Infantile colic

Infantile colic is a condition characterised by persistent and inconsolable crying in otherwise healthy infants.  

Overview

• Benign condition that resolves on its own.

• Symptoms age:

  • begins in second or third week

  • reach their peak around 6 weeks

  • and typically resolve by the age of 12 weeks

• Persistent and inconsolable crying, irritability, and screaming episodes in an otherwise healthy and well-fed infant.

• 3 Hours - 3 days - 3 Weeks: The crying is usually for more than three hours a day, more than three days a week, for more than three weeks

• Common in the late afternoon and evening,

• Child shows red-faced appearances, leg-drawing, and abdominal tension during the episode.

• Affects nearly 10 to 20% of newborns and infants

• The underlying cause of colic unknown.

• Traditional soothing methods are mostly ineffective.

• Caregivers often perceive excessive crying as a sign of illness or as evidence of poor caretaking skill

• Diagnosis is Clinical through a history and physical examination after eliminating potential pathological causes. When the symptoms spontaneously resolve, they confirm the diagnosis.

Possible Causes / theories:

Exact causes not known, likely multifactorial.

• Biological, gastrointestinal, and psychosocial elements postulated.

• Gastrointestinal factors

  • Cow's milk protein intolerance or lactose intolerance

  • Gut inflammation (↑ fecal calprotectin)

  • Gut hyper-motility (? Increased motilin)

  • Inflammatory conditions

  • Dysbiosis - Altered gut microbiome

• Feeding issues

  • Overfeeding,

  • Underfeeding,

  • Improper burping

  • Underlying illness.

• Maternal diets (contradictory evidences.)

• Psychosocial stress in caregivers

Episodes:

• Have a clear beginning and end.

• Occur during the late afternoon and evening hours.

• Newborn or infant is happy, sleeping, playing, and eating well between episodes.

• The specific triggers are unknown.

• The cry with colic is typically louder and more urgent like a screaming.

• Red face, clenching fists, leg-drawing, abdominal tension common during episodes.

• Infant appears healthy between episodes (feeding, activity, playfulness, sleeping, ect)

• Cry often unresponsive to soothing

• Less than 10% of infants have an organic cause,

• In most infants colic resolve spontaneously, with no lasting effects.

Diagnosis:

1. Diagnosis is Clinical, exclude other possible organic causes, like

   1. Gastroesophageal reflux

   2. Milk protein allergy

   3. Infections

2. Thorough history, physical examination, and review of the growth chart is essential to exclude organic conditions.

3. Persistent and inconsolable crying, irritability, and screaming episodes in an otherwise healthy and well-fed infant. for 3 Hours - 3 days - 3 Weeks: The crying is usually for more than three hours a day, more than three days a week, for more than three weeks

4. 3 weeks criteria may not be practical because only a few parents can wait 3 weeks to initiate evaluation or intervention when their baby is suffering.

5. Be aware that healthy infants often cry.

6. In the first 6 weeks, the average duration of crying ranges from 117 to 133 min/d

7. By 8 to 9 weeks, the mean duration is reduced to 68 min/d.

   
   

Management:

1. Educate and reassure caregivers

2. Rule out other conditions like Gut disorders, allergies.

3. Teach and counsel about proper feeding techniques

4. Manage caregiver stress and promote bonding

5. Avoid unnecessary medications. Following medications tried but not proven (may or may not help)

   1. Simethicone drops

   2. Probiotics (Lactobacillus reuteri)

   
   

6. Parental Support

   1. Reassurance

      Colic is not your fault. It has nothing to do with what you did or didn’t do. M

   2. Take breaks—ask for help from family or friends

   3. Remember: Colic is temporary. Most babies outgrow colic by 3-4 months, rarely last past 6 months

   4. It has no long-term effects.

   5. You’re doing a great job. Be kind to yourself!

      
      

What caregiver Can Do at Home

It is self limited condition, there's no cure, but several strategies may help soothe a colicky baby

1. Comfort Techniques

   • Hold your baby upright and gently rock or bounce

   • Use a white noise machine or quiet music

   • Try swaddling for a sense of security

   • Offer a pacifier

   • Take baby for a walk in a stroller or car ride

   • Warm baths

2. Feeding Tips

   • Burp your baby during and after feeds

   • Keep baby upright after feeding

   • If breastfeeding, consider cutting dairy from your diet (talk to your doctor first)

   • Try smaller, more frequent feeds

3. Create a Calm Environment

   • Limit stimulation (bright lights, loud noises)

   • Try a warm bath to relax baby

   • Stay calm—babies pick up on stress

When to Call the Doctor

• Baby has a fever (especially under 3 months old)

• Not feeding well, vomiting, or not gaining weight

• Bloody or mucous stools

• Crying is unusually high-pitched, constant, or baby is limp