Baby colic

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

Colic
Crying newborn
Classification and external resources
Specialty	Pediatrics
ICD-10	R10.4
ICD-9-CM	789.7
MedlinePlus	000978
eMedicine	ped/434
Patient UK	Baby colic
MeSH	D003085

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 between the ages of two weeks and four months. The cause of colic is generally unknown. Fewer than 5% of infants with excess crying have an underlying organic disease.

Crying associated with a baby's colic can cause relationship stress, breastfeeding failure, postpartum depression, excess visits to the doctor, and child abuse, such as shaken baby syndrome.

It is present in 5–25% of infants. Treatment is generally conservative with little to no role for medications, either conventional or alternative. It often disappears when the baby is three to four months old, but can last up to one year. Colic typically does not result in long term problems.

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. By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks. With 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 (piercing).

Effect on the family

An infant with colic may affect family stability and be a cause of short-term anxiety or depression in the mother. It may also contribute to exhaustion and stress in the parents.

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. Babies with colic may be exposed to abuse, especially shaken baby syndrome.

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, cows' milk allergy, anal fissures, subdural hematomas, or infantile migraine. While previously believed to be related to intestinal causes such as gas pains, 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 with rates similar in both groups.

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.

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."

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.

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

• 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:

• 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).

Treatment

Management of colic is generally conservative and involves the reassurance of parents. 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. Eye contact, talking, and holding an infant are also reasonable measures, though is not entirely clear if these actions have any effect beyond placebo. 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. Evidence does not support the use of cimetropium bromide, and there is little evidence for alternative medications or techniques.

Diet

Dietary changes by infants are generally not needed. In mothers who are breastfeeding, a hypoallergenic diet by the mother — not eating milk products, eggs, wheat, or nuts — may improve matters. If symptoms are due to a cow milk allergy switching to a soy-based or hydrolyzed protein formula may help. Evidence of benefit is greater for hydrolyzed protein formula with the benefit from soy based formula being disputed. Additionally both these formulas have greater cost and are not as palatable. Supplementation with fiber has no benefit.

Alternative medicine

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

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 5–25% 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, 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.

External links

• Baby colic at DMOZ