Baby colic

This article is about baby colic. For other types of colic, see Colic.
Colic
Other names: Infantile colic
A crying newborn
SpecialtyPediatrics
SymptomsCrying for more than three hours a day, for more than three days a week, for three weeks[1]
ComplicationsFrustration for the parents, depression following delivery, child abuse[1]
Usual onsetSix weeks of age[1]
DurationTypically goes away by six months of age[1]
CausesUnknown[1]
Diagnostic methodBased on symptoms after ruling out other possible causes[1]
Differential diagnosisCorneal abrasion, hair tourniquet, hernia, testicular torsion[2]
TreatmentConservative treatment, extra support for the parents[1][3]
PrognosisNo long term problems[4]
Frequency~25% of babies[1]

Baby colic, also known as infantile colic, is defined as episodes of crying for more than three hours a day, for more than three days a week, for three weeks in an otherwise healthy child.[1] Often crying occurs in the evening.[1] It typically does not result in long-term problems.[4] The crying can result in frustration of the parents, depression following delivery, excess visits to the doctor, and child abuse.[1]

The cause of colic is unknown.[1] Some believe it is due to gastrointestinal discomfort like intestinal cramping.[5] Diagnosis requires ruling out other possible causes.[1] Concerning findings include a fever, poor activity, or a swollen abdomen.[1] Fewer than 5% of infants with excess crying have an underlying organic disease.[1]

Treatment is generally conservative, with little to no role for either medications or alternative therapies.[3] Extra support for the parents may be useful.[1] Tentative evidence supports certain probiotics for the baby and a low-allergen diet by the mother in those who are breastfed.[1] Hydrolyzed formula may be useful in those who are bottlefed.[1]

Colic affects 10–40% of babies.[1] It is most common at six weeks of age and typically goes away by six months of age.[1] It rarely lasts up to one year of age.[6] It occurs at the same rate in boys and in girls.[1] The first detailed medical description of the problem occurred in 1954.[7]

Signs and symptoms

Colic is defined as episodes of crying for more than three hours a day, for more than three days a week for at least a three-week duration in an otherwise healthy child.[8] It is most common around six weeks of age and gets better by six months of age.[8] By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks.[8] With colic, periods of crying most commonly happen in the evening and for no obvious reason.[1] Associated symptoms may include legs pulled up to the stomach, a flushed face, clenched hands, and a wrinkled brow.[8] The cry is often high pitched (piercing).[8]

Effect on the family

An infant with colic may affect family stability and be a cause of short-term anxiety or depression in the father and mother.[8] It may also contribute to exhaustion and stress in the parents.[9]

Persistent infant crying has been associated with severe marital discord, postpartum depression, early termination of breastfeeding, frequent visits to doctors, and a quadrupling of excessive laboratory tests and prescription of medication for acid reflux. Babies with colic may be exposed to abuse, especially shaken baby syndrome.[8]

A 2019 Cochrane review on parent training programs for managing infantile colic found limited evidence for the effectiveness, one analysis showed some reduction in crying time.[10]

Causes

The cause of colic is generally unknown. Fewer than 5% of infants who cry excessively turn out to have an underlying organic disease, such as constipation, gastroesophageal reflux disease, lactose intolerance, anal fissures, subdural hematomas, or infantile migraine.[8] Babies fed cow's milk have been shown to develop antibody responses to the bovine protein, causing colic.[11][12] Studies performed showed conflicting evidence about the role of cow's milk allergy.[8] While previously believed to be related to gas pains, this does not appear to be the case.[8] Another theory holds that colic is related to hyperperistalsis of the digestive tube (increased level of activity of contraction and relaxation). The evidence that the use of anticholinergic agents improve colic symptoms supports this hypothesis.[8]

Psychological and social factors have been proposed as a cause, but there is no evidence. Studies performed do not support the theory that maternal (or paternal) personality or anxiety causes colic, nor that it is a consequence of a difficult temperament of the baby, but families with colicky children may eventually develop anxiety, fatigue and problems with family functioning as a result.[8] There is some evidence that cigarette smoke may increase the risk.[1] It seems unrelated to breast or bottle feeding with rates similar in both groups.[13] Reflux does not appear to be related to colic.[14]

Diagnosis

Colic is diagnosed after other potential causes of crying are excluded.[8] This can typically be done via a history and physical exam, and in most cases tests such as X-rays or blood tests are not needed.[8] Babies who cry may simply be hungry, uncomfortable, or ill.[15] Less than 10% of babies who would meet the definition of colic based on the amount they cry have an identifiable underlying disease.[16]

Cause for concern include: an elevated temperature, a history of breathing problems or a child who is not appropriately gaining weight.[8]

