Let’s review infant colic.
Infant colic happens in the
first six months of life.
And it’s a period when a
child has extreme crying.
This can be remarkably
frustrating for parents.
These infants may be complete inconsolable
with their normal interventions
such as rocking or bouncing them
or taking them for a stroll.
It can be very frustrating because
parents may think that something’s wrong
and yet they take their child to the
doctor and there’s nothing going on.
It typically happens at
the same time of day.
And usually around two to six weeks of age.
It may start and stop quickly.
They may have a three-week period
when they’re screaming and crying
and then it just goes away.
And it’s not attributable
to any other cause.
We should examine these children and
make sure there’s nothing going on like,
classically, a scratched cornea or they
may present with crying very severely
and it turns out they have a hair
tourniquet around their finger.
So what are some things that could
cause excessive crying in children
that are not colic that
we have to rule out.
There’s a mnemonic, ITCRIESS, with two S’s.
We can go through that.
I is infections such as urinary tract
infection, meningitis or osteomyelitis.
These infants typically will have fevers.
Trauma, which may
When you examine these patients,
you want to gently squeeze
every bone in their body to make
sure there’s not a broken bone.
Parents who have committed trauma don’t
usually immediately fess up to it.
They may have
There are some way you can figure that out
and you can listen to that more
in my child abuse lecture.
Patients may have cardiac issues.
They may be in congenital heart failure.
So that’s something you want to watch for.
Children very rarely can have reflux or
allergy to formula, which causes crying.
They may have immunization
reactions or insect bites.
They may have corneal abrasions.
In any child who presents
with excessive crying,
it’s very reasonable to
do a fluorescein exam
of the eye to look for
a corneal abrasion.
That will heal up
in a day or two.
Rarely, patients have a surgical issue.
Examples would be malrotation,
which is sort of like volvulus,
or intussusception or an inguinal hernia.
Or they may have a strangulation from a
hair tourniquet like you can see here.
It’s where a hair accidentally
gets wrapped around fingers,
toes, the penis, or the clitoris.
All those things can happen.
So how do we define infant colic?
We have a rule of threes.
A child should have crying for
at least three hours a day.
It should occur three days a week.
And it should be present
for at least three weeks.
If it satisfies these criteria, we typically
say, “Yes, your infant has infant colic.”
There aren’t a lot of things unfortunately
we can do for infant colic that are
hugely effective except assuring families
that eventually their child will outgrow it.
Changing formula is common,
but it very rarely helps.
What usually happens is they change
their formula to something else,
the colic goes away,
and the parent becomes insistent that
that formula change was the key thing.
So if they do change the formula,
when the child gets better,
it’s reasonable to go back to the
old formula if it’s more expensive.
So if they, for some reason, ended up on for
example Alimentum, which is very costly,
it might be reasonable to go back
to a cow’s milk based formula
to give it a try so you might save
that family some substantial money.
It’s important to acknowledge the parent’s
frustration and screen for abuse.
A really good question is how is
your child to get along with?
If the parent describes
you need to screen for abuse
in that circumstance.
It’s important that patients feed their
babies upright with frequent burping.
Babies who lie down or don’t
get burped may have reflux
that may be exacerbating
Smaller amounts more frequent are better
than the larger amounts less frequently.
It’s important to reduce extra
stimulation in these infants.
If they’re sleeping, let them lie.
Also, soothing music,
swaddling is key,
massaging or rocking
are all options.
And a pacifier use may help.
Although sometimes, it’s hard to get the
child off the pacifier later in life.
Let’s briefly discuss breath holding
spells to end this lecture.
Breath holding spells are a
common phenomenon in children
and can be completely
terrifying to parents.
They’re normal and they
don’t cause problems.
Basically, when a child experiences
something that they don’t like,
it can be a frustration, it can
be something that frightens them
or it can be almost random,
they start with crying,
and then they just
hold their breath.
It’s almost like they’re
opposition to the world is
“I’m going to hold my
breath and show you.”
Then, they can develop color change.
They may develop cyanosis, like
this boy is pictured having.
This may result in a loss of tone or
even frank loss of consciousness.
Children can hold their
breath until they pass out.
This can start as early as six months
and generally go for several years.
The way to avoid these and
the way to treat these
is to encourage the parents
to use distraction therapy
and not to give them too much
attention when they do it,
once it’s established that
this in fact what’s going on
and it’s not a seizure or
something more significant.
Generally, six months to eighteen
months of age is the typical age.
And for this, really no testing is needed.
If it fits the general criteria
of having a stimulation
and following through those
steps that I’ve described.
Generally, care is largely supportive.
We have to help the parents learn
to manage their children’s tantrums.
Emphasize the benign nature of the event
and encourage distraction techniques.
Rarely iron supplements
may reduce the frequency
even in patients who
don’t have anemia.
Nobody’s really sure why that
works, but sometimes it does,
and in severe cases, you
can certainly try it.
So that’s my review of these general
behavioral problems in kids.
Thanks for your time.