Colic

Colic is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

  • Crying is considered a normal part of human behavior and is a baby’s most effective form of communication. However, when crying is perceived to be in excess than what is expected, it can cause a family a great deal of distress.
  • Colic is a syndrome of excessive crying for which no organic cause can be identified. It is described as unexplained end-of-the-day crying that begins at age 2 to 3 weeks, peaks at 8 weeks, and tapers at 12 weeks.
  • No standard definition of colic exists. Dr. Brazelton defined it as any excessive crying that worried parents. However, the consensus definition is from 1954 (Wessel) and referred to as the rule of 3’s. He defined colic by the amount of crying:
    • >3 hours a day
    • >3 days a week
    • And lasting at least 3 weeks
  • Colic episodes usually begin suddenly, with no clear reason, and at the end of the day or evening. The crying is intense and high pitched. Infants may have a flushed face, furrowed brow, and postural changes such as bending or drawing up of the knees, clenched fists, and tensed abdominal muscles. Episodes may end with a bowel movement or passing of gas.

Epidemiology

  • Crying is one of the most common reasons families present to a health care professional during the 1st months of life.
  • One in six families who have children with colic seek care from a health care professional.
  • Estimates are difficult to make due to lack of standard definition; literature suggests a prevalence of 3–40%.
  • Incidence is similar in male and females and in breastfed and bottle-fed infants.

Risk Factors

  • Possible risk factors include maternal smoking, increased maternal age, and being the first-born child.
  • In addition, colic has been associated with higher levels of maternal stress, anxiety, and depression.

General Prevention

Although no study has shown any certain way to prevent colic, educating parents about infant crying can be helpful. Remind parents that crying is an infant’s way to communicate, inform them of the expected average hours a day and infant may cry, and teach them soothing techniques.

Etiology

  • The term colic is now considered a misnomer because it derives from the Greek word for colon. Studies in the early 1900s suggested colic was a result of gastrointestinal (GI) dysfunction, whereas today, there are many theories.
  • Causes of colic are multifactorial, and it is typically considered to result from an interaction between infant, maternal, and paternal factors and the environment at a unique time of biologic vulnerability. No single cause has been identified. Several hypotheses for the etiology exist.
    • GI disturbances are often implicated in colic. Abnormal motility has been hypothesized and is somewhat supported by the fact that anticholinergics may improve symptoms. Other studies have shown infants with colic have decreased amounts of lactobacilli and increased amounts of coliform bacteria. Although another theory is that increased gas production can cause colic, this theory is not supported based on radiographs taken during crying spells. Recent studies have suggested an association with Helicobacter pylori and infantile colic. Others theorized that colic is a form of milk protein allergy. However, these studies are limited, and no causality has been established.
    • Psychosocial issues have been implicated including family tension, parental anxiety, or inadequate parent–infant interactions. However, in studies where infants are cared for by trained occupational therapists, symptoms did not improve.
    • A neurodevelopmental etiology is supported by the fact that infants with colic have similar patterns of crying to infants without colic and that colic is outgrown. Excessive crying has also been considered a manifestation of normal emotional development where colic is on the end of a spectrum of crying.

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