Baby colic
Template:For Template:Infobox medical condition (new) Baby colic, also known as infantile colic, is defined as episodes of crying for more than three hours a day, for more than three days a week, for three weeks in an otherwise healthy child.<ref name=AFP2015/> Often crying occurs in the evening.<ref name=AFP2015/> It typically does not result in long-term problems.<ref name=Gri2014>Template:Cite book</ref> The crying can result in frustration of the parents, depression following delivery, excess visits to the doctor, and child abuse.<ref name=AFP2015>Template:Cite journal</ref>
The cause of colic is unknown.<ref name=AFP2015/> Some believe it is due to gastrointestinal discomfort like intestinal cramping.<ref>Template:Cite journal</ref> Diagnosis requires ruling out other possible causes.<ref name=AFP2015/> Concerning findings include a fever, poor activity, or a swollen abdomen.<ref name=AFP2015/> Fewer than 5% of infants with excess crying have an underlying organic disease.<ref name=AFP2015/>
Treatment is generally conservative, with little to no role for either medications or alternative therapies.<ref name=Bia2016>Template:Cite journal</ref> Extra support for the parents may be useful.<ref name=AFP2015/> Tentative evidence supports certain probiotics for the baby and a low-allergen diet by the mother in those who are breastfed.<ref name=AFP2015/> Hydrolyzed formula may be useful in those who are bottlefed.<ref name=AFP2015/>
Colic affects 10–40% of babies.<ref name=AFP2015/> Equally common in bottle and breast-fed infants, it begins during the second week of life, peaks at 6 weeks, and resolves between 12 and 16 weeks.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It rarely lasts up to one year of age.<ref>Template:Cite journal</ref> It occurs at the same rate in boys and in girls.<ref name=AFP2015/> The first detailed medical description of the problem was published in 1954.<ref>Template:Cite book</ref>
Signs and symptomsEdit
Colic is defined as episodes of crying for more than three hours a day, for more than three days a week for at least a three-week duration in an otherwise healthy child.<ref name=AFP2004/> It is most common around six weeks of age and gets better by six months of age.<ref name=AFP2004/> By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks.<ref name=AFP2004/> With colic, periods of crying most commonly happen in the evening and for no obvious reason.<ref name=AFP2015/> Associated symptoms may include legs pulled up to the stomach, a flushed face, clenched hands, and a wrinkled brow.<ref name=AFP2004/> The cry is often high pitched (piercing).<ref name=AFP2004/>
Effect on the familyEdit
An infant with colic may affect family stability and be a cause of short-term anxiety or depression in the parent(s).<ref name=AFP2004/> It may also contribute to exhaustion and stress in the parent(s).<ref name=Ia2012>Template:Cite journal</ref>
Persistent infant crying has been associated with severe marital discord, postpartum depression, early termination of breastfeeding, frequent visits to doctors, a quadrupling of laboratory tests, and prescription of medication for acid reflux.Template:Citation needed Babies with colic may be exposed to abuse, especially shaken baby syndrome.<ref name=AFP2004/>
Parent training programs for managing infantile colic may result in a reduction in crying time.<ref>Template:Cite journal</ref>
CausesEdit
The cause of colic is generally unknown. Fewer than 5% of infants who cry excessively turn out to have an underlying organic disease, such as constipation, gastroesophageal reflux disease, lactose intolerance, anal fissures, subdural hematomas, or infantile migraine.<ref name=AFP2004/> Babies fed cow's milk have been shown to develop antibody responses to the bovine protein, and some studies have shown an association between consumption of cow's milk and infant colic.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Studies performed showed conflicting evidence about the role of cow's milk allergy.<ref name=AFP2004/> While previously believed to be related to gas pains, this does not appear to be the case.<ref name=AFP2004/> Another theory holds that colic is related to hyperperistalsis of the digestive tube (increased level of activity of contraction and relaxation). The evidence that the use of anticholinergic agents improve colic symptoms supports this hypothesis.<ref name=AFP2004/>
Psychological and social factors have been proposed as a cause, but there is no evidence. Studies performed do not support the theory that maternal (or paternal) personality or anxiety causes colic, nor that it is a consequence of a difficult temperament of the baby, but families with colicky children may eventually develop anxiety, fatigue and problems with family functioning as a result.<ref name=AFP2004/> There is some evidence that cigarette smoke may increase the risk.<ref name=AFP2015/> It seems unrelated to breast or bottle feeding with rates similar in both groups.<ref name=Sher2010>Template:Cite journal</ref> Reflux does not appear to be related to colic.<ref name=Ben2016/>
DiagnosisEdit
Colic is diagnosed after other potential causes of crying are excluded.<ref name=AFP2004>Template:Cite journal</ref> This can typically be done via a history and physical exam, and in most cases tests such as X-rays or blood tests are not needed.<ref name=AFP2004/> Babies who cry may simply be hungry, uncomfortable, or ill.<ref>Template:Cite journal</ref> Less than 10% of babies who would meet the definition of colic based on the amount they cry have an identifiable underlying disease.<ref>Template:Cite journal</ref>
Cause for concern include: an elevated temperature, a history of breathing problems or a child who is not appropriately gaining weight.<ref name=AFP2004/>
