What is Infantile Colic?

Infantile colic is a common condition that usually starts in the second or third week of a baby’s life and can cause a lot of belly discomfort. Symptoms include persistent crying that cannot be calmed, even though the baby is otherwise healthy and well-fed. This condition can be stressful for parents and caregivers and is responsible for 10% to 20% of visits to the child’s doctor in the first few weeks of life.

The main signs of infantile colic are periods of inconsolable crying, irritability, and screaming that last for 3 hours or more with no clear reason. Babies with colic often show these symptoms in the evening. They may become red in the face, draw their legs up, and have tension in their stomach. Unfortunately, traditional methods of soothing don’t usually help during these episodes.

Doctors diagnose infantile colic based on a medical history and physical examination, after ruling out other potential causes of the symptoms. When the symptoms go away on their own, it helps to confirm this diagnosis.

What Causes Infantile Colic?

Baby colic is a common condition that causes belly pain in newborn babies in the first few weeks after they are born. The exact cause of colic is still unknown because the studies that have been done so far haven’t been very clear, and their results have sometimes contradicted each other. That said, colic could be caused by many factors, such as issues related to the biology of the baby, problems with the baby’s digestive system, and even certain social elements. Additionally, a combination of different factors could cause the signs and symptoms of colic to appear.

Often, people think colic happens because of incorrect feeding of the baby, such as overfeeding, underfeeding, or not burping the baby enough. If the mother consumes dairy products like cow’s milk, this could cause distress in breastfeeding babies with colic. This suggests that these babies might not tolerate cow’s milk proteins well. There is also some evidence linking colic to lactose intolerance, but this evidence is somewhat contradictory.

Some studies suggest that babies with colic have higher levels of a hormone called motilin, suggesting that these babies’ gut muscles might be moving more than usual due to an imbalance in their nervous system. Inflammation in the gut (measured by a protein called calprotectin in the baby’s stool) and changes in the types of bacteria present in the baby’s stool might also contribute to colic.

A few studies have noted a link between colic and migraine, showing that babies who had colic might have a higher likelihood of developing migraines later in adolescence. It has also been suggested that other factors, such as the mother smoking or using nicotine replacement therapy, undeveloped nervous and digestive systems, sleep disruptions, sensitivity to the surroundings, exposure to too much sensory stimulation, family stress, acid reflux, and parents’ anxiety might contribute to colic.

Risk Factors and Frequency for Infantile Colic

Infantile colic, a condition that affects babies, is seen in approximately 3% to 28% of infants around the globe. Some research suggests this figure could be as high as 40%. According to one study, the occurrence of colic was 17% to 25% in newborns and babies under 6 weeks old, 11% in those aged 8 to 9 weeks, and 0.6% in babies aged 10 to 12 weeks. However, the prevalence of colic seems to be unrelated to factors such as the baby’s gender, whether they are breastfed or formula-fed, whether they are premature or full-term, their birth order, or socioeconomic status. Interestingly, it has been observed that white infants living in industrialized countries located further from the equator have a higher prevalence of colic.

It’s hard to measure exactly, but studies indicate that infantile colic might be linked to caregiver stress, frustration in the parents’ relationship, family stress, and a lack of parental confidence during pregnancy.

Signs and Symptoms of Infantile Colic

Colic is a common condition in babies, causing them to cry loudly and suddenly due to abdominal discomfort. It’s usually harmless and goes away on its own. However, parents and caregivers should keep an eye out for other symptoms to rule out any more serious health issues. Signs of discomfort during a colic episode include a red face, pale area around the mouth, back arching, tightened tummy, stiff arms, and pulled-up legs.

Doctors will want to know about the baby’s eating, bathroom routines, and sleep patterns to help diagnose the condition. If a baby is showing unusual symptoms like blood in their stool or projectile vomiting, these could point to a food allergy, digestive problems, or other conditions. In rare cases, extreme fussiness in infants can also be a sign of serious conditions like sepsis or meningitis.

When taking a baby to a healthcare provider for a checkup, the baby will usually appear healthy and gaining weight normally, even with colic. Doctors may want to observe the baby during a crying episode and see how parents or caregivers try to soothe the baby.

There are some physical symptoms to look out for that could suggest a more serious condition than colic:

  • A bulging soft spot on the baby’s head which may indicate increased pressure on the brain or meningitis.
  • Mouth thrush or tongue tie which can cause difficulties in feeding.
  • An eye injury or foreign object in the eye.
  • An ear infection.
  • Reduced bowel sounds or tenderness in the tummy which could suggest a blockage.
  • Signs of a hernia in the groin area or twisted testicle.
  • Signs of bruising or other injuries that weren’t caused by an accident.
  • A hair tied tightly around a finger, toe, or private parts.

Testing for Infantile Colic

Colic is a condition often seen in babies, marked by excessive crying and fussiness. It can sometimes be challenging to diagnose. However, a guideline known as the Wessel’s “Rule of 3” has been used since 1954. According to this rule, a baby might have colic if they cry for more than 3 hours a day, for 3 or more days a week, for over 3 weeks. Modern doctors don’t always use the 3-week requirement because most parents seek help sooner when their infant is distressed.