"Red flag" indicating that further investigations may be needed include:[17]

  • Vomiting (vomit that is green or yellow, bloody or occurring more than five times a day)
  • Change in stool (constipation or diarrhea, especially with blood or mucous)
  • Abnormal temperature (a rectal temperature less than 97.0 °F (36.1 °C) or over 100.4 °F (38.0 °C)
  • Irritability (crying all day with few calm periods in between)
  • Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over six hours)
  • Poor weight gain (gaining less than 15 grams a day)

Problems to consider when the above are present include:[17]

  • Infections (e.g. ear infection, urine infection, meningitis, appendicitis)
  • Intestinal pain (e.g. food allergy, acid reflux, constipation, intestinal blockage)
  • Trouble breathing (e.g. from a cold, excessive dust, congenital nasal blockage, oversized tongue)
  • Increased brain pressure (e.g., hematoma, hydrocephalus)
  • Skin pain (e.g. a loose diaper pin, irritated rash, a hair wrapped around a toe)
  • Mouth pain (e.g. yeast infection)
  • Kidney pain (e.g. blockage of the urinary system)
  • Eye pain (e.g. scratched cornea, glaucoma)
  • Overdose (e.g. excessive Vitamin D, excessive sodium)
  • Others (e.g. migraine headache, heart failure, hyperthyroidism)

Persistently fussy babies with poor weight gain, vomiting more than five times a day, or other significant feeding problems should be evaluated for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).[18]

Treatment

Management of colic is generally conservative and involves the reassurance of parents.[8] Calming measures may be used and include soothing motions, limiting stimulation, pacifier use, and carrying the baby around in a carrier,[8] although it is not entirely clear if these actions have any effect beyond placebo.[8][19] Swaddling does not appear to help.[1]

Medication

No medications have been found to be both safe and effective.[8] Simethicone is safe but does not work, while dicyclomine works but is not safe.[8] Evidence does not support the use of cimetropium bromide,[19] and there is little evidence for alternative medications or techniques.[20] While medications to treat reflux are common, there is no evidence that they are useful.[14]

Diet

Dietary changes by infants are generally not needed.[8] In mothers who are breastfeeding, a hypoallergenic diet by the mother—not eating milk and dairy products, eggs, wheat, and nuts—may improve matters,[8][9][21] while elimination of only cow's milk does not seem to produce any improvement.[21] In formula-fed infants, switching to a soy-based or hydrolyzed protein formula may help.[9] Evidence of benefit is greater for hydrolyzed protein formula with the benefit from soy based formula being disputed.[22][23] Both these formulas have greater cost and are not as palatable.[23] Supplementation with fiber has not been shown to have any benefit.[9] A 2018 Cochrane review was unable to recommend any dietary interventions.[24]

Alternative medicine

No clear beneficial effect from spinal manipulation[25][26] or massage has been shown.[8] Further, as there is no evidence of safety for cervical manipulation for baby colic, it is not advised.[27] There is a case of a three-month-old dying following manipulation of the neck area.[27]

Little clinical evidence supports the efficacy of "gripe water" and caution in use is needed, especially in formulations that include alcohol or sugar.[8] Evidence does not support lactase supplementation.[19] The use of probiotics, specifically Lactobacillus reuteri, decreases crying time at three weeks by 46 minutes in breastfeed babies but has unclear effects in those who are formula fed.[28] Fennel also appears effective.[29][30]

Prognosis

Infants who are colicky do just as well as their non colicky peers with respect to temperament at one year of age.[8]

Epidemiology

Colic affects 10–40% of children,[1] occurring at the same rate in boys and in girls.[13]

History

The word "colic" is derived from the ancient Greek word for intestine (sharing the same root as the word "colon").[31]

It has been an age-old practice to drug crying infants. During the second century AD, the Greek physician Galen prescribed opium to calm fussy babies, and during the Middle Ages in Europe, mothers and wet nurses smeared their nipples with opium lotions before each feeding. Alcohol was also commonly given to infants.[32]

