Colic - Causes, Diagnosis, and Management

Introduction:

A colic baby is a healthy baby characterized by intense crying for a prolonged time duration repeatedly. They are inconsolable and scream without any obvious reason. These babies are often referred to as colicky. Usually, colic presents at the same time of the day, especially during the evening when the parents are often tired. This can be stressful for both the baby and the parents. Colic or infantile colic affects about 20 % of all infants. It is typically seen in the second or third week of life, with its peak in the sixth week, and resolves after three to four months of age.

What Are the Causes of Colic?

Despite being a common condition, researchers could not rule out the exact cause of infantile colic. It remains unpredictable. However, several other etiological factors contribute to colic in infants.

• Immaturity of the gastrointestinal system.

• Imbalance in the intestinal microflora.

• Improper feeding patterns, either overfeeding or underfeeding the baby.

• An anxious baby. Fear, frustration, and even such emotions cause colic pain in them.

• Intolerance to certain foods, especially the cow’s milk protein, proteins in breast milk, or formula milk.

• Any change in the diet of the breastfeeding mom.

• Increased serotonin secretion.

• Maternal smoking or nicotine therapy.

• According to Rhoad’s JM, Fatheree et al. and Savino F, and De Marco et al., higher levels of fecal calprotectin (a marker of colonic inflammation) in infants cause colic.

How to Identify Your Colic Baby?

Colic develops suddenly. Babies tend to be fussier, uncomfortable, and do not eat and sleep well. They cry continuously for more than three hours a day. Here are some clues to identify your colicky baby,

• High-pitched crying. Crying subsides when the baby gets tired or when gas stool is passed.

• Hard to soothe.

• The face appears red and pale around the mouth.

• The belly is swollen and tense.

• Stiffened legs, arms, clenched fist.

• They draw up the legs creating tension in the abdomen.

Are There Any Criteria for Colic?

Of course, yes, there are two traditional criteria where the first one has undergone a transition over the years and later is more consistent.

1. Wessel’s Rule of 3’s Diagnostic Criteria:

Symptoms lasting for more than

• Three hours a day.

• Three or more days a week.

• Three or more weeks starting around three months of age.

2. The Rome IV Criteria:

It describes colic from birth to five months of age.

• Symptoms start and stop in an infant younger than five months of age.

• Recurrent, prolonged episodes of crying without any obvious cause and cannot be calmed down by the parent or caretaker.

• The baby appears perfectly healthy, without any history of fever, illness, or failure to thrive.

Who Gets Colic?

• Any baby between two and six weeks of age can get colic.

• All families can have a colicky baby.

• There is no associated risk with the gender, socioeconomic status, feeding practices, or preterm or full-term baby.

• However, infants born to mothers who smoked during or after pregnancy are at high risk.

How Is Colic Diagnosed?

Although colic is a self-limiting condition, thorough health history and physical examination are required to rule out any underlying serious health issues. The doctor or a pediatrician diagnoses colic based on the pattern of symptoms. So always record the baby’s activity during the colic spell.

Things to be told to the doctor:

• Baby’s sleep pattern.

• Bowel movements.

• What your baby eats- frequency, any dietary changes introduced.

Examination to be done by the doctor:

• Baby’s height, weight, head circumference.

• Listening to heart, lungs, and abdominal sounds.

• Examining the limbs, toes, eyes, and genitals.

• Check for esophageal reflux, hernia, or intussusception.

How to Treat or Manage Your Colicky Baby?

1. Parent's Self-care:

The first line of treatment should be concerned with the distressed parents, educating them about colic and assuring that it is self-limiting, not a serious condition. Parents are requested to calm themselves and not to get frustrated by infants crying. Frustrated parents may sometimes injure the baby and themselves. Always remember not to shake your baby; it may result in a serious condition called shaken baby syndrome that can cause blindness, brain damage, and even death.

2. Soothing Techniques:

Here are some techniques which can calm your fussy baby:

• Swaddle your baby.

• Gently rock your baby. This calms your baby and helps the baby to pass gas. You can also try an infant swing when the baby can hold up their head.

• Hold your baby in an upright position; it relieves heartburn.

• Singing a lullaby to the baby or playing soft music.

• Burping your baby to relieve trapped gas bubbles.

• Try giving them warm baths.

• You can also try taking them for a drive in a car.

• Place warm towels in your baby’s stomach.

• Take your baby for a walk in a stroller.

• Decrease the stimulation by reducing the lighting in the room and toys that make loud noises.

3. Dietary Modifications:

• If your baby is breastfed, mothers can avoid taking milk products, caffeine, onions, cabbage, or any irritating foods in their diet.

• The American academy of pediatrics discourages the use of soy-based formulas in colic treatment.

4. Medications:

• Probiotics - Lactobacillus Reuteri has significantly reduced colic symptoms without any adverse effects. However, they are recommended only for breastfed infants and not for bottle-fed ones.

• Simethicone - The Simethicone drops used to treat colic are inconsistent and show no effect on improving the condition.

• Dicyclomine Anticholinergics - Dicyclomine has significantly proved to be better in improving the baby’s condition. But they are contraindicated in babies less than six months of age due to adverse effects such as respiratory depression, constipation, and diarrhea. However, pharmacological approaches are not recommended to treat colic.

When to Call Your Doctor for Help?

• If your baby has a fever (100.4 or more), vomiting (green in color or blood).

• Loose stools, blood in the stools.

• When you are unable to calm your baby.

• If your baby is three months old and still has colic.

Will Your Colicky Baby Get Better?

Yes, always remember colic is temporary. It is a self-limiting condition that goes away by the age of three to four months of age. You need not get frightened of colic, especially first-time parents and it is not harmful to your baby.

Conclusion:

Colic or infantile colic is a very common condition seen in babies. Proper parent counseling by doctors and health care professionals helps in managing the fussy baby. Most of the time, they do not even require hospital visits. So ignore the myths about colic and enjoy your parenthood.