- Infantile colic is defined as episodes of uncontrollable crying or fussing in an otherwise healthy infant
- described as paroxysmal and may be characterized by facial grimacing, leg flexion, and passing flatus.
- Peaks at age of 6 weeks and resolves at age of 3-4 months.
- It is a diagnosis of exclusion.
- Fewer than 5% of infants evaluated for excessive crying have an organic etiology.
- It has been associated with shaken baby syndrome, postpartum depression, parental guilt, and multiple physician visits.
Infantile Colic 2016 ROME IV Criteria
- Age <5 months when the symptoms start and stop
- Recurrent and prolonged periods of crying, fussing, or irritability that start and stop without obvious cause and cannot be prevented or resolved by caregivers
- No evidence of poor weight gain, fever, or illness
- Caregiver reports of crying/fussing for ≥3 hours per day on ≥3 days/week in a telephone or face-to-face interview
- Total daily crying confirmed to be ≥3 hours when measured by at least one prospectively kept 24-hour
Full Examination is a Must
***The diagnosis of colic is made only when the physical examination reveals no organic cause for the infant’s excessive crying. ***
A thorough inspection may identify possible sources of pain (differential diagnosis):
- Skin lesions
- Corneal abrasions
- Hair tourniquets
- Nonaccidental trauma such as bruising or fracture
- Cow’s milk protein intolerance
- Gastroesophageal reflux disease (GERD)
- Maternal substance use including nicotine
- Poor infant regulation including fatigue, hunger, parental anxiety, and chaotic and disruptive environmental conditions
ApproachY
- Education (including the natural history and features of colic)
- Demystification, and a discussion of its natural course
- Techniques for calming infants include Dr. Harvey Karp’s “5 Ss”:
- Swaddling
- Side or stomach holding
- Soothing noises (such as shushing, singing, or white noise)
- Swinging or slow rhythmic movement (such as rocking, walking, or riding in a car)
- Sucking on a pacifier