Infantile Colic Diagnosis And Treatment

Infantile colic is characterized by excessive, inconsolable crying and fussiness in an otherwise healthy infant, usually begins by 2 to 3 weeks of age, peaks by 6 weeks, and resolves by 3 months.

• The exact cause of Infantile colic is not well understood, but it is thought to be a combination of factors, including gas, gut sensitivity, and temperament.
• Colic usually resolves on its own by 3-5 months of age, but it can be distressing for both the infant and the caregivers.
• It is a diagnosis of exclusion for prolonged cry in early infancy.

Normal crying pattern in children

• Normal physiological behaviour
• 6-8 weeks: 2-3 h/24h (worse in late afternoon or evenining)
• Disappears by 3-4 months

Common Cause of Crying

• Hunger/Thirst
• Soiled or wet diapers
• Too hot or too cold
• Flatus
• Loneliness
• A sudden or startling movement
• Excessive tiredness
• Wanting to be held

Average Sleep

• Birth: 16-18 h
• 3 Months: 14-15h
• 6 weeks: tired after awake for 1.5 hours
• 3 months: tired after awake for 2 hours

History and examination

Age (typically 2 weeks to 4 months), feeding method (breastfed or formula-fed), pattern of crying episodes, passage of loose stool usually foul smelling

Symptoms	Signs
Excessive crying (often in the late afternoon or evening), pulling legs toward the belly, clenching fists, arching back, passing gas	Obtain Vital Signs Normal growth and development, no signs of illness or injury

Examination to rule out other cause

• Obtain growth (identify Failure to Thrive)
• Fontanelle (Meningitis/Dehydration)
• Eyes for foreign body (e.g. eye lash) or Corneal Abrasion,
• Ears for Otitis Media
• Nose – obstruction
• Mouth for Stomatitis, Thrush or frenulum tear
• Lung Exam for respiratory disease
• Cardiovascular exam for perfusion and pulses (consider Heart Failure), Evaluate for SVT
• Abdominal exam for acute abdominal signs
• Examine for abdominal mass (e.g. Intussusception)
• Examine for blood in the stool (e.g. Anal Fissure)
• Genitourinary exam – Incarcerated Hernia, Testicular Torsion
• Neurologic Exam (early CP)
• Joint exam for Septic Arthritis, Osteomyelitis
• General exam for signs of Trauma or Fracture
• Decreased extremity use
• Skin Exam, Bruising or rashes
• Evaluate for Hair Tournique

Differential diagnosis (D/D) & Complication

D/D:

• Gastroesophageal reflux (spitting up, poor weight gain, irritability during feeding)
• Intussusception
• Lactose intolerance (diarrhea, gas, abdominal pain)
• UTI
• Corneal abrasion
• Foreign body
• Acute otitis media
• Nasal congestion
• Oral thrush
• Bronchiolitis
• Genital tourniquet
• Early CP
• Meningitis
• Hypoglycemia
• Dehydration
• Digital tourniquet
• Fractures
• Septic arthritis
• Insect bites
• Diaper dermatitis
• Post – immunisation (DPT)
• Infection (fever, lethargy, poor feeding)
• Hunger or overfeeding
• Supraventricular Tachycardia

Complications: Sleep disturbances, parental stress, postpartum depression, shaken baby syndrome

Investigation

First rule out other cause of excessive crying in an infant. It’s important to remember that colic is a diagnosis of exclusion in a well-thriving infant. If a baby is visibly sick, the diagnosis of colic should not be considered.

Send investigation to rule out other possible cause.

• X-ray chest – Pneumonia / Bronchiolitis/fractures
• USG Abdomen – Intussusception
• Urine analysis – UTI

Management

There are no established guidelines for the management of colic. Treatment is typically individualized and symptomatic.

Medical:

Dicyclomine acts as antispasmodic and Simethicone break down gas bubbles and allows easy passage of gas. However, their role in treatement of infantile colic is not well established.

Note: Dicyclomine is contraindicated in age < 6 months as it cause constipation, breathing difficulty,affect memory, speech and movement.

Infantile colic is diagnosis of exclusion. If you suspect any organic or structural cause, prescribe medication accordingly.

Dietary Intervention:

• Probiotic supplementation, particularly Lactobacillus reuteri DSM 17938
• Restrict cow milk or lactogen feeding
• Encourage breastmilk

• Reassurance and support for caregivers
• Feeding modifications: smaller, more frequent feedings; burping the infant frequently during feeding; trying a hypoallergenic formula (if formula-fed)
• Comfort measures: gentle rocking or swaddling, soothing sounds or white noise, warm baths, infant massage, use of a pacifier
• Gas-relief techniques: bicycle leg exercises, applying gentle pressure to the infant’s abdomen

Advices

• Reassure caregivers that colic is a self-limiting condition that typically resolves by 4-6 months of age
• Encourage caregivers to take breaks and seek support from friends and family to manage stress
• Consult a healthcare provider if the infant is not thriving or if the excessive crying persists beyond 6 months of age

Referral

• Refer to a pediatrician or pediatric gastroenterologist if there are concerns about underlying medical conditions or if the infant is not thriving

Follow up

• Follow up within 1-2 months to monitor the infant’s growth, development, and response to management strategies

References:

1. Savino, F., Castagno, E., Bretto, R., Brondello, C., Palumeri, E., & Oggero, R. (2005). A prospective 10-year study on children who had severe infantile colic. Acta Paediatrica, 94(2), 129-132.