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![DIETARY SUPPLEMENTATION
Lactase supplementation
Probiotic supplementation
Hydrolyzed infant formula/ infants with cow milk allergy [CMA]
Fermented formula with oligosaccharides
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Infantile colic
Infantile colic is a self-limiting condition characterized by periods of crying in otherwise healthy infants under 5 months of age. While the exact cause is unknown, potential contributors include immature gastrointestinal and central nervous systems, lactose intolerance, altered gut microflora, and behavioral factors. The main treatment is parental counseling and reassurance as the condition typically resolves by 3 months of age. Dietary interventions like lactase supplementation or probiotics containing Lactobacillus reuteri have shown benefits, but more research is still needed on effective management options.
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Infantile colic
- 1. INFANTILE COLIC DR RPETER M.D.(PAED)., D.M.(NEO)., CONSULTANT NEONATOLOGIST
- 2. INTRODUCTION • Crying isgood signal that child is in need but a poor signal of what the child needs • Self limiting condition • Anxiety & distress for parents and challenge for doctors • Behavioral Syndrome of Early Infancy 2
- 3. NORMAL PATTERNS OFCRYING • All infants, whether or not they have colic, cry more during the first three months of life than at any other time. • In a meta-analysis of 28 studies of diaries documenting the duration of fussing and crying in 8690 infants, • Mean duration of crying was 117 to 133 minutes per day during the first six weeks of life • Decreased to 68 minutes per day by 10 to 12 weeks, • Varied widely from infant to infant • “Normal" and “Abnormal" crying depend upon the context and quality of crying 3
- 4. DEFINITIONS • Wessel –1954 • A condition occurring in an otherwise healthy , well fed infant with crying or fussing for more than three hours a day a week and for more than three weeks • Modified wessel – duration reduced from 3 weeks to 1 weeks • FGID- Functional Gasterointestinal Disorder • Infants from birth to four months , paroxysm of irritability, fussing/crying that starts and stops without any obvious cause, episodes lasting three or more hours /day for at least one week and no failure to thrive 4
- 5.
- 6. DEFINITIONS • ROME IV “Aninfant who is less than five months of age when symptoms start and stop; recurrent and prolonged periods of infant crying , fussing or irritability reported by care givers that occurs without any obvious cause and cannot be prevented or resolved by caregivers ; no evidence of infant failure to thrive , fever or illiness “ Fussing refers to intermittent distressed vocalization that is not quite crying but not awake and content either 6
- 7. PATHOPHYSIOLOGY Gastrointestinal • Developmental Lactoseintolerance • Immaturity of enteric nervous system, • Increased motilin receptor or cow milk hyper sensitivity • Altered Gut microorganism Non Gastrointestinal • Behavioral causes • Altered parent child interaction • Immaturity of CNS • Early form of migraine 7
- 8. LACTOSE INTOLERANCE Hydrogen breathtest >20ppm 8
- 9. ALTERED GUT FLORA Microbiota alteration Implication in infant colic Low microbiota diversity and stability: changes in metabolome Alterations in intestinal transit Spasmodic bowel movements Gas accumulation Higher levels of calprotectin: inflammation ↑Enterobacteriaceae Gas accumulation: bloating and digestive discomfort Pro-inflammatory and hyperalgesia reaction to LPS ↓Bifidobacterium Immune response modulation ↓Lactobacillus Expression of anti-inflammatory genes 9
- 10. CLINICAL FEATURES • Theover-anxious parent with an inconsolable infant. • These cries are associated with hypertonia, facial flushing, withdrawal of legs towards abdomen and flatulence. • Infant colic begins by 2 to 3 weeks of age, peaks by 6 weeks and resolves by 3 months • There is no sex predisposition; but familial predisposition has been suggested Important negative history includes history of fall, fever, vomiting, seizures, poor oral acceptance, crying associated with micturition, ear discharge or vaccination. 10
- 11.
- 12. DIAGNOSIS • Barr BabyDay Diary • Ames Cry Score • Parental Diary of Infant Cry and Fuss Behaviour • Crying pattern Questionnaire • Infant Colic Scale • R4PDQ questionnaire- online 12
- 13. BARR BABY DAYDIARY13
- 14. PARENTAL DIARY OFINFANT CRY AND FUSS BEHAVIOUR 14
- 15. TREATMENT • The maintreatment of infant colic is first excluding all causes of excessive crying in an infant followed by counseling and reassurance of the parents. • It is emphasized that colic is a diagnosis of exclusion in a well thriving infant and if a baby is visibly sick, diagnosis of colic is not considered. • There are no established guidelines for management of colic. • In general, treatment is individualized with special emphasis on counseling the parents 15
- 16. TREATMENT Parental behavioral interventions, Dietarysupplementation, Pharmacological intervention and Manipulative therapies. 16
- 17. PARENTAL BEHAVIORAL INTERVENTIONS •5s technique 1. Swaddling, 2. Side/ stomach, 3. Shh-sound, 4. Swinging the baby with tiny jiggly movements, 5. Suckling (letting the baby suckle on breast/ clean pacifier) • Other techniques of infant calming include use of white noise, minimal handling, and simulating car ride. 17
- 18. PHARMACOLOGICAL INTERVENTION • Dicyclominehydrochloride, • Cimetropium bromide, • Simethicone, • Sucrose • Herbal medications 18
- 19. In a studyconducted in JIPMER on 335 mothers of infant aged 1-6 months showed that 64.28% of mothers used gripe water and their most common belief was that it aided in digestion and decreased abdominal pain Jain K, Gunasekaran D, Venkatesh C, Soundararajan P. Gripe Water Administration in Infants 1-6 months of Age-A Cross-sectional Study. J Clin Diagn Res. 2015;9(11):SC06-8.
