Infantile Colic

1. See Also
   1. Inconsolable Crying in Infants
2. Epidemiology
   1. Very common (25% of infants)
   2. More common in bottle-fed Infants
3. Etiology
   1. Unknown cause
   2. Two fold risk associated with maternal smokers
   3. Thoroughly studied with inconclusive results
      1. Hyperperistalsis
      2. Cow's Milk Allergy (may account for 10-15% of colic)
      3. Lactose Intolerance
      4. Parent or Infant relationship disturbance
      5. Neurophysiologic response of immature infant
4. Signs: Colic episode
   1. Infant has unpredictable episodes often in evening
      1. Not provoked by environment
      2. Not relieved with soothing or feeding
   2. High pitched screaming
   3. Facial Flushing
   4. Clenched fists
   5. Infant pulls legs up to Abdomen
5. Diagnosis: Wessel Criteria (Rule of 3's)
   1. Unexplained fussiness or crying
      1. Otherwise healthy infant
      2. Critical that organic causes are ruled out
         1. See Inconsolable Crying in Infants
   2. Child under age 3 months
   3. Lasts (cumulative) more than 3 hours per day
   4. Occurs more than 3 days per week
   5. Persists longer than 3 weeks
6. Differential Diagnosis
   1. Normal crying in infants without colic
      1. Overall, Infants cry 2.2 hours/day on average
      2. Crying duration peaks at 6 weeks and then decreases
   2. Assess for other etiology of excessive crying
      1. See Inconsolable Crying in Infants
7. Management
   1. Describe condition to parent
   2. Explain that cause is unknown
   3. Reassurance that colic passes by age of 3-5 months
      1. Greatly improves even if it continues longer
   4. Discuss parental coping strategies
   5. Consider potentially soothing measures: Harmless and potentially helpful (Five S's)
      1. Swaddling
      2. Side or Stomach position
      3. Shushing sounds
      4. Swinging
      5. Sucking (Breast Feeding)
   6. Have parent call or follow-up in 2 weeks
   7. Medications do not help colic
      1. Avoid Dicyclomine (Bentyl) due to risk of apnea
      2. Avoid Phenergan
      3. Avoid Simethicone (no more effective than Placebo)
         1. Metcalf (1994) Pediatrics 94:29-34
      4. Avoid Tylenol for relief of colic
      5. Avoid herbal tea preparations
         1. May result in malnutrition from less milk intake
      6. Avoid sucrose (reduces crying for only minutes)
      7. Avoid scopolamine (ineffective)
      8. Avoid lactase enzyme (ineffective)
   8. Physical stimulation does not appear helpful
      1. No evidence to support car-ride simulators
      2. No evidence to support carrying infant more
      3. No evidence to support decreased infant stimulation
      4. No evidence to support Behavior Modification
   9. Changing Formula has variable effect on colic
      1. Most infants are unlikely to benefit from change
      2. Whey hydrolysate formula (e.g. Carnation Good Start)
         1. Appears to reduce crying by 1 hour per day
      3. Study of colicky infants in Denmark
         1. Improved when switched to Soy Formula: 18%
         2. Improved with no change (Control Group): 29%
         3. Improved on Casein Hydrolysate (Nutramigen): 53%
      4. Changing formula is benign option for parent (but unlikely to benefit)
         1. See also Infant Nutrition Components
         2. Avoid multiple formula changes
         3. Options
            1. Consider Lactose-Free Formula trial for 1 week
            2. Consider Hypoallergenic Formula or Nonallergenic Formula trial for 1 week
         4. Changes formula manufacturers have tried
            1. Change in Linoleic Acid
            2. Change in Whey to Casein Protein ratio
         5. Changes not shown to be effective
            1. Soy Formula does not appear effective
               1. Garrison (2000) Pediatrics 106:184-90
            2. Fiber-enrichment does not appear effective
   10. Dietary changes in Breast Feeding mothers
       1. Atopic mother
          1. Avoid cow's milk
       2. Non-atopic mother
          1. Avoid milk
          2. Avoid egg
          3. Avoid wheat
          4. Avoid nuts
       3. Efficacy
          1. Low allergan diet may reduce colic in some infants
          2. Hill (2005) Pediatrics 116:709-15
8. Course
   1. Onset as early as 2 weeks
   2. Resolves by 4 months
9. Reference
   1. Balon (1997) Am Fam Physician 55(1):235-46
   2. Garrison (2000) Pediatrics 106:184-90
   3. Lothe (1982) Pediatrics 70:7-10
   4. Lucassen (2000) Pediatrics 106:1349-54
   5. Lucassen (1998) BMJ 316:1563-9
   6. Reijneveld (2000) Arch Dis Child 83(4):302-3