Author: Gauri Kshirsagar
What is infantile colic?
Colic is a common, but uncomfortable condition that some babies experience during the first 3 months of life. The baby cries hard and seems to be in great pain, as if he/she has a severe stomach-ache
*Not the same as Reflux!
How common is infantile colic?
It is very common, occurs in 1 per 5 babies
What causes colic?
The underlying cause is UNKNOWN. It occurs in both breast-fed babies and in bottle fed babies.
Suggested underlying causes include:
- Transient intolerance to the protein in cow’s milk or to lactose.
- Gastrointestinal causes, due to immature intestinal tract.
- Parenting factors: Anxieties and tensions in the family may increase the frequency of colic
- Others have suggested that colic is just the extreme end of normal crying, or that it is due to the baby’s temperament.
- Colic does not interfere with baby’s growth and development.
How to identify Infantile colic?
- Colic starts in the first weeks of life and resolves by around 4 months of age.
- Crying most often occurs in the late afternoon or evening.
- The baby draws its knees up to its abdomen, or arches its back when crying.
- Often the baby’s abdomen is hard and tense, and may pass gas.
What is Wessel’s Rule of 3?
Pediatrician Dr. Morris Wessel first described infantile colic in 1954 when he observed healthy infants experience inconsolable crying without any medical explanation. He developed the Wessel Criteria, which has become the gold standard for diagnosing infantile colic. The Wessel Criteria is also known as the “Rule of 3’s”. A baby is considered to have colic when he or she is otherwise healthy and yet exhibits excessive crying for more than 3 hours per day, for at least 3 days per week, for more than 3 weeks.
What is GERD?
Most babies have reflux, with peak symptoms around 4 months of age, and resolution by 12 months.
In about 8% of babies, reflux results in concerning symptoms, and we then assume that the infant suffers from gastroesophageal reflux disease (GERD). GERD is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus.
Mechanism of GERD:
- Lower esophageal sphincter (LES) is a muscle between the esophagus and the stomach
- LES matures at 6-7 weeks
- While immature, it does not close tightly, so feedings can go in a reverse direction, from stomach to esophagus
How to differentiate Infantile colic from GERD? OR when to suspect GERD in excessively crying baby?
- Crying that is worse around feeding
- Frequent spitting up that seems uncomfortable
- Refusing feeding
- Trouble with weight gain
- Back arching (right)
- Coughing, choking, gagging
- Breathing difficulty
What things are to be assessed if the baby starts crying suddenly?
- Hunger or thirst (assess feeding technique: is the baby feeding often enough?).
- Too hot or too cold (assess suitability of clothing, keep room temperature at around 18ｰC if possible).
- Too itchy (e.g. eczema, or itchy clothes or clothes labels).
- Nappy rash.
- Woman’s diet if breastfeeding (e.g. too much coffee, tea, or soft drinks that contain caffeine, or too much alcohol or spicy food).
- Parental depression or anxiety, or inability to interact normally with the baby
How to manage an episode of colic?
STEP 1: To provide strategies to help soothe a crying baby to reduce parental anxiety and stress
- Reassurance of the parents is very important that their baby is well, they are not doing something wrong, the baby is not rejecting them, and that colic is common and is a phase that will pass within a few months.
- If your baby is formula-fed, ask your doctor to review the formula or may change it
- Check the bottle teats to make sure the holes are proper size.
- Do not feed the baby too rapidly, especially if the baby is spoon fed.
- Burp the baby frequently after feed so as to release swallowed air.
- Holding the baby through the crying episode may be helpful. Sometimes colicky baby will be more comfortable lying on her/his stomach.
- Other strategies that may help to soothe a crying infant include:
- Gentle motion (e.g. pushing the pram, rocking the crib)
- ‘White noise’ (e.g. vacuum cleaner, hairdryer, running water).
- Bathing in a warm bath.
- Use a good branded feeding bottle, I personally prefer Philip’s ‘AVENT’\
STEP 2: Medical Treatment (under supervision of a peadiatrician)
Only consider trying medical treatments if parents feel unable to cope despite advice and reassurance. The options for medical treatments are:
- A 1-week trial of simeticone drops:
- Simethicone (Mylicon), a safe, over-thecounter drug for decreasing intraluminal gas, has been promoted as an agent to decrease colicky episodes
- Simeticone is available as 40mg/ml oral suspension sugar free
- Give one drop (0.5ml) before each feed. Increase to two drops (1ml) if required
- It is an Antiflatulent
- Most commomly available brand in India is “COLICAID”
- Carminative mixture syrup
- A 1-week trial of diet modification i.e Hypoallergenic diet
There is limited evidence that switching to a hypoallergenic formula for bottle-fed babies, or to a hypoallergenic diet for breastfeeding mothers (free of milk, eggs, wheat, and nuts) may help ease the symptoms of colic.
STEP 3: Seek advice from a paediatrician if:
- The parents are not coping despite advice, reassurance, and primary care interventions.
- There is diagnostic doubt (e.g. the baby is not thriving; crying is not starting to get better or is getting worse after 4 months of age; significant gastro-oesophageal reflux is suspected).
- Unable to wean off treatment by the age of 6 months.
*PLEASE NOTE: Infantile Colic is also a stressor for parents. If your baby has colic, have some part-time help, if at possible, so that you can take a ‘time-out’. An afternoon away from home once a week may also help you cope with this very tiring experience. Remember, worrying only makes it harder to cope.
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