Baby colic

Last updated
Colic
Other namesInfantile colic
Human-Male-White-Newborn-Baby-Crying.jpg
A crying newborn
Specialty Pediatrics
Symptoms Crying for more than three hours a day, for more than three days a week, for three weeks [1]
Complications Frustration 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 method Based on symptoms after ruling out other possible causes [1]
Differential diagnosis Corneal abrasion, hair tourniquet, hernia, testicular torsion [2]
Treatment Conservative treatment, extra support for the parents [1] [3]
Prognosis No 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]

Contents

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] Equally common in bottle and breast-fed infants, it begins during the second week of life, peaks at 6 weeks, and resolves between 12 and 16 weeks. [6] It rarely lasts up to one year of age. [7] It occurs at the same rate in boys and in girls. [1] The first detailed medical description of the problem was published in 1954. [8]

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. [9] It is most common around six weeks of age and gets better by six months of age. [9] By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks. [9] 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. [9] The cry is often high pitched (piercing). [9]

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. [9] It may also contribute to exhaustion and stress in the parents. [10]

Persistent infant crying has been associated with severe marital discord, postpartum depression, early termination of breastfeeding, frequent visits to doctors, a quadrupling of laboratory tests, and prescription of medication for acid reflux.[ citation needed ] Babies with colic may be exposed to abuse, especially shaken baby syndrome. [9]

Parent training programs for managing infantile colic may result in a reduction in crying time. [11]

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. [9] Babies fed cow's milk have been shown to develop antibody responses to the bovine protein, and some studies have shown an association between consumption of cow's milk and infant colic. [12] [13] Studies performed showed conflicting evidence about the role of cow's milk allergy. [9] While previously believed to be related to gas pains, this does not appear to be the case. [9] 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. [9]

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. [9] 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. [14] Reflux does not appear to be related to colic. [15]

Diagnosis

Colic is diagnosed after other potential causes of crying are excluded. [9] 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. [9] Babies who cry may simply be hungry, uncomfortable, or ill. [16] Less than 10% of babies who would meet the definition of colic based on the amount they cry have an identifiable underlying disease. [17]

Cause for concern include: an elevated temperature, a history of breathing problems or a child who is not appropriately gaining weight. [9]

Indications that further investigations may be needed include: [18]

Problems to consider when the above are present include: [18]

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). [19]

Treatment

Management of colic is generally conservative and involves the reassurance of parents. [9] Calming measures may be used and include soothing motions, limiting stimulation, pacifier use, and carrying the baby around in a carrier, [9] although it is not entirely clear if these actions have any effect beyond placebo. [9] [20] Swaddling does not appear to help. [1]

Medication

No medications have been found to be both safe and effective. [9] Simethicone is safe but does not work, while dicyclomine works but is not safe. [9] Evidence does not support the use of cimetropium bromide, [20] and there is little evidence for alternative medications or techniques. [21] While medications to treat reflux are common, there is no evidence that they are useful. [15]

Diet

Dietary changes by infants are generally not needed. [9] In mothers who are breastfeeding, a hypoallergenic diet by the mother—not eating milk and dairy products, eggs, wheat, and nuts—may improve matters, [9] [10] [22] while elimination of only cow's milk does not seem to produce any improvement. [22] In formula-fed infants, switching to a soy-based or hydrolyzed protein formula may help. [10] Evidence of benefit is greater for hydrolyzed protein formula with the benefit from soy based formula being disputed. [23] [24] Both these formulas have greater cost and may not be as palatable. [24] Supplementation with fiber has not been shown to have any benefit. [10] A 2018 Cochrane review of 15 randomized controlled trials involving 1,121 infants was unable to recommend any dietary interventions. [25] A 2019 review determined that probiotics were no more effective than placebo although a reduction in crying time was measured. [26]

Complimentary and alternative medicine

No clear beneficial effect from spinal manipulation [27] [28] or massage has been shown. [9] Further, as there is no evidence of safety for cervical manipulation for baby colic, it is not advised. [29] There is a case of a three-month-old dying following manipulation of the neck area. [29]

