Baby colic

This article is about baby colic. For other types of colic, see Colic.

Baby colic
Specialty	Pediatrics

Baby colic (also known as infantile colic) is a condition in which an otherwise healthy baby cries or displays symptoms of distress (cramping, moaning, etc.) frequently and for extended periods, without any discernible reason. The condition typically appears within the first month of life and often disappears rather suddenly, before the baby is three to four months old, but can last up to one year.

Colic is typically defined as episodes of crying for more 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. The cause of the colic is unknown. Less than 5% of infants with excess crying have a relevant organic cause.

Crying and the exhaustion associated with the baby's colic can trigger serious problems, including relationship stress, breastfeeding failure, postpartum depression, excess visits to the doctor/emergency room, and even child abuse, such as shaken baby syndrome.

Signs and symptoms

Colic is defined as episodes of crying for more three hours a day for more than three days a week for three weeks in an otherwise health child between the ages of two weeks and four months. This is in contrast to a normal infant which cry's an average of just over two hours a day, with a maximum duration occurring at six weeks. In colic periods of crying most commonly happen in the evening and for no obvious reason. Associated symptoms may include: legs pulled up to the stomach, a flushed face, clenched hands, and a wrinkled brow. The cry is often high pitched and may be described as piercing.

Effect on the family

An infant with colic may negatively effect family stability and result in short term anxiety or depression in the mother.

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. Baby's with colic may be prone to abuse.

Parents are at especially high risk of experiencing a serious reaction to their infant's crying; at-risk parents include teens, drug addicts, foster parents, parents of premies and parents of multiples. Families living in apartment buildings may also suffer strained relationships with neighbors and landlords if their babies cry loudly for extended periods of time each day.

Causes

The cause of colic is unknown with serious issues present in less than 5% of infants who cry excessively. This less than 5% have issues including: constipation, gastroesophageal reflux disease, lactose intolerance, cows milk allergy, anal fissures, subdural hematomas, and infantile migraine among others. While previously believed to be related to intestinal case, this does not appear to be the case. Psychological and social factors also appear to play little role. There is some evidence that cigarette smoke may increase the risk. It seems unrelated to breast or bottle feeding as rates are similar in both groups.

Parents and doctors commonly switch fussy babies to a soy formula; however, it is not clear that soy reduces colic.

Some reports have associated colic to changes in the bacterial balance in a baby's intestine. They suggest treating the crying with daily doses of probiotics (such as Lactobacillus acidophilus or Lactobacillus reuteri).

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.

In truth, most babies have mild reflux, often referred to as "spitting up." Over the past 5 years, several studies have proven that GERD rarely causes infant crying. 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 gram/day), vomiting more than 5 times/day; or other significant feeding problems.

Diagnosis

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

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

Parents should be especially suspicious of illness or pain as the cause if the cry is accompanied by at least one of the following six "red flag" symptoms:

• Vomiting (vomit that is green or yellow, bloody or occurring more than 5/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 100.2 °F (37.9 °C)
• Irritability (crying all day with few calm periods in between)
• Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over 6 hours)
• Poor weight gain (gaining less than 15 gram a day)

Babies with persistent crying or any "red flag" symptoms should be checked by a healthcare professional to rule out illness. The top ten medical problems to consider in irritable babies with "red flag" symptoms are:

• 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 5 times a day, or other significant feeding problems should be evaluated by a healthcare professional for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).

Treatment

Management of colic is generally conservative and involves the reassurance of parents. No medications have been found to be both safe and effective. Simethicone is safe but does not appear to work, while dicyclomine works but is not safe. There is tentative evidence to support the use of probiotics.

Diet

Dietary changes by the infant are generally not needed. In mothers who are breastfeeding, not eating mild products, eggs, wheat, or nuts may improve matters.

If the crying is related to a cow's milk allergy benefits are usually seen within 2–7 days. Mothers can then choose to add back small amounts of the suspected offending food a little bit at a time as long as persistent crying does not reappear. If crying reappears, the offending foods may need to be avoided for many months.

Alternative medicine

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. It however is not entirely clear if these measures are better than a placebo. Eye contact, talking, and holding an infant are additional reasonable measure. A clearly beneficial effect from spinal manipulation or message has not been shown. Gripe water, a combinations or herbs, is claimed to improve symptoms. There are; however, potential safety issues with its use.

Prognosis

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

Epidemiology

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

History

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

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.

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 have been stopped because of potential serious side-effects, including death.

Another age-old practice recommended by doctors is the "cry-it-out" approach (also known as "controlled crying.") The "cry-it-out" approach refers to the practice of leaving crying babies in their cribs and letting them cry themselves to sleep. First recommended in the U.S. by Luther Emmett Holt, it was later also recommended by Benjamin Spock in his best-selling book, Baby and Child Care. More recently, Richard Ferber has recommended a modified version of this approach.

Several pediatricians and psychologists have claimed that the "cry-it-out" approach is harmful to infants because it can interfere with the development of trust and secure attachment.

External links

• Helping you get through the first year
• American Academy of Pediatrics on Colic
• American Family Physician on Infantile Colic
• University of Hawaii Medical: Red Flags Parents Should Watch For