Introduction to Colic

Colic is commonly described as a behavioral syndrome characterized by excessive, paroxysmal crying. Colic is most likely to occur in the evenings, and it occurs without any identifiable cause. During episodes of colic, an otherwise healthy neonate or infant aged 2 weeks to 4 months is difficult to console. They stiffen, draw up their legs, and pass flatus. Colic is one of the common reasons parents seek the advice of a pediatrician or family practitioner during their child’s first 3 months of life.

Definition
The most widely used definition of colic is based on the amount of crying (i.e, paroxysms of crying lasting >3 hours, occurring >3 days in any week for 3 weeks).

Causes
Colic is a poorly understood phenomenon. It is equally likely to occur in both breastfed and formula-fed infants. Although potential adverse sequelae have been described, the disorder is generally believed to be self-limited and benign. Different feeding practices and crying may result in large amounts of air entering the gastric lumen, which suggests that excessive aerophagia may be associated with colic. Colonic fermentation is the second proposed source of excessive intestinal gas in infants. However, no experimental evidence supports either theory.

Epidemiology

• Colic affects 10-30% of infants worldwide.
• This condition is encountered in male and female infants with equal frequency.
• The colic syndrome is commonly observed in neonates and infants aged 2 weeks to 4 months.

Clinical Presentation

Colic remains a diagnosis of exclusion.

Crying by infants with or without colic is mostly observed during evening hours and peaks at the age of 6 weeks. The cause of this diurnal rhythm is not known. The amount of crying is not related to an infant’s sex; the mother’s parity; or the parents’ socioeconomic status, education, or ages.

Obtain a detailed history about the timing, the amount of crying, and the family’s daily routine. The benign nature of colic should be emphasized.

Infants with colic often have accelerated growth. Weight gain is typical, whereas failure to thrive should make one suspicious about the diagnosis of colic.

Treatment and Management

Rule out common causes of crying is the first step in treating an infant with persistent crying (ie, colic).

Recommend that the parents not exhaust themselves and encourage them to consider leaving their baby with other caretakers for short respites.

Drug treatment generally has no place in the management of colic, unless the history and investigations reveal gastroesophageal reflux.

Consistent follow-up and a sympathetic physician are the cornerstones of management.

Many benign but unproven treatment modalities are available for colic.

Dicyclomine hydrochloride is an anticholinergic drug that has been proven in clinical trials to be effective in the treatment of colic.

Oral hypertonic glucose and sterile water were compared for treatment of colic in infants in a randomized trial. In the group receiving glucose, 30% had significantly less colic than the placebo group.

Remind parents about the importance of feeding a hungry baby, changing wet diapers, and comforting a baby who is cold and crying as a result of these factors. Soothing music accompanied with parental attention (including eye contact, talking, touching, rocking, walking, and playing) may be effective in some infants and is never harmful.

Encourage parents to discuss their feelings and concerns with each other to obtain support. Emphasize the responsibility of the whole family in the care of a baby with colic.