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Infantile colic
This document discusses infantile colic, including definitions, pathophysiology, clinical features, diagnosis, and treatment options. Infantile colic is characterized by paroxysms of crying or fussing in an otherwise healthy infant under 4 months of age for at least 3 hours per day and for at least 1 week. The cause is unknown but may involve factors like immature gastrointestinal tract, cow's milk protein intolerance, or altered gut flora. Treatment focuses on parental counseling and reassurance, with some evidence that probiotic supplementation may help in severe cases.
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Introduction to infant crying as a signal of need, its implications for parents and doctors, and the behavioral syndrome associated with early infancy.
Normal crying patterns in infants vary; all cry more in the first three months; context determines normality of crying.
Definitions of crying conditions such as infant colic and FGIDs; 1 in 2 infants have FGIDs; common types include regurgitation and colic.
Exploring pathophysiology, lactose intolerance, altered gut flora, and clinical features related to infant crying and colic.
Importance of detailed caregiver history and physical examination to rule out causes; vital signs and growth measurements are critical.
Treatment focuses on parental counseling, possible dietary and pharmacological interventions; recognizes the benign nature of colic yet acknowledges parent stress.
Management is multifactorial; evidence suggests dietary modifications may help, but more research is needed for definitive treatments.
A list of references and studies supporting the information presented throughout the slides.
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Infantile colic
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- 3. 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
- 4. 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. • Varied widely from infant to infant • “Normal" and “Abnormal" crying depend upon the context and quality of crying
- 5. 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
- 6. What are FGIDs? •FGIDs are gastrointestinal disorders that include chronic or recurrent symptoms that cannot be explained by obvious structural or biochemical abnormalities • Almost 1 in every 2 infants experience at least one FGID or related symptoms in the first years after birth • The most frequent FGIDs are3: • Regurgitation 30% • Infantile colic 20% • Constipation 15% 1. Benninga MA, et al. Gastroenterol, 150(6):1443–55, 2016 2. Iacono G, et al. Dig Liver Dis, 37(6): 432–8, 2005. 3.Vandenplas Y, et al. J Pediatr Gastroenterol Nutr, 61(5): 531–7, 2015
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- 12. DIAGNOSIS • Explore commoncauses of crying
- 13. •A comprehensive historyof the caregiving of the child should be obtained, including feeding, sleeping and toileting patterns. • It is important to elicit this history from the main caregiver, who may not always be the parents.
- 14. Physical examination • Physicalexamination is important to exclude other possible causes of screaming and crying, such as otitis media, intussusception, fracture, corneal abrasion, incarcerated hernia, or anal fissure. • Weight, height, and head circumference should be plotted on standard growth charts, since poor growth suggests the possibility of an underlying chronic systemic disorder. • Vital signs should be noted. • Fever indicates an underlying infection. • UTI may be suspected when the infant has fever or malodorous urine and is not feeding well or not gaining weight.
- 15. Investigations •Investigations are notrequired for the diagnosis of colic, but if clinical findings suggest another cause, appropriate investigations may be indicated.
- 16. 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
- 17. •Parental behavioral interventions, •Dietarysupplementation, •Pharmacological intervention and •Manipulative therapies
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- 19. • Breastfeeding mothersshould continue breastfeeding • Use of hypo-allergenic diets by breastfeeding mothers should be considered at least for those infants with severe colic or with atopic features • Where a suspicion of cow's milk protein allergy exists there is some evidence that the use of an empirical time-limited trial of a completely hydrolysed formula is a reasonable option • Partially hydrolysed formulas are not recommended for the management of infantile colic • There is no proven role for the use of soy-based formulas or of lactase therapy in the management of baby colic and these interventions are not recommended
- 20. •Lactase supplementation •Probiotic supplementation •Fermentedformula with oligosaccharides
- 21. PHARMACOLOGICAL INTERVENTION (Unproveninterventions) a systematic review found that it is no better than a placebo. • Dicyclomine hydrochloride, • Cimetropium bromide, • Simethicone, • Sucrose • Herbal medications
- 22. 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. • Other strains of Lactobacillus and Bifidobacter have also been used but the scientific evidence is limited.
- 23. 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
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- 25. 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.
- 27. Referancess Akman I, etal. Arch Dis Child, 91(5):417–9, 2006. Benninga MA, et al. Gastroenterol, 150(6):1443–55, 2016 Bongers ME, et al. Nutr J, 6:8, 2007. Brown MM, et al. Curr OpinOphthalmol, 20(3):188–94 ,2009. Iacono G, et al. Dig Liver Dis, 37(6): 432–8, 2005. Indrio F, et al. Eur J Pediatr, 174(6):841-2, 2015. Miller-LoncarC, et al. Arch Dis Child, 89(10):908–12, 2004. Morris S. Econ Hist Rev, 54(3):525–45, 2001. Partty A, et al. JAMA Pediatr, 167: 977–8, 2013 Rautava P, et al. Pediatrics, 96(1) :43–7, 1995. Sano F, et al. Eur J Clin Nutr, 60:1304–10, 2006. Sano F, et al. Eur J Clin Nutr, 60:1304–10, 2006. Schmelze H, et al. JPGN, 36:343–51, 2003. SommersT, et al. Am J Gastroenterol, 110(4):572–9, 2015. VandenplasY, et al. J Pediatr Gastroenterol Nutr, 61(5): 531–7, 2015. VandenplasY, et al.The 47th ESPGHANAnnual Meeting, 9–12 June, 2014, Jerusalem, Israel.Abstract #PO-N-0253. VeitlV, et al. J Emahrüngsmed, 2:14–20, 2000. VikT, et al. Acta Paediatr, 98(8):1344–8, 2009