In past decades, doctors recommended treating colicky babies with sedative medications (e.g. phenobarbital, Valium, alcohol), analgesics (e.g. opium) or anti-spasm drugs (e.g. scopolamine, Donnatal, dicyclomine), but all of these are no longer recommended because of potential serious side-effects, including death.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Johnson, JD; Cocker, K; Chang, E (1 October 2015). "Infantile Colic: Recognition and Treatment". American Family Physician. 92 (7): 577–82. PMID 26447441. Archived from the original on 26 August 2017. Retrieved 22 July 2017.
  2. ↑ "Colic Differential Diagnoses". emedicine.medscape.com. 3 September 2015. Archived from the original on 5 November 2017. Retrieved 1 June 2017.
  3. 1 2 Biagioli, E; Tarasco, V; Lingua, C; Moja, L; Savino, F (16 September 2016). "Pain-relieving agents for infantile colic". The Cochrane Database of Systematic Reviews. 9: CD009999. doi:10.1002/14651858.CD009999.pub2. PMC 6457752. PMID 27631535.
  4. 1 2 Grimes JA, Domino FJ, Baldor RA, Golding J, eds. (2014). The 5-minute clinical consult premium (23rd ed.). St. Louis: Wolters Kluwer Health. p. 251. ISBN 9781451192155. Archived from the original on 2015-02-25.
  5. ↑ Shamir, Raanan; St James-Roberts, Ian; Di Lorenzo, Carlo; Burns, Alan J.; Thapar, Nikhil; Indrio, Flavia; Riezzo, Giuseppe; Raimondi, Francesco; Di Mauro, Antonio (2013-12-01). "Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms". Journal of Pediatric Gastroenterology and Nutrition. 57 Suppl 1: S1–45. doi:10.1097/MPG.0b013e3182a154ff. ISSN 1536-4801. PMID 24356023.
  6. ↑ Barr, RG (2002). "Changing our understanding of infant colic". Archives of Pediatrics & Adolescent Medicine. 156 (12): 1172–4. doi:10.1001/archpedi.156.12.1172. PMID 12444822.
  7. ↑ Long, Tony (2006). Excessive Crying in Infancy. John Wiley & Sons. p. 5. ISBN 9780470031711. Archived from the original on 2016-10-18.
  8. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Roberts, DM; Ostapchuk, M; O'Brien, JG (Aug 15, 2004). "Infantile colic". American Family Physician (Review). 70 (4): 735–40. PMID 15338787. Archived from the original on 2014-08-28.
  9. 1 2 3 4 Iacovou, M; Ralston, RA; Muir, J; Walker, KZ; Truby, H (August 2012). "Dietary management of infantile colic: a systematic review". Maternal and Child Health Journal. 16 (6): 1319–31. doi:10.1007/s10995-011-0842-5. PMID 21710185. S2CID 8404014.
  10. ↑ Gordon, Morris; Gohil, Jesal; Banks, Shel Sc (3 December 2019). "Parent training programmes for managing infantile colic". The Cochrane Database of Systematic Reviews. 12: CD012459. doi:10.1002/14651858.CD012459.pub2. ISSN 1469-493X. PMC 6890412. PMID 31794639.
  11. ↑ Lucassen, P. L.; Assendelft, W. J.; Gubbels, J. W.; van Eijk, J. T.; van Geldrop, W. J.; Neven, A. K. (1998-05-23). "Effectiveness of treatments for infantile colic: systematic review". BMJ (Clinical Research Ed.). 316 (7144): 1563–1569. doi:10.1136/bmj.316.7144.1563. ISSN 0959-8138. PMC 28556. PMID 9596593.
  12. ↑ Delire, M.; Cambiaso, C. L.; Masson, P. L. (1978-04-13). "Circulating immune complexes in infants fed on cow's milk". Nature. 272 (5654): 632. Bibcode:1978Natur.272..632D. doi:10.1038/272632a0. ISSN 0028-0836. PMID 565472. S2CID 534896.
  13. 1 2 Shergill-Bonner, R (2010). "Infantile colic: practicalities of management, including dietary aspects". The Journal of Family Health Care. 20 (6): 206–9. PMID 21319674.
  14. 1 2 Benninga, MA; Faure, C; Hyman, PE; St James Roberts, I; Schechter, NL; Nurko, S (15 February 2016). "Childhood Functional Gastrointestinal Disorders: Neonate/Toddler". Gastroenterology. 150 (6): 1443–1455.e2. doi:10.1053/j.gastro.2016.02.016. PMID 27144631.
  15. ↑ Barr, RG (1998). "Colic and crying syndromes in infants". Pediatrics. 102 (5 Suppl E): 1282–6. PMID 9794970.
  16. ↑ Hyman, PE; Milla, PJ; Benninga, MA; Davidson, GP; Fleisher, DF; Taminiau, J (April 2006). "Childhood functional gastrointestinal disorders: neonate/toddler". Gastroenterology. 130 (5): 1519–26. doi:10.1053/j.gastro.2005.11.065. PMID 16678565.
