reduced infant stimulation while crying
    • Using a pacifier
    • Providing a warm bath
    • Rubbing the infant's abdomen
    • Reducing loud music
    • Using dimmed lighting
    • Preventing exposure to strong smell such as cologne or perfume or cooking
    • Encouraging gentle rocking instead of bouncing or jiggling the infant
    Changes in feeding technique
    • If breastfeeding, ensuring good breast attachment.
    • If bottle feeding, minimizing air intake by
      • Avoiding over shaking bottle when reconstituting
      • Keeping nipple filled with formula
      • Altering nipple size and opening to avoid excessive air swallowing
      • Considering use of anticolic bottles (with air vent/collapsible bag)
    • Burping infant 1-2 times during feed and once post feed using straight back position.
    • Avoiding overfeeding.

    Further interventions that can be considered for families with infants unresponsive to general measures, or for parents or caregivers who feel unable to cope include

    Although simethicone drops area readily available and often used to treat colic, a systematic review reported worsening symptoms or no improvement in 5 studies comparing simethicone to placebo or other treatments in 2858 infants with colic.

    • Simethicone is generally considered to be safe, but it may interact with levothyroxine in infants being treated for congenital hypothyroidism resulting in undertreatment.



    Complementary and Alternative Therapies

    Complementary and alternative therapies are generally not recommended due to a lack of efficacy, limited or conflicting evidence for benefit, or potential adverse effects.

    • Gripe water (may contain dill seed oil, bicarbonates, sugar and herbal extracts).
    • Herbal supplements, such as balm mint, chamomile and fennel.
    • Spinal manipulation, infant massage and acupuncture.



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