Baby colic

Source: Wikipedia, the free encyclopedia.
For other types of colic, see Colic.
Colic
Other namesInfantile colic
A crying newborn
SpecialtyPediatrics
SymptomsCrying for more than three hours a day, for more than three days a week, for three weeks[1]
ComplicationsFrustration 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 methodBased on symptoms after ruling out other possible causes[1]
Differential diagnosisCorneal abrasion, hair tourniquet, hernia, testicular torsion[2]
TreatmentConservative treatment, extra support for the parents[1][3]
PrognosisNo 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]

The cause of colic is unknown.

organic disease.[1]

Treatment is generally conservative, with little to no role for either medications or alternative therapies.

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]

  • Vomiting (vomit that is green or yellow, bloody or occurring more than five times a day)
  • Change in stool (constipation or diarrhea, especially with blood or mucous)
  • Abnormal temperature (a rectal temperature less than 97.0 °F (36.1 °C) or over 100.4 °F (38.0 °C)
  • Irritability (crying all day with few calm periods in between)
  • Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over six hours)
  • Poor weight gain (gaining less than 15 grams a day)

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

  • Infections (e.g. ear infection, urine infection, meningitis, appendicitis)
  • Intestinal pain (e.g. food allergy, acid reflux, constipation, intestinal blockage)
  • Trouble breathing (e.g. from a cold, excessive dust, congenital nasal blockage, oversized tongue)
  • Increased brain pressure (e.g. hematoma, hydrocephalus)
  • Skin pain (e.g. a loose diaper pin, irritated rash, a hair wrapped around a toe)
  • Mouth pain (e.g. yeast infection)
  • Kidney pain (e.g. blockage of the urinary system)
  • Eye pain (e.g. scratched cornea, glaucoma)
  • Overdose (e.g. excessive Vitamin D, excessive sodium)
  • Others (e.g. migraine headache, heart failure, hyperthyroidism)

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.

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.

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

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 "

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]

References

  1. ^
    PMID 26447441. Archived
    from the original on 26 August 2017. Retrieved 22 July 2017.
  2. ^ "Colic Differential Diagnoses". emedicine.medscape.com. 3 September 2015. Archived from the original on 5 November 2017. Retrieved 1 June 2017.
  3. ^
    PMID 27631535
    .
  4. ^
    ISBN 9781451192155. Archived
    from the original on 2015-02-25.
  5. S2CID 30840225
    .
  6. ^ "Colic". Pediatrics in Review.
  7. PMID 12444822
    .
  8. ISBN 9780470031711. Archived
    from the original on 2016-10-18.
  9. ^
    PMID 15338787. Archived
    from the original on 2014-08-28.
  10. ^
    S2CID 8404014
    .
  11. PMID 31794639
    .
  12. PMID 9596593
    .
  13. S2CID 534896
    .
  14. ^
    PMID 21319674
    .
  15. ^
    PMID 27144631
    .
  16. S2CID 40640662
    .
  17. PMID 16678565
    .
  18. ^
    ISBN 978-0-553-38146-7.[page needed
    ]
  19. S2CID 40915052
    .
  20. ^
    S2CID 41709424
    .
  21. S2CID 19536242
    .
  22. ^
    PMID 25808260
    .
  23. PMID 18450914
    .
  24. ^
    S2CID 26003983
    .
  25. PMID 30306546
    .
  26. PMID 30865287
    .
  27. PMID 23235617
    .
  28. PMID 23402252
    .
  29. ^
    PMID 27647578
    .
  30. PMID 29279326
    .
  31. S2CID 26126920
    .
  32. PMID 28562281
    .
  33. ^ Sanghavi, Darshak (Mar 29, 2005). "Bleary parents crave colic cure". Boston Globe. Archived from the original on 2013-11-06.
  34. ISBN 9780961307363
    .

External links

Look up colic in Wiktionary, the free dictionary.
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