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Colic

by Deborah M. Consolini, MD

Colic is frequent and extended periods of crying for no discernible reason in an otherwise healthy infant.

Although the term colic suggests an intestinal origin, etiology is unknown.

Colic typically appears within the first month of life, peaks at about age 6 wk and reliably and spontaneously ends by age 3 to 4 mo. Paroxysms of crying and fussiness often occur at about the same time of day or night and continue for hours for no apparent reason. A few infants cry almost incessantly. Excessive crying may cause aerophagia, which results in flatulence and abdominal distention. Typically, colicky infants eat and gain weight well, although vigorous nonnutritive sucking may suggest excessive hunger. Colic probably has no relation to development of an insistent, impatient personality.

Evaluation

The goal is to distinguish colic from other causes of excessive crying (see Crying), particularly serious and/or treatable medical disorders such as ear infection, UTI, meningitis, appendicitis, food allergy, acid reflux, constipation, intestinal obstruction, increased intracranial pressure, hair tourniquet, corneal abrasion, glaucoma, and nonaccidental injury.

History

History of present illness should establish the onset and duration of crying and response to attempts to console and thus determine whether the infant’s crying is outside the normal range (up to 3 h/day in a 6-wk-old infant).

Review of systems should seek symptoms of causative disorders, including constipation, diarrhea, and vomiting (GI disorders) and cough, wheezing, and nasal congestion (respiratory infection).

Past medical history involves thorough questioning, which may reveal that crying is not the chief concern but a symptom that the parents have used to justify their visiting the physician to present another problem—eg, concern over the death of a previous child or over their feelings of inability to cope with a new infant.

Physical examination

Physical examination begins with review of vital signs and then a thorough examination for signs of trauma or medical illness. The examination in children with colic typically detects no abnormalities but reassures parents.

Red flags

The following findings are of particular concern:

  • Vomiting (especially if vomit is green or bloody or occurs > 5 times a day

  • Constipation or diarrhea, especially with blood or mucus

  • Fever

  • Respiratory distress

  • Lethargy

  • Poor weight gain

Interpretation of findings

Often, infants with colic present after days or weeks of repetitive, daily crying; an otherwise normal history and examination at this point is more reassuring than in infants with acute (1 to 2 days) crying.

Testing

No testing is necessary unless specific abnormalities are detected by history and examination.

Treatment

Parents should be reassured that the infant is healthy, that the irritability is not due to poor parenting, and that colic will resolve on its own with no long-term adverse effects. Physicians should also offer reassurance that they understand how stressful a colicky infant can be for parents.

The following measures may help:

  • For infants who cry for short periods: Being held, rocked, or patted gently

  • For infants who have a strong sucking urge and who fuss soon after a feeding: Opportunity to suck more (eg, a pacifier)

  • If bottle-feeding takes < 15 to 20 min: Nipples with smaller holes, a pacifier, or both

  • For very active, restless infants: Paradoxically, being swaddled tightly

An infant swing, music, and white noise (eg, from a vacuum cleaner, car engine, or clothes or hair dryer) may also be calming. Because fatigue often contributes to excessive crying, parents should also be instructed to routinely lay the infant in the crib while the infant is awake to encourage self-soothing and good sleep habits and to prevent the infant from becoming dependent on the parents, rocking, a pacifier, a specific noise, or something else to fall asleep.

A hypoallergenic formula may be tried briefly to determine whether infants have cow's milk protein intolerance, but frequent formula switching should be avoided. Sometimes in breastfed infants, removing cow's milk or another food (particularly stimulant foods [eg, coffee, tea, cola, chocolate, diet supplements]) from the mother’s diet brings relief, as may stopping drugs that contain stimulants (eg, decongestants).

Key Points

  • Colic is excessive crying for no discernible reason in an otherwise healthy infant.

  • Colic should end by age 3 to 4 mo.

  • Rule out medical causes of crying by history and physical examination; testing is unnecessary unless there are specific findings.

  • Physical measures (eg, rocking, swinging, swaddling) can be tried, as may dietary changes; response to these measures varies, and often colic resolves only with time.

* This is a professional Version *