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Infantile ColicAka: Colic in Infants

See Also
1. Inconsolable Crying in Infants
Epidemiology
1. Very common (25% of infants)
2. More common in bottle-fed Infants
Etiology
1. Unknown cause
2. Two fold risk associated with maternal smokers
3. Thoroughly studied with inconclusive results
  1. Hyperperistalsis
  2. Cow's Milk Allergy (may account for 10-15% of colic)
  3. Lactose Intolerance
  4. Parent or Infant relationship disturbance
  5. Neurophysiologic response of immature infant
Signs: Colic episode
1. Infant has unpredictable episodes often in evening
  1. Not provoked by environment
  2. Not relieved with soothing or feeding
2. High pitched screaming
3. Facial Flushing
4. Clenched fists
5. Infant pulls legs up to abdomen
Diagnosis: Wessel Criteria (Rule of 3's)
1. Unexplained fussiness or crying
  1. Otherwise healthy infant
  2. Critical that organic causes are ruled out
    1. See Inconsolable Crying in Infants
2. Child under age 3 months
3. Lasts (cumulative) more than 3 hours per day
4. Occurs more than 3 days per week
5. Persists longer than 3 weeks
Differential Diagnosis
1. Normal crying in infants without colic
  1. Overall, Infants cry 2.2 hours/day on average
  2. Crying duration peaks at 6 weeks and then decreases
2. Assess for other etiology of excessive crying
  1. See Inconsolable Crying in Infants
Management
1. Describe condition to parent
2. Explain that cause is unknown
3. Reassurance that colic passes by age of 3-5 months
  1. Greatly improves even if it continues longer
4. Discuss parental coping strategies
5. Have parent call or follow-up in 2 weeks
6. Medications do not help colic
  1. Avoid Dicyclomine (Bentyl) due to risk of apnea
  2. Avoid Phenergan
  3. Avoid Simethicone (no more effective than Placebo)
    1. Metcalf (1994) Pediatrics 94:29
  4. Avoid Tylenol for relief of colic
  5. Avoid herbal tea preparations
    1. May result in malnutrition from less milk intake
  6. Avoid sucrose (reduces crying for only minutes)
  7. Avoid scopolamine (ineffective)
  8. Avoid lactase enzyme (ineffective)
7. Physical stimulation does not appear helpful
  1. No evidence to support car-ride simulators
  2. No evidence to support carrying infant more
  3. No evidence to support decreased infant stimulation
  4. No evidence to support Behavior Modification
8. Changing Formula has variable effect on colic
  1. Most infants are unlikely to benefit from change
  2. Whey hydrolysate formula (e.g. Carnation Good Start)
    1. Appears to reduce crying by 1 hour per day
  3. Study of colicky infants in Denmark
    1. Improved when switched to Soy Formula: 18%
    2. Improved with no change (Control Group): 29%
    3. Improved on Casein Hydrolysate (Nutramigen): 53%
  4. Changing formula is benign option for parent
    1. See also Infant Nutrition Components
    2. Avoid multiple formula changes
    3. Initial option
      1. Consider whey hydrolysate formula
    4. Other options
      1. Consider change to soy formula (e.g. Prosobee)
        
        Soy formula change not recommended by AAP
        
        Garrison (2000) Pediatrics 106:184
      2. Consider change in Linoleic Acid (e.g. Similac)
      3. Consider change in Whey to Casein Protein ratio
      4. Fiber-enrichment does not appear effective
9. Dietary changes in Breast Feeding mothers
  1. Atopic mother
    1. Avoid cow's milk
  2. Non-atopic mother
    1. Avoid milk
    2. Avoid egg
    3. Avoid wheat
    4. Avoid nuts
  3. Efficacy
    1. Low allergan diet may reduce colic in some infants
    2. Hill (2005) Pediatrics 116:709
Course
1. Onset as early as 2 weeks
2. Resolves by 4 months
Reference

Pediatrics Book

Behavioral Disorders

Miscellaneous

Vomiting

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Infantile ColicAka: Colic in Infants

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