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Baby colic

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This article is about baby colic. For other types of colic, see Colic.
Baby colic
SpecialtyPediatrics Edit this on Wikidata

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. Often crying occurs in the evening.[1] It typically does not result in long term problems.[2] The crying can cause frustration for the parents, depression following delivery, excess visits to the doctor, and child abuse.[1]

The cause of colic is unknown.[1] Some believe it is due to gastrointestinal discomfort like intestinal cramping.[3] Diagnosis requires ruling out other possible causes. Concerning findings include a fever, poor activity, or a swollen abdomen. 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.[4] 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 bottlefeed.[1]

Colic affects 10–40% of children. It is most common at six weeks of age and typically goes away by six months of age.[1] It rarely lasts up to one year of age.[5] It occurs at the same rate in boys and in girls.[1] The first detailed medical description of the problem occurred in 1954.[6]

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 a three-week duration in an otherwise healthy child between the ages of two weeks and four months.[7] By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks.[8] 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.[8] The cry is often high pitched (piercing).[8]

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

Persistent infant crying has been associated with severe marital discord, postpartum depression, early termination of breastfeeding, frequent visits to doctors, and 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.[8]

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.[8] Babies fed cow's milk has been shown to develop antibody responses to the bovine protein, causing colic.[10][11] Studies performed showed conflicting evidence about the role of cow's milk allergy.[8] While previously believed to be related to gas pains, this does not appear to be the case.[8] 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.[8] Other theories involve the so-called "fourth trimester" where it is thought a baby is not ready for life outside the womb and therefore reacts to this by crying [12]

Psychological and social factors have been proposed as a cause, but there is no evidence. Studies performed don't 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.[8] There is some evidence that cigarette smoke may increase the risk.[7] It seems unrelated to breast or bottle feeding with rates similar in both groups.[13]

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.[14]

Some researchers have proposed that colic is an evolved strategy of deception: colicky babies get more attention than other babies. The rate of colic represents a compromise between the evolutionary need for reliable infant communication and the individual benefit of this deception. "If every infant had these genes for colic, it would not work," says Maestripieri, a primatologist at the University of Chicago. "But if it's rare enough so that parents don't know if they're being honest or not, it works." [15]

Diagnosis

Colic is diagnosed after other potential causes of crying are excluded.[8] 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.[8] Babies who cry may simply be hungry, uncomfortable, or ill.[16]

Cause for concern include: an elevated temperature, a history of breathing problems or a child who is not appropriately gaining weight.[8]

"Red flag" indicating that further investigations may be needed include:[17]

  • 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 100.4 °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 6 hours)
  • Poor weight gain (gaining less than 15 grams a day)

Problems to consider when the above are present include:[17]

  • 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 for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).[18]

Treatment

Management of colic is generally conservative and involves the reassurance of parents.[8] Calming measures may be used and include: swaddling with the legs flexed, holding the baby on its side or stomach, swinging the baby side to side or back and forth while supporting the head, making a shushing sound, and breast feeding or the use of a pacifier.[7] Eye contact, talking, and holding an infant are also reasonable measures,[7] though is not entirely clear if these actions have any effect beyond placebo.[8][19]

Medication

No medications have been found to be both safe and effective.[7] Simethicone is safe but does not appear to work, while dicyclomine works but is not safe.[8] Evidence does not support the use of cimetropium bromide,[19] and there is little evidence for alternative medications or techniques.[20]

Diet

Dietary changes by infants are generally not needed.[8] In mothers who are breastfeeding, a hypoallergenic diet by the mother — not eating milk and dairy products, eggs, wheat, and nuts — may improve matters,[8][9][21] while elimination of only cow’s milk does not seem to produce any improvement.[21] In formula-fed infants, switching to a soy-based or hydrolyzed protein formula may help.[9] Evidence of benefit is greater for hydrolyzed protein formula with the benefit from soy based formula being disputed.[22][23] Additionally both these formulas have greater cost and are not as palatable.[23] Supplementation with fiber has no benefit.[9]

Alternative medicine

No clear beneficial effect from spinal manipulation[24][25] or massage has been shown.[8] No evidence supports the efficacy of so-called "gripe water", and its use poses risks, especially in formulations that include alcohol or sugar.[8] Evidence does not support lactase,[19] or supplementing formula with probiotics.[26]

The use of the probiotic Lactobacillus reuteri in babies who are breastfed has tentative evidence.[1][27]

Prognosis

Infants who are colicky do just as well as their non colicky peers with respect to temperament at one year of age.[8]

Epidemiology

Colic affects 5–25% of children,[8] occurring at the same rate in boys and in girls.[13]

History

The word "colic" is derived from the ancient Greek word for intestine (sharing the same root as the word "colon").[28]

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.[29]

