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Baby colic

Baby colic is commonly defined as distress or crying in an infant, which lasts for more than three hours a day, for more than three days a week for at least three weeks in an otherwise healthy infant. It is a common, benign, self-limiting condition and, despite much research on the subject, the underlying cause is still not clear.

Baby colic can cause considerable distress for parents and paediatricians. Despite 40 years of research, its pathogenesis is incompletely understood and treatment remains an open issue.
Epidemiology

Baby colic is very common, occurring in round 10-30% of infants. It affects males and females equally.
Breast-fed and formula-fed infants are equally affected.
It is one of the most common reasons for parents to consult their doctor in the first three months of their baby’s life.
Smoking and also nicotine replacement therapy during pregnancy have been shown to be risk factors for baby colic.
A multicentre trial found that mothers who report colic or excessive infant crying have higher scores on the Edinburgh Postnatal Depression Scale (EPDS), with increased odds of high scores at six months even if the crying is resolved.
Baby colic may be associated with intolerance to cow’s milk in some cases.
The composition of intestinal microbiota, especially an inadequate amount of lactobacilli and an increased concentration of coliforms, has been suggested in some studies to influence the pathogenesis of baby colic.

Symptoms

The symptoms seen in infants described as having colic are all nonspecific and baby colic must be a diagnosis of exclusion when the clinician is satisfied that the child is otherwise healthy. Commonly described features of colic include:

Inconsolable crying – typically, high-pitched and occurring frequently in the afternoon or evening.
Redness of the face.
Drawing up of the knees.
Flatus.

A history should include:

Feeding – breast/bottle.
Weight gain.
Bowel habit – stool consistency/colour/blood.
Vomiting or reflux.
Timing of crying.
Duration of crying.

An examination should include:

General examination, including weight.
Abdominal examination, including hernial orifices and genitalia.

Differential diagnosis

Inconsolable crying and distress may indicate pain or other physical discomfort and other possible causes of pain should be sought in an acute situation, although many parents usually present with a history of inconsolable crying and an infant who appears to be thriving and content.

In an acute situation when faced with a distressed infant, consider:

Physical discomfort – cold, wet, hungry.
Severe nappy rash.
Corneal abrasion from the infant’s nails.
Intussusception.
Volvulus.
Strangulated hernia.
Torsion of the testis.
Non-accidental injury.

When the history is over a longer period of time, consider:

Reflux oesophagitis.
Lactose intolerance.
Parenting skills and experience of parents.
Maternal postnatal depression.

Gasto-oesophageal reflux disease is the most common differential diagnosis.
Investigations

The diagnosis is usually made using history and examination alone and does not normally require any further investigations.
Normal weight gain is typical in these infants.
An alternative diagnosis should be considered if failure to thrive is present.
Infants who exhibit atypical features, or in whom the diagnosis is in doubt, should be referred for a specialist opinion either as an emergency or to an outpatient clinic, depending on the clinical presentation.

The parents of infants with colic often require support, as they will be anxious as to the cause of the crying and their apparent inability to help the child.
A caring and compassionate healthcare professional is the cornerstone in the management of colic.
General advice to the parents may be all that is needed in terms of feeding regimes, temperature of the child’s room, and clothing worn by the child, together with an explanation of the likely course of the condition.
Parents may be advised to share childcare with each other and friends/grandparents until this stage is passed, in order to prevent physical/mental exhaustion.
There is some scientific evidence to support the use of a casein hydrolysate formula (eg, Nutramigen® and Pregestimil®) in formula-fed infants or a low-allergen (eg, low in soy, eggs, peanuts, shellfish) maternal diet in breast-fed infants with baby colic.
There is no proven role for the use of soy-based formulas or of lactase therapy in the management of baby colic, and these interventions are not recommended.
Currently, there are insufficient data to make a recommendation on the effect of probiotics for baby colic.
There is inconclusive evidence for spinal manipulation.

Drugs

There is little scientific evidence to support the use of simethicone (eg, Infacol®) or dicyclomine hydrochloride.
There are no clear management guidelines for the treatment of baby colic, and no evidence-based cures.

Prognosis

The prognosis is excellent.
Most infants with colic recover spontaneously by 3-4 months of age.

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