Baby colic

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Colic
Classification and external resources
Crying newborn.jpg
Crying newborn
ICD-10R10.4
ICD-9789.7
MedlinePlus000978
eMedicineped/434
MeSHD003085
 
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Colic
Classification and external resources
Crying newborn.jpg
Crying newborn
ICD-10R10.4
ICD-9789.7
MedlinePlus000978
eMedicineped/434
MeSHD003085

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 between the ages of two weeks and four months.[1] The cause of the colic is generally unknown.[2] Less than 5% of infants with excess crying have an underlying organic disease.[2]

Crying associated with a baby's colic can cause relationship stress, breastfeeding failure, postpartum depression, excess visits to the doctor, and child abuse, such as shaken baby syndrome.[3]

It is present in between 5 and 25% of infants. Treatment is generally conservative with little to no role for medications, either conventional or alternative. It often disappears when the baby is three to four months old, but can last up to one year.[4] There are no long term problems associated with the condition.

Signs and symptoms[edit]

Colic is defined as episodes of crying for more than three hours a day, for more than three days a week for a three week duration in an otherwise healthy child between the ages of two weeks and four months.[1] By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks.[2] 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.[2] The cry is often high pitched (piercing).[2]

Effect on the family[edit]

An infant with colic may affect family stability and be a cause of short-term anxiety or depression in the mother.[2] It may also contribute to exhaustion and stress in the parents.[5]

Persistent infant crying has been associated with severe marital discord, postpartum depression, early termination of breastfeeding, frequent visits to doctors, maternal smoking and over a quadrupling of excessive laboratory tests and prescription of medication for acid reflux.[citation needed] Babies with colic may be exposed to abuse, especially shaken baby syndrome.[2]

Causes[edit]

The cause of colic is generally unknown. Less than 5% of infants who cry excessively turn out to have an underlying organic disease, such as constipation, gastroesophageal reflux disease, lactose intolerance, cows' milk allergy, anal fissures, subdural hematomas, or infantile migraine.[2] While previously believed to be related to intestinal causes, this does not appear to be the case.[2] Psychological and social factors also appear to play little role.[2] 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.[6]

Birth complications may have a direct impact on the infant. Researchers have found correlations between childbirth complications and amount of infant crying. More stressful deliveries were linked to more crying.[7]

Most babies have mild acid reflux,[8] often referred to as "spitting up." Several studies indicate that gastroesophageal reflux rarely causes infant crying.[citation needed] Even crying during feeding and crying accompanied by writhing and back arching is rarely related to acid reflux, unless the baby also has poor weight gain (less than 15 g/day), vomiting more than 5 times per day, or other significant feeding problems.[citation needed]

Diagnosis[edit]

Colic is diagnosed after other potential causes of crying are excluded.[2] 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.[2] Babies who cry may simply be hungry, uncomfortable or ill.[9]

Cause for concern include: an elevated temperature, a history of breathing problems or a child who is not appropriately gaining weight.[2]

"Red flag" indicating that further investigations may be needed include:[10]

Problems to consider when the above are present include:[10]

Persistently fussy babies with poor weight gain, vomiting more than 5 times a day, or other significant feeding problems should be evaluated for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).[11]

Treatment[edit]

Management of colic is generally conservative and involves the reassurance of parents.[2] Calming measures may be used and include: swaddling with the legs flexed, holding the baby on their side or stomach, swinging the baby once gently back and forth while supporting the head, making a shushing sound, and breast feeding or the use of a pacifier.[1] Eye contact, talking, and holding an infant are also reasonable measures,[1] though is not entirely clear if these actions have any effect beyond placebo.[2][12] No medications have been found to be both safe and effective.[1] Simethicone is safe but does not appear to work, while dicyclomine works but is not safe.[2] Evidence does not support the use of cimetropium bromide,[12] and there is little evidence for alternative medications or techniques.[13]

Diet[edit]

Dietary changes by infants are generally not needed.[2] In mothers who are breastfeeding, a hypoallergenic diet by the mother — not eating milk products, eggs, wheat, or nuts — may improve matters.[2][5] If symptoms are due to a cow milk allergy switching to a soy-based or hydrolyzed protein formula may help.[5] Evidence of benefit is greater for hydrolyzed protein formula with the benefit from soy based formula being disputed.[14][15] Additionally both these formulas have greater cost and are not as palatable.[15] Supplementation with fiber has no benefit.[5]

