PEDBASE.org - The Pediatric Database - Detailed information of COLIC

COLIC

DEFINITION:

A self-limiting disorder characterized by intermittent unexplained excessive crying for 3 or more hours per day for at least 4 days per week in a thriving child.

EPIDEMIOLOGY:

incidence: 15-20% of infants
age of onset:
- first month of life
risk factors:
- ?

PATHOGENESIS:

1. Background

1. Early Patterns of Crying

gradual increase with a peak at 6 weeks of age (median time of crying/day = 2 ¾ hours)
gradual decline until 4 months of age

2. Role of Crying

a reflex to promote mother-infant proximity and to provide an opportunity for social interaction

2. Etiology (3 Theories)

1. Interactional Model

failed attempt of infant to communicate with parents

2. Neural Model

immature central nervous system

3. Gut Dismotility Model

1. Motilin

increased levels of the gut hormone motilin -> increased intestinal peristalsis -> colic

2. Lactose Intolerance

lactose intolerance -> osmotic action of unabsorbed lactose -> increased intestinal peristalsis -> colic

3. Protein Intolerance

proteins in cows milk (82% casein, 18% whey) and soya formulas -> protein intolerance -> colic

3. Types of Colic

1. Consolable

2. Inconsolable

CLINICAL FEATURES:

1. Colic

onset within the first month of life with spontaneous resolution by 4 months of age
crying in late afternoon into early evening for greater than 3 hours for 3 or more days per week
episodes may last from 30 minutes to 2 hours
episodes characterized by intense crying with knees brought up to abdomen and flatus expelled

INVESTIGATIONS:

all normal

MANAGEMENT:

1. Parental

initially log the crying spells over a one week period (in order to define colic)
keep a running diary in order to record the response to therapy and to note when improvement begins
reassurance
- colic is a self-limiting disorder and will stop by 4 months of age (if the crying persists then consider another diag-nosis)
- no long term sequelae of colic
- parents are not responsible for the infants crying
- by definition, the infant is healthy and thriving
- demystify myths on colic
relief
- ensure parents have relief from the infant during unbearable periods ("Colic Hot Line")

2. Infant

1. Consolable Colic

1. Behavioural Approach

feed, provide pacifier, hold, stimulate, and put down to sleep
if crying continues for more than 5 minutes with any one response try the next response, if all 5 responses fail try again or try combinations of the responses i.e., feed and carry
other behaviours which may be tried:
- rhythmic sounds or motions - rock

2. Inconsolable Colic

1. Formula-Fed Infants

change formula to a casein hydrolysate (Nutramigen)

2. Breast-Fed Infants

eliminate all dairy products from mother's diet

3. Medications

no role in the management of colic
1. Simethicone (Mylicon, Phazyme)
- no more effective than placebo in treating colic
2. Dicyclomine HCl (Bentyl)
- associated with apnea and seizures

INTERNET LINKS:

Infant Colic Resources on the Net

Pediatric Database - COLIC

Pediatric Organization - Pedbase [at] Gmail.com