Indications that further investigations may be needed include:<ref name="Karp">Template:Cite bookTemplate:Page needed</ref>
- Vomiting (vomit that is green or yellow, bloody or occurring more than five times a day)
- Change in stool (constipation or diarrhea, especially with blood or mucus)
- Abnormal temperature (a rectal temperature less than Template:Convert or over Template:Convert
- Irritability (crying all day with few calm periods in between)
- Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over six hours)
- Poor weight gain (gaining less than 15 grams a day)
Problems to consider when the above are present include:<ref name="Karp" />
- Infections (e.g. ear infection, urine infection, meningitis, appendicitis)
- Intestinal pain (e.g. food allergy, acid reflux, constipation, intestinal blockage)
- Trouble breathing (e.g. from a cold, excessive dust, congenital nasal blockage, oversized tongue)
- Increased brain pressure (e.g. hematoma, hydrocephalus)
- Skin pain (e.g. a loose diaper pin, irritated rash, a hair wrapped around a toe)
- Mouth pain (e.g. yeast infection)
- Kidney pain (e.g. blockage of the urinary system)
- Eye pain (e.g. scratched cornea, glaucoma)
- Overdose (e.g. excessive Vitamin D, excessive sodium)
- Others (e.g. migraine headache, heart failure, hyperthyroidism)
Persistently fussy babies with poor weight gain, vomiting more than five times a day, or other significant feeding problems should be evaluated for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).<ref name="Heine">Template:Cite journal</ref>
TreatmentEdit
Management of colic is generally conservative and involves the reassurance of parents.<ref name=AFP2004/> Calming measures may be used and include soothing motions, limiting stimulation, pacifier use, and carrying the baby around in a carrier,<ref name=AFP2004/> although it is not entirely clear if these actions have any effect beyond placebo.<ref name=AFP2004/><ref name=Ches2012>Template:Cite journal</ref> Swaddling does not appear to help.<ref name=AFP2015/>
MedicationEdit
No medications have been found to be both safe and effective.<ref name=AFP2004/> Simethicone is safe but ineffective, while dicyclomine works but is unsafe.<ref name=AFP2004/> Evidence does not support the use of cimetropium bromide,<ref name=Ches2012/> and there is little evidence for alternative medications or techniques.<ref>Template:Cite journal</ref> While medications to treat reflux are common, there is no evidence that they are useful.<ref name=Ben2016>Template:Cite journal</ref> Doses of Lactase taken orally along with milk may help.<ref>Template:Cite journal</ref>
DietEdit
Dietary changes by infants are generally not needed.<ref name=AFP2004/> In mothers who are breastfeeding, a hypoallergenic diet by the mother—not eating milk and dairy products, eggs, wheat, and nuts—may improve matters,<ref name=AFP2004/><ref name=Ia2012/><ref name=NocerinoPezzella2015>Template:Cite journal</ref> while elimination of only cow's milk does not seem to produce any improvement.<ref name=NocerinoPezzella2015 /> In formula-fed infants, switching to a soy-based or hydrolyzed protein formula may help.<ref name=Ia2012/> Evidence of benefit is greater for hydrolyzed protein formula with the benefit from soy based formula being disputed.<ref>Template:Cite journal</ref><ref name=Savino2010>Template:Cite journal</ref> Both these formulas have greater cost and may not be as palatable.<ref name=Savino2010/> Supplementation with fiber has not been shown to have any benefit.<ref name=Ia2012/> A 2018 Cochrane review of 15 randomized controlled trials involving 1,121 infants was unable to recommend any dietary interventions.<ref>Template:Cite journal</ref> A 2019 review determined that probiotics were no more effective than placebo although a reduction in crying time was measured.<ref>Template:Cite journal</ref>
Complementary and alternative medicineEdit
No clear beneficial effect from spinal manipulation<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> or massage has been shown.<ref name=AFP2004/> Further, as there is no evidence of safety for cervical manipulation for baby colic, it is not advised.<ref name=CamilleriPark2017>Template:Cite journal</ref> There is a case of a three-month-old dying following manipulation of the neck area.<ref name=CamilleriPark2017 />
Little clinical evidence supports the efficacy of "gripe water" and caution in use is needed, especially in formulations that include alcohol or sugar.<ref name=AFP2004/> Evidence does not support lactase supplementation.<ref name=Ches2012/> The use of probiotics, specifically Lactobacillus reuteri, decreases crying time at three weeks by 46 minutes in breastfeed babies but has unclear effects in those who are formula fed.<ref>Template:Cite journal</ref> Fennel also appears effective.<ref name="Harb">Template:Cite journal</ref><ref>Template:Cite journal</ref>
PrognosisEdit
Infants who are colicky do just as well as their non colicky peers with respect to temperament at one year of age.<ref name=AFP2004/>
EpidemiologyEdit
Colic affects 10–40% of children,<ref name=AFP2015/> occurring at the same rate in boys and in girls.<ref name=Sher2010/>
HistoryEdit
The word "colic" is derived from the ancient Greek word for intestine (sharing the same root as the word "colon").<ref>Template:Cite news</ref>
It has been an age-old practice to drug crying infants. During the second century AD, the Greek physician Galen prescribed opium to calm fussy babies, and during the Middle Ages in Europe, mothers and wet nurses smeared their nipples with opium lotions before each feeding. Alcohol was also commonly given to infants.<ref name="Solter 1998">Template:Cite book</ref>