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 all of these are no longer recommended because of potential serious side-effects, including death.[citation needed]

References

  1. ^ a b c d e f g h i j k Johnson, JD; Cocker, K; Chang, E (1 October 2015). "Infantile Colic: Recognition and Treatment". American family physician. 92 (7): 577–82. PMID 26447441.
  2. ^ Grimes, edited by Frank Domino, Robert A. Baldor, Jeremy Golding, Jill A. (2014). The 5-minute clinical consult premium 2015 (23rd ed.). St. Louis: Wolters Kluwer Health. p. 251. ISBN 9781451192155. {{cite book}}: |first1= has generic name (help)CS1 maint: multiple names: authors list (link)
  3. ^ Shamir, Raanan; St James-Roberts, Ian; Di Lorenzo, Carlo; Burns, Alan J.; Thapar, Nikhil; Indrio, Flavia; Riezzo, Giuseppe; Raimondi, Francesco; Di Mauro, Antonio (2013-12-01). "Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms". Journal of Pediatric Gastroenterology and Nutrition. 57 Suppl 1: S1–45. doi:10.1097/MPG.0b013e3182a154ff. ISSN 1536-4801. PMID 24356023.
  4. ^ Biagioli, E; Tarasco, V; Lingua, C; Moja, L; Savino, F (16 September 2016). "Pain-relieving agents for infantile colic". The Cochrane database of systematic reviews. 9: CD009999. PMID 27631535.
  5. ^ 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.
  6. ^ Long, Tony (2006). Excessive Crying in Infancy. John Wiley & Sons. p. 5. ISBN 9780470031711.
  7. ^ a b c d e 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.{{cite journal}}: CS1 maint: unflagged free DOI (link) (Retracted. If this is an intentional citation to a retracted paper, please replace {{retracted|...}} with {{retracted|...|intentional=yes}}.)
  8. ^ 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 (Review). 70 (4): 735–40. PMID 15338787.
  9. ^ 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.
  10. ^ Lucassen, P. L.; Assendelft, W. J.; Gubbels, J. W.; van Eijk, J. T.; van Geldrop, W. J.; Neven, A. K. (1998-05-23). "Effectiveness of treatments for infantile colic: systematic review". BMJ (Clinical research ed.). 316 (7144): 1563–1569. doi:10.1136/bmj.316.7144.1563. ISSN 0959-8138. PMC 28556. PMID 9596593.
  11. ^ Delire, M.; Cambiaso, C. L.; Masson, P. L. (1978-04-13). "Circulating immune complexes in infants fed on cow's milk". Nature. 272 (5654): 632. doi:10.1038/272632a0. ISSN 0028-0836. PMID 565472.
  12. ^ , HuffingtonPost http://www.huffingtonpost.co.uk/sarah-ockwellsmith/fourth-trimester-newborns_b_9607642.html, retrieved 2016-07-29 {{citation}}: Missing or empty |title= (help)
  13. ^ 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.
  14. ^ 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.
  15. ^ Zimmer, Carl (8 Mar 2005). "A Darwinian Look at a Wailing Baby". The New York Times. Retrieved 4 May 2014.
  16. ^ Barr, RG (1998). "Colic and crying syndromes in infants". Pediatrics. 102 (5 Suppl E): 1282–6. PMID 9794970.
  17. ^ 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]
  18. ^ 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.
  19. ^ 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.
  20. ^ 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.
  21. ^ a b Nocerino R; Pezzella V; Cosenza L; Amoroso A; Di Scala C; Amato F; et al. (2015). "The controversial role of food allergy in infantile colic: evidence and clinical management". Nutrients (Review). 7 (3): 2015–25. doi:10.3390/nu7032015. PMC 4377897. PMID 25808260.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  22. ^ 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.
  23. ^ 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.
  24. ^ 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.
  25. ^ Aase, K; Blaakær, J (Feb 11, 2013). "Chiropractic care of infants with colic lacks evidence". Ugeskrift for laeger. 175 (7): 424–8. PMID 23402252.
  26. ^ 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.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  27. ^ Xu, Man; Wang, Jiao; Wang, Ning; Sun, Fei; Wang, Lin; Liu, Xiao-Hong (1 January 2015). "The Efficacy and Safety of the Probiotic Bacterium Lactobacillus reuteri DSM 17938 for Infantile Colic: A Meta-Analysis of Randomized Controlled Trials". PloS One. 10 (10): e0141445. doi:10.1371/journal.pone.0141445. ISSN 1932-6203. PMC 4624960. PMID 26509502.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  28. ^ Sanghavi, Darshak (Mar 29, 2005). "Bleary parents crave colic cure". Boston Globe.
  29. ^ Solter, A (1998). Tears and Tantrums: What to Do When Babies and Children Cry. Goleta, CA: Shining Star Press. ISBN 9780961307363.
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