Alternative medicine[edit]

No clear beneficial effect from spinal manipulation[16][17] or massage has been shown.[2] Various kinds of gripe water (a home remedy based on sweet-tasting concoctions of herbs, sometimes with alcohol) have been claimed to improve symptoms, but there are potential safety issues with their use.[2] Evidence does not support lactase,[12] or probiotics.[18]

Prognosis[edit]

Infants who are colicky do just as well as their non colicky peers with respect to temperament at one year of age.[2]

Epidemiology[edit]

Colic affects 5 to 25% of children,[2] occurring at the same rate in boys and in girls.[6]

History[edit]

The word "colic" is derived from the ancient Greek word for intestine (sharing the same root as the word "colon").[19]

It has been an age-old practice to drug crying infants. During the second century BC, 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.[20]

In past decades, doctors recommended treating colicky babies with sedative medications (e.g. phenobarbital, Valium, ethanol), 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.[citation needed]

References[edit]

  1. ^ a b c d e f g Kheir, AE (Jul 23, 2012). "Infantile colic, facts and fiction.". Italian journal of pediatrics 38: 34. doi:10.1186/1824-7288-38-34. PMID 22823993. 
  2. ^ a b c d e f g h i j k l m n o p q r s t u v Roberts, DM; Ostapchuk, M; O'Brien, JG (Aug 15, 2004). "Infantile colic.". American family physician 70 (4): 735–40. PMID 15338787. 
  3. ^ Catherine, Nicole L.A.; Ko, Jenny J.; Barr, Ronald G. (2008). "Getting the Word Out: Advice on Crying and Colic in Popular Parenting Magazines". Journal of Developmental & Behavioral Pediatrics 29 (6): 508–11. doi:10.1097/DBP.0b013e31818d0c0c. PMID 19034044. 
  4. ^ 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. 
  5. ^ a b c d 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. 
  6. ^ a b Shergill-Bonner, R (2010). "Infantile colic: practicalities of management, including dietary aspects.". The journal of family health care 20 (6): 206–9. PMID 21319674. 
  7. ^ de Weerth, C; Buitelaar, JK (2007). "Childbirth complications affect young infants’ behavior". European Child and Adolescent Psychiatry 16 (6): 379–388. doi:10.1007/s00787-007-0610-7. PMID 17401610. 
  8. ^ Liu, XL; Wong, KK (October 2012). "Gastroesophageal reflux disease in children" (PDF). Hong Kong Medical Journal 18 (5): 421–8. PMID 23018071. Retrieved 29 June 2013. 
  9. ^ Barr, RG (1998). "Colic and crying syndromes in infants". Pediatrics 102 (5 Suppl E): 1282–6. PMID 9794970. 
  10. ^ a b 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. [page needed]
  11. ^ 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. 
  12. ^ a b c 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. 
  13. ^ 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. 
  14. ^ 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. 
  15. ^ a b 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. 
  16. ^ Dobson, D; Lucassen, PL; Miller, JJ; Vlieger, AM; Prescott, P; Lewith, G (Dec 12, 2012). "Manipulative therapies for infantile colic.". Cochrane Database of Systematic Reviews 12: CD004796. doi:10.1002/14651858.CD004796.pub2. PMID 23235617. 
  17. ^ Aase, K; Blaakær, J (Feb 11, 2013). "[Chiropractic care of infants with colic lacks evidence].". Ugeskrift for laeger 175 (7): 424–8. PMID 23402252. 
  18. ^ Mugambi, MN; Musekiwa, A; Lombard, M; Young, T; Blaauw, R (Oct 4, 2012). "Synbiotics, probiotics or prebiotics in infant formula for full term infants: a systematic review.". Nutrition journal 11: 81. doi:10.1186/1475-2891-11-81. PMID 23035863. 
  19. ^ Sanghavi, Darshak (Mar 29, 2005). "Bleary parents crave colic cure". Boston Globe. 
  20. ^ Solter, A (1998). Tears and Tantrums: What to Do When Babies and Children Cry. Goleta, CA: Shining Star Press. ISBN 9780961307363. 

External links[edit]