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.

1. INFANTILE COLIC
DR R PETER M.D.(PAED)., D.M.(NEO).,
CONSULTANT NEONATOLOGIST

2. 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
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3. 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.
• 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
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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
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5. FGID5

6. DEFINITIONS
• ROME IV
“An infant 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
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7. PATHOPHYSIOLOGY
Gastrointestinal
• Developmental Lactose intolerance
• 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
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8. LACTOSE INTOLERANCE
Hydrogen breath test >20ppm
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9. ALTERED GUT FLORA
Micro biota 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
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10. CLINICAL FEATURES
• The over-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.
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11. 11

12. DIAGNOSIS
• Barr Baby Day Diary
• Ames Cry Score
• Parental Diary of Infant Cry and Fuss Behaviour
• Crying pattern Questionnaire
• Infant Colic Scale
• R4PDQ questionnaire- online
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13. BARR BABY DAY DIARY13

14. PARENTAL DIARY OF INFANT CRY AND FUSS
BEHAVIOUR
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15. 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
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16. TREATMENT
Parental behavioral interventions,
Dietary supplementation,
Pharmacological intervention and
Manipulative therapies.
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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.
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18. PHARMACOLOGICAL INTERVENTION
• Dicyclomine hydrochloride,
• Cimetropium bromide,
• Simethicone,
• Sucrose
• Herbal medications
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19. In a study conducted 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, 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.

22. DIETARY SUPPLEMENTATION
Lactase supplementation
Probiotic supplementation
Hydrolyzed infant formula/ infants with cow milk allergy [CMA]
Fermented formula with oligosaccharides
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23. 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.
• Wreeth et al – Prophylactic
• Other strains of Lactobacillus and Bifidobacter have also been
used but the scientific evidence is limited.
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24. Lactobacillus Reuteri DSM 17938
• 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
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25. 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
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26. COLIC CASCADE CONTROL26
Kalliomaki M, Laippala P et al.

28. 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.
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29. THANK YOU