Infantile Colic: Difference between revisions
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* Maternal smoking or nicotine replacement therapy | * Maternal smoking or nicotine replacement therapy | ||
== Clinical Presentation == | == Clinical Presentation and Diagnosis == | ||
Fussing and crying are typical in the first 3 months of life. In an article written in the American Family Physician, infants will cry an average of 2.2 hours a day. This most often peaks at 6 weeks and gradually decreases. <ref name=":4">Roberts DM, Ostapchuk M, O’BRIEN JG. [https://www.aafp.org/pubs/afp/issues/2004/0815/p735.html#:~:text=The%20most%20commonly%20accepted%20definition,well%2Dfed%20and%20otherwise%20healthy. Infantile colic]. American family physician. 2004 Aug 15;70(4):735-40.</ref>It must be noted that these are statistics taken from a Westernized cultural demographic. | |||
= | ''The "rule of three" has generally been used to diagnose colic:<ref name=":4" />'' | ||
# ''Crying for more than 3 hours a day'' | |||
# ''For more than than 3 days per week'' | |||
# ''For more than 3 weeks'' | |||
Modifications to this diagnosis have been introduced, with the most recent being the new Rome IV criteria.<ref>Holm LV, Jarbøl DE, Christensen HW, Søndergaard J, Hestbæk L. [https://www.researchgate.net/publication/350976819_The_effect_of_chiropractic_care_on_infantile_colic_results_from_a_single-blind_randomised_controlled_trial The effect of chiropractic care on infantile colic: results from a single-blind randomised controlled trial]. Chiropractic & Manual Therapies. 2021 Dec;29:1-1.</ref> | |||
For '''clinical diagnosis''', this includes:<ref name=":5">Koppen IJ, Nurko S, Saps M, Di Lorenzo C, Benninga MA. [https://www.nestlenutrition-institute.org/early-nutrition-influence-preventive-and-therapeutic-aspects/the-pediatric-rome-iv-criteria---what-is-new#:~:text=For%20the%20clinical%20diagnostic%20criteria%2C%20Rome%20IV%20states%3A&text=Caregivers%20report%20recurrent%20and%20prolonged,to%20thrive%2C%20fever%20or%20illness. The pediatric Rome IV criteria: what’s new?]. Expert review of gastroenterology & hepatology. 2017 Mar 4;11(3):193-201.</ref> | |||
# '''The infant is 5 months or younger when symptoms start or stop.''' | |||
# '''Caregivers report recurrent and prolonged periods of crying, fussing or irritability which occurs without obvious cause and cannot be prevented or resolved by caregivers.''' | |||
# '''No evidence of failure to thrive, fever or illness.''' | |||
For '''research purposes''' this includes:<ref name=":5" /> | |||
# '''The above 3 points and...''' | |||
# '''Caregiver reported that the infant has cried or fussed for > 3 hours per day during ? 3 days out of 7 in a telephone or face-to-face screening interview with researcher or clinician.''' | |||
# '''Total of 24-hours of crying plus fussing confirmed to >3 hours measured by > 1 prospectively kept 24 hour behaviors' diary'''. | |||
In addition, motor behaviors have also been used in the definition of colic, including <ref name=":4" /> | |||
* A flushed face | |||
* Furrowed brow | |||
* Clenched fists | |||
* Legs pulled up to the abdomen | |||
* Infants emitting a piercing, high-pitched scream. | |||
Generally, colic is seen to develop around 2 weeks of age, with resolution around the 4-month mark. Crying is usually concentrated around the late afternoon and evening for prolonged periods of time and is unpredictable and spontaneous. The child cannot be soothed, even by feeding.<ref name=":4" /> | |||
== Management / Interventions<br> == | == Management / Interventions<br> == | ||
Revision as of 20:50, 30 August 2023
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Introduction[edit | edit source]
Infantile colic is described as excessive crying with no clear cause in infants who otherwise present as healthy. Its presentation is widely reported - as little as 3% or up to 40% of infants worldwide. An Australian journal recently reported 20%, while the Singapore Medical Journal reported 40% presentation in the healthcare sector.[1][2][3]
In general, it appears that infant colic is one of the most common causes for hospital emergency visits in the first few months of life.[1]
It is generally described as a self-limiting condition, resolving after three to four months of life.[2]
Pathological Process[edit | edit source]
While colic implies a gastrointestinal origin, research into conditions relating to the gastrointestinal system and the prevalence of colic has found inconclusive or weak associations.[1][3][2]
Among the topics researched, the following were most prevalent:
- Microbiota and inflammatory markers (both in the gut and systemically)
- Lactose intolerance
- Gastro-oesophageal reflux
Other possible causes have included:[4]
- Increased serotonin secretion
- Poor feeding technique
- Maternal smoking or nicotine replacement therapy
Clinical Presentation and Diagnosis[edit | edit source]
Fussing and crying are typical in the first 3 months of life. In an article written in the American Family Physician, infants will cry an average of 2.2 hours a day. This most often peaks at 6 weeks and gradually decreases. [5]It must be noted that these are statistics taken from a Westernized cultural demographic.