Little clinical evidence supports the efficacy of "gripe water" and caution in use is needed, especially in formulations that include alcohol or sugar. [9] Evidence does not support lactase supplementation. [20] 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. [30] Fennel also appears effective. [31] [32]

Prognosis

Infants who are colicky do just as well as their non colicky peers with respect to temperament at one year of age. [9]

Epidemiology

Colic affects 10–40% of children, [1] occurring at the same rate in boys and in girls. [14]

History

The word "colic" is derived from the ancient Greek word for intestine (sharing the same root as the word "colon"). [33]

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. [34]

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 none of these are now recommended because of potential serious side-effects, including death.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Gastroesophageal reflux disease</span> Medical condition

Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or complications. Symptoms include dental corrosion, dysphagia, heartburn, odynophagia, regurgitation, non-cardiac chest pain, extraesophageal symptoms such as chronic cough, hoarseness, reflux-induced laryngitis, or asthma. In the long term, and when not treated, complications such as esophagitis, esophageal stricture, and Barrett's esophagus may arise.

<span class="mw-page-title-main">Otitis media</span> Inflammation of the middle ear

Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. The other main type is otitis media with effusion (OME), typically not associated with symptoms, although occasionally a feeling of fullness is described; it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks. It may be a complication of acute otitis media. Pain is rarely present. All three types of otitis media may be associated with hearing loss. If children with hearing loss due to OME do not learn sign language, it may affect their ability to learn.

<span class="mw-page-title-main">Irritant diaper dermatitis</span> Medical condition

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<span class="mw-page-title-main">Preterm birth</span> Birth at less than a specified gestational age

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<span class="mw-page-title-main">Bronchiolitis</span> Blockage of the small airways in the lungs due to a viral infection

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Gripe water is a non-prescription product sold in many countries around the world to relieve colic and other gastrointestinal ailments and discomforts of infants. No evidence supports the efficacy of gripe water and one limited study in India questions whether the consumption of gripe water is related to vomiting in babies that already showed signs of colic. The original formula contained alcohol and sugar in addition to sodium bicarbonate and dill oil. Present-day products do not contain alcohol, and may contain fennel, ginger, chamomile or lemon balm in addition to, or as a replacement for, dill oil. Some gripe water products still contain sugar, while others may contain charcoal. Amounts given are one to several teaspoons per day.

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BioGaia is a Swedish biotechnology company that develops, markets and sells a range of probiotic products. It has patented the use of several Lactobacillus reuteri strains and offers gut and immune health products containing L. reuteri Protectis, one of the human L. reuteri strain and oral health products containing L. reuteri Prodentis, a blend of the L. reuteri strains DSM 17938 and ATCC PTA 5289. Products containing L. reuteri have been proven to be both effective and safe in several applications: infant colic, diarrhea prevention and mitigation in children, eradication of H. pylori infection and reduction of side effects from standard H. pylori treatment, amelioration of gingivitis, and general illness prevention in children and adults. BioGaia was ranked 9th in the Top 30 Global Probiotic Food Ingredient Companies list by FoodTalks in 2021. The BioGaia -B share is listed on the NASDAQ OMX Nordic Exchange.

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<span class="mw-page-title-main">Pain management in children</span> Medical condition

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<span class="mw-page-title-main">Infant crying</span> Medical condition

Infant crying is the crying of infants as a response to an internal or external stimulus. Infants cry as a form of basic instinctive communication. Essentially, newborns are transitioning from life in the womb to the external environment. Up to 27% of parents describe problems with infant crying in the first four months. Up to 38% identify a problem with their infant crying within the first year. Parents can be concerned about the amount of time that their infant cries, how the infant can be consoled, and disrupted sleeping patterns. Colic is used as a synonym for excessive crying of infants, even though colic may not be the cause of excessive crying.

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