Definition of Pediatric (infantile) Colic
Pediatric colic is a very common symptom that occurs in infants during the first few months of life. Colic describes an infant’s behavior when they have episodes of inconsolable screaming or crying, while drawing up the legs.
To distinguish infantile colic from normal crying, infantile colic is said to be defined by the “rule of three”:
- Crying for more than three hours per day,
- Crying for more than three days per week, and
- Crying for longer than three weeks in an infant who is well-fed and otherwise healthy.
Epidemiology and Etiology of Pediatric Colic
Colic is a common problem. The prevalence of colic in infants has been estimated to be 3 – 28%.
The causes of colic are poorly understood. The term “colic” is used because it is assumed that this symptom occurs in infants as a result of colicky abdominal pain; the drawing up of the legs is thought to be due to a tense abdomen with abdominal pain.
However, this is controversial. Some believe that colic represents the upper limit of normal crying. Various theories have also been proposed, such as infant temperament, food allergy, parental stress, gastrointestinal immaturity and maternal smoking, contributing to the display of colic in infants.
Symptoms and Diagnosis of Pediatric Colic
Infants with colic have attacks of screaming, during which they draw up their legs and are not able to be comforted. They are otherwise healthy and thriving infants. There is no significant vomiting and bowel motions are normal.
Colic is a clinical diagnosis, based on a complete history from the parents. A thorough history and physical examination usually reveals no abnormalities, and is done to exclude organic causes of the infant’s irritability. Laboratory testing is unnecessary, but is performed in cases where an organic cause is suspected.
Differential Diagnosis of Pediatric Colic
Clinical pictures similar to colic
Gastro-esophageal reflux disease (episodes of fussiness accompanied by emesis and symptoms, usually present just after feeding).
Milk protein intolerance (associated with diarrhea or hematochezia).
Intussusception (during episodes, the infant becomes pale, and, over time, appears very unwell and lethargic).
Infection e.g. otitis media, meningitis, and urinary tract infection (fever is present).
Therapy of Pediatric Colic
Treatment for colic is just supportive. Parental education and reassurance is essential. The parents should be informed that the infant is not ill and that the excessive crying that occurs is not harmful. Continued inconsolable crying in infants can lead to anxiety, frustration and feelings of inadequacy in parents. These feelings should be acknowledged and the parents reassured that they are not to blame and that they are able caregivers.
Simple interventions may be helpful in improving some cases of colic. Parents should check if the infant is hungry and needs feeding, is tired or soiled. If this is the case, the infant may be settled by feeding, sleeping or having their diaper changed. Otherwise, parents can soothe their crying baby with techniques such as swaddling the infant, gentle rocking motions or non-nutritive sucking.
If the crying persists, parents can allow the infant to cry for a short period of time. Parents should look after themselves too. Getting the support of other family members or friends can be helpful in reducing stress.
It is also important to consider the risk of abuse of infants with ongoing colic, especially in family situations that are unstable, and, in such cases, referral to children’s services is essential.
Progression and Prognosis of Pediatric Colic
Symptoms of colic are generally present in the first three months of life, and tend to disappear by the fourth month. The presence of colic in a young infant does not mean the baby will have a more difficult temperament when they are older.