The "rule of three" has generally been used to diagnose colic:[5]
- Crying for more than 3 hours a day
- For more than than 3 days per week
- For more than 3 weeks
Modifications to this diagnosis have been introduced, with the most recent being the new Rome IV criteria.[6]
For clinical diagnosis, this includes:[7]
- The infant is 5 months or younger when symptoms start or stop.
- Caregivers report recurrent and prolonged periods of crying, fussing or irritability which occurs without obvious cause and cannot be prevented or resolved by caregivers.
- No evidence of failure to thrive, fever or illness.
For research purposes this includes:[7]
- The above 3 points and...
- Caregiver reported that the infant has cried or fussed for > 3 hours per day during ? 3 days out of 7 in a telephone or face-to-face screening interview with researcher or clinician.
- Total of 24-hours of crying plus fussing confirmed to >3 hours measured by > 1 prospectively kept 24 hour behaviors' diary.
In addition, motor behaviors have also been used in the definition of colic, including [5]
- A flushed face
- Furrowed brow
- Clenched fists
- Legs pulled up to the abdomen
- Infants emitting a piercing, high-pitched scream.
Generally, colic is seen to develop around 2 weeks of age, with resolution around the 4-month mark. Crying is usually concentrated around the late afternoon and evening for prolonged periods of time and is unpredictable and spontaneous. The child cannot be soothed, even by feeding.[5]
Management / Interventions
[edit | edit source]
Because of its benign nature, the first recommendation for treatment is parental education, including the aspect that colic is benign and self-limiting. In addition, supportive resources can also be offered.[4]
Medical Management[edit | edit source]
Probiotics
Medications
Dietary Modifications
Physical Therapies
Herbal Supplements
Differential Diagnosis
[edit | edit source]
Conditions that should be checked for unexplained crying in infants include:[4]
- Hirschsprung disease
- Incarcerated hernia or testicular torsion
- Child abuse
- Gastroesophageal reflux
- Pyloric stenosis
- Anal fissure
- Corneal abrasion
- Cow's milk allergy
- Hair tourniquet syndrome
- Inadequate bottle feeding
- Inadequate breast feeding
The above causes are detailed in regards to findings, physical examinations, historical clues and diagnostic testing here.
Red flags which point to other more serious conditions are:[4]
- Distended abdomen
- Fever
- Lethargy
Details are found here.
Resources
[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Ellwood J, Draper-Rodi J, Carnes D. Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines. BMJ Open. 2020; 10 (2): e035405.
- ↑ 2.0 2.1 2.2 Sung V. Infantile colic. Australian prescriber. 2018 Aug;41(4):105.
- ↑ 3.0 3.1 Lam TM, Chan PC, Goh LH. Approach to infantile colic in primary care. Singapore medical journal. 2019 Jan;60(1):12.
- ↑ 4.0 4.1 4.2 4.3 Johnson JD, Cocker K, Chang E. Infantile colic: recognition and treatment. American family physician. 2015 Oct 1;92(7):577-82.
- ↑ 5.0 5.1 5.2 5.3 Roberts DM, Ostapchuk M, O’BRIEN JG. Infantile colic. American family physician. 2004 Aug 15;70(4):735-40.
- ↑ Holm LV, Jarbøl DE, Christensen HW, Søndergaard J, Hestbæk L. The effect of chiropractic care on infantile colic: results from a single-blind randomised controlled trial. Chiropractic & Manual Therapies. 2021 Dec;29:1-1.
- ↑ 7.0 7.1 Koppen IJ, Nurko S, Saps M, Di Lorenzo C, Benninga MA. The pediatric Rome IV criteria: what’s new?. Expert review of gastroenterology & hepatology. 2017 Mar 4;11(3):193-201.
