3. INTRODUCTION
• Crying is good 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 OF CRYING
• 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
13. •A comprehensive history of 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
• Physical examination 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 not required for the diagnosis of
colic, but if clinical findings suggest another cause,
appropriate investigations may be indicated.
16. TREATMENT
• The main treatment 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
19. • Breastfeeding mothers should 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
21. PHARMACOLOGICAL INTERVENTION (Unproven interventions)
a systematic review found that it is no better than a placebo.
• Dicyclomine hydrochloride,
• Cimetropium bromide,
• Simethicone,
• Sucrose
• Herbal medications
22. PROBIOTIC SUPPLEMENTATION
• The most 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 colic is 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. CONCLUSION
• Multi-factorial etiology with 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.
26.
27. Referancess
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Benninga MA, et al. Gastroenterol, 150(6):1443–55, 2016
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Iacono G, et al. Dig Liver Dis, 37(6): 432–8, 2005.
Indrio F, et al. Eur J Pediatr, 174(6):841-2, 2015.
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Partty A, et al. JAMA Pediatr, 167: 977–8, 2013
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