- 20. Jain K, GunasekaranD, Venkatesh C, Soundararajan P. Gripe Water Administration in Infants 1-6 months of Age-A Cross-sectional Study. J Clin Diagn Res. 2015;9(11):SC06-8.
- 22. DIETARY SUPPLEMENTATION Lactase supplementation Probioticsupplementation Hydrolyzed infant formula/ infants with cow milk allergy [CMA] Fermented formula with oligosaccharides 22
- 23. PROBIOTIC SUPPLEMENTATION • Themost researched bacteria is Lactobacillus reuteri DSM 17938 • Orally in a dose of 1x108 CFU as five drops a day • Improvement with the use of probiotics can be actually a part of the natural course of the condition than the actual effect. • Wreeth et al – Prophylactic • Other strains of Lactobacillus and Bifidobacter have also been used but the scientific evidence is limited. 23
- 24. Lactobacillus Reuteri DSM17938 • Savino, F. et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics 126, 526–533 (2010). • Chau, Kim et al. Probiotics for Infantile Colic: A Randomized, Double-Blind, Placebo-Controlled Trial Investigating Lactobacillus reuteri DSM 17938. The Journal of Pediatrics , Volume 166 , Issue 1 , 74 - 78.e1 • Significant increase in fecal lactobacilli and reduction in e.coli and ammonia • Reduction in daily crying time 24
- 25. CONSEQUENCES • Infant colicis a benign condition which improves with time. • Despite its benign nature it can act as a significant stressor for parents which leads to self-doubt, premature termination of breast feeding or even child abuse. • Long term consequences though few have been documented in literature include recurrent abdominal pain, behavioral problem, eating problem and migraine 25
- 26. COLIC CASCADE CONTROL26 KalliomakiM, Laippala P et al.
- 28. CONCLUSION • Multi-factorial etiologywith wide variety of treatment options. • The diagnosis is entirely clinical and laboratory investigations are not recommended. • Counseling is the cornerstone of management till high-level evidence regarding other treatment options is available. • Even though there is insufficient evidence regarding the effective treatment options for infant colic, few commonly used options have been rejected based on current evidence like Simethicone, Dicyclomine, Proton-pump inhibitors, and Gripe water. • Dietary modifications like lactase and probiotic supplementation have shown benefits but more randomized control trials will be required. 28
- 29.
Editor's Notes
- #2 Good evening to all I am going to speak about big problem in small babies Persistent Headache for parents and recurrent headache for treating paediatricians That is nothing but INFANTILE COLIC The most common reason for consulting doctor
- #3 Crying is an essential behavior to communicate the demands of the baby so that it can be fulfilled by the caregiver. Crying is a good signal that child is in need but a poor signal of what the child needs. Prolonged crying or fussing, particularly unsoothable crying is a source of anxiety and distress for the parents, and challenge for the doctor. Infant colic is a diagnosis of exclusion for prolonged cry in early infancy. Infantile colic considered as a marker of Behavioral Syndrome of Early Infancy
- #4 Before going to discuss infantile colic let see what is normal in relation with patterns of cry
- #5 Let see the various definitions for Infantile colic In 1954 wessel defined infantile colic a condition A condition occurring in an otherwise healthy , well fed infant with crying or fussing for more than three hours a day a week and for more than three weeks So it was very difficulty to ask the parents to wait for three weeks to conclude as infantile colic Then they have modified the definition to 1 week Again the problem arised in respect with duration
- #6 Functional gastero intestinal disorders that include chronic or recurrent symptoms that cannot be explained by obvious structural or biochemical abnormalities Occurs in almost one in every 2 infants experience at least one FGID in the first years after birth The most common FGID are 30% regurgitation followed by INFANTILE COLIC THEN Constipation
- #8 Two broad theories explained for pathophysiology of infantile colic 1. Gastero intestinal 2. non gastero intestinal
- #9 Diurnal variation not explained , reducing substance negative
- #14 In this diary, each day was divided into four time rulers representing night, morning, afternoon and evening. Each time ruler was further divided into six divisions representing six hours. The smallest time division which could be represented in this diary is five minutes. These time rulers have to be shaded by the parents according to infant behavior: sleeping, awake and feeding, awake and content, awake and fussing, awake and crying, awake and sucking
- #17 Broadly these interventions are classified as Parental behavioral interventions, Dietary supplementation, Pharmacological intervention and Manipulative therapies.
- #29 Infant colic is a condition of multi-factorial etiology with wide variety of treatment options. The diagnosis of infant colic is entirely clinical and laboratory investigations are not recommended. Even after the diagnosis of colic, the child should be properly followed-up. At a time when most of the research is being focused on infant feed supplementation, it should not be forgotten that counseling is the cornerstone of management till high-level evidence regarding other treatment options is available. Even though there is insufficient evidence regarding the effective treatment options for infant colic, few commonly used options have been rejected based on current evidence like Simethicone, Dicyclomine, Proton-pump inhibitors, and Gripe water. Dietary modifications like lactase and probiotic supplementation have shown benefits but more randomized control trials will be required. More research is needed in this field with uniformity in definition, large sample size, different population, and uniform outcome measures.