  17. 1 2 Karp, Harvey (2003). The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer. New York: Bantam. ISBN 978-0-553-38146-7.
  18. ↑ Heine, Ralf G; Jordan, Brigid; Lubitz, Lionel; Meehan, Michele; Catto-Smith, Anthony G (2006). "Clinical predictors of pathological gastro-oesophageal reflux in infants with persistent distress". Journal of Paediatrics and Child Health. 42 (3): 134–9. doi:10.1111/j.1440-1754.2006.00812.x. PMID 16509914.
  19. 1 2 3 Hall, B; Chesters, J; Robinson, A (February 2012). "Infantile colic: a systematic review of medical and conventional therapies". Journal of Paediatrics and Child Health. 48 (2): 128–37. doi:10.1111/j.1440-1754.2011.02061.x. PMID 21470331.
  20. ↑ Perry, R; Hunt, K; Ernst, E (April 2011). "Nutritional supplements and other complementary medicines for infantile colic: a systematic review". Pediatrics. 127 (4): 720–33. doi:10.1542/peds.2010-2098. PMID 21444591. S2CID 19536242.
  21. 1 2 Nocerino R; Pezzella V; Cosenza L; Amoroso A; Di Scala C; Amato F; et al. (2015). "The controversial role of food allergy in infantile colic: evidence and clinical management". Nutrients (Review). 7 (3): 2015–25. doi:10.3390/nu7032015. PMC 4377897. PMID 25808260.
  22. ↑ Bhatia, J; Greer, F; American Academy of Pediatrics Committee on Nutrition (May 2008). "Use of soy protein-based formulas in infant feeding". Pediatrics. 121 (5): 1062–8. doi:10.1542/peds.2008-0564. PMID 18450914.
  23. 1 2 Savino, F; Tarasco, V (December 2010). "New treatments for infant colic". Current Opinion in Pediatrics. 22 (6): 791–7. doi:10.1097/MOP.0b013e32833fac24. PMID 20859207. S2CID 26003983.
  24. ↑ Gordon, Morris; Biagioli, Elena; Sorrenti, Miriam; Lingua, Carla; Moja, Lorenzo; Banks, Shel Sc; Ceratto, Simone; Savino, Francesco (10 October 2018). "Dietary modifications for infantile colic". The Cochrane Database of Systematic Reviews. 10: CD011029. doi:10.1002/14651858.CD011029.pub2. ISSN 1469-493X. PMC 6394439. PMID 30306546.
  25. ↑ Dobson, D; Lucassen, PL; Miller, JJ; Vlieger, AM; Prescott, P; Lewith, G (Dec 12, 2012). "Manipulative therapies for infantile colic" (PDF). Cochrane Database of Systematic Reviews. 12: CD004796. doi:10.1002/14651858.CD004796.pub2. hdl:2066/108617. PMID 23235617. Archived from the original on August 27, 2021. Retrieved September 24, 2019.
  26. ↑ Aase, K; Blaakær, J (Feb 11, 2013). "Chiropractic care of infants with colic lacks evidence". Ugeskrift for Laeger. 175 (7): 424–8. PMID 23402252.
  27. 1 2 Camilleri M, Park SY, Scarpato E, Staiano A (2017). "Exploring hypotheses and rationale for causes of infantile colic". Neurogastroenterol Motil (Review). 29 (2): e12943. doi:10.1111/nmo.12943. PMC 5276723. PMID 27647578.
  28. ↑ Sung, V; D'Amico, F; Cabana, MD; Chau, K; Koren, G; Savino, F; Szajewska, H; Deshpande, G; Dupont, C; Indrio, F; Mentula, S; Partty, A; Tancredi, D (January 2018). "Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis". Pediatrics. 141 (1): e20171811. doi:10.1542/peds.2017-1811. PMID 29279326.
  29. ↑ Harb, T; Matsuyama, M; David, M; Hill, RJ (May 2016). "Infant Colic-What works: A Systematic Review of Interventions for Breast-fed Infants". Journal of Pediatric Gastroenterology and Nutrition. 62 (5): 668–86. doi:10.1097/MPG.0000000000001075. PMID 26655941. S2CID 26126920.
  30. ↑ Anheyer, D; Frawley, J; Koch, AK; Lauche, R; Langhorst, J; Dobos, G; Cramer, H (June 2017). "Herbal Medicines for Gastrointestinal Disorders in Children and Adolescents: A Systematic Review". Pediatrics. 139 (6): e20170062. doi:10.1542/peds.2017-0062. PMID 28562281.
  31. ↑ Sanghavi, Darshak (Mar 29, 2005). "Bleary parents crave colic cure". Boston Globe. Archived from the original on 2013-11-06.
  32. ↑ Solter, A (1998). Tears and Tantrums: What to Do When Babies and Children Cry. Goleta, CA: Shining Star Press. ISBN 9780961307363.
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