Generally, diagnosing colic depends on a review of the baby’s behavior and a physical examination, rather than laboratory tests or scans. It’s worth noting that it’s normal for healthy babies to cry a lot, especially during their first few weeks of life.

In addition, there are specific guidelines referred to as the Rome IV criteria, established in 2016, used for diagnosing colic. According to these criteria, your baby might have colic if:

  • They show symptoms of crying, fussiness, or irritability that start and stop, particularly before they turn 5 months old,
  • Their bouts of crying have no obvious cause that parents can resolve,
  • They’re not showing signs of poor weight gain, fever, or other diseases.

In fact, this guideline doesn’t strictly stick to the ‘Rule of 3’, as it might lead to overlooking babies who cry for slightly less than 3 hours each day. Nevertheless, for research studies, the guidelines suggest recording crying time and maintaining a 24-hour behavior diary if a baby cries more than 3 hours a day on 3 or more days in a week.

If your baby is showing the symptoms described in the Rome IV criteria or the Wessel “Rule of 3” and there are no significant physical issues found, doctors can reliably diagnose colic. There’s typically no need for lab tests or image scans. But, if your baby shows symptoms such as fever or abdominal distension (swelling), further investigations like blood and urine tests, x-rays, ultrasound, and even a procedure to get a sample of spinal fluid (lumbar puncture) might be needed. Similarly, if your baby starts crying excessively after the third month of life or continues beyond the fourth month, further evaluations are necessary since this is outside the typical age range for colic.

Treatment Options for Infantile Colic

Managing a baby’s colic is centered on finding ways to provide comfort and support to the caregiver while trying to ease the baby’s crying. But since there are no universal guidelines for this, it’s crucial to establish an environment where caregivers feel supported and confident in dealing with this challenging period. It’s important for doctors and healthcare professionals to assure caregivers that when a baby cries due to colic, it doesn’t mean the baby is sick or that it resulted from something they did wrong. It’s a normal part of infancy that typically resolves by the time the baby is 3 to 4 months old.

Doctors should also express empathy for caregivers’ feelings of exhaustion, anger, guilt, and frustration. They should validate caregivers’ efforts and encourage them to develop techniques to handle the baby’s fussiness, reducing the chances of unintentional harm to the baby from frustration. This might include safe practices like putting the baby in their crib and taking a break when frustration rises. They can also share caregiving responsibilities with others, or accept help when offered.

For bottle-fed babies, holding them upright during feeding, using a curved bottle or a bottle with a collapsible bag can help reduce the amount of swallowed air, which can cause discomfort. For breastfeeding moms, techniques can be customized to their needs. It’s important to remember that soothing techniques may not work every time, so caregivers should feel free to try different ones. Some of these may include using a pacifier, gently rocking the baby, playing soft white noise, having a warm bath, or swaddling the baby, although caution is advised with swaddling due to potential risks with older babies.

Adjusting the environment can also help soothe a colicky baby. Decreasing room lighting, lowering music volume, avoiding strong odors, and feeding the baby in a dark room can help in reducing crying and facilitating sleep.

If standard comforting measures don’t work, doctors might suggest individualized strategies. Although data on these interventions are limited, dietary modifications could be considered. For instance, breastfeeding moms may eliminate dairy, eggs, nuts, wheat, and soy from their diet, as this may reduce crying time. Similarly, babies fed with formula might see improvement by switching from cow’s milk formula to a hydrolyzed infant formula. Though it’s more expensive and may not be covered by insurance, it might help reduce colic symptoms for some infants. However, if no improvement is observed within two weeks, doctors may recommend going back to the original cow’s milk formula. Soy-based formulas are usually not recommended for infants younger than 6 months.

Probiotic supplementation, like Lactobacillus reuteri, has been studied as a potential treatment to modify the baby’s gut bacteria and reduce crying time. For some formula-fed babies, this method seemed to work, but the results were inconsistent. Moreover, probiotics are not regulated by the Food and Drug Administration (FDA) and they can be expensive. It’s also important to note that some treatments, like lactose-free infant formulas, sucrose, full body massage, herbal remedies, homeopathic preparations, chiropractic manipulation, and acupuncture, have been found to be ineffective.

In conclusion, while colic can be a challenging time for caregivers, it’s important to remember that it’s a temporary period. Caregivers should always feel supported and encouraged to express their concerns. It’s important for doctors to reassure caregivers, discuss coping mechanisms, and remind them that colic will usually resolve on its own.

If a newborn or infant is crying excessively and for no known reason, it may be due to a condition known as infantile colic. This is usually determined by ruling out other potential causes and seeing if the symptoms get better on their own. When doctors evaluate a distressed infant, they consider a whole range of possibilities which include:

  • Conditions that can increase pressure in the brain, or conditions like sepsis or meningitis
  • Something in the baby’s eye
  • Tongue-tie or other oral feeding issues
  • Ear infection
  • Conditions affecting the stomach and intestines, like pyloric stenosis, acid reflux or blockage
  • Heart conditions, such as fast heart rate
  • Allergy to cow’s milk protein or inability to tolerate formula—though, this is experienced by less than 5% of infants
  • A hair wrapped too tightly around the penis, fingers, or toes
  • Twisted testes or an inguinal hernia
  • Any injury caused by mistreatment

It’s also worth noting that excessive crying could potentially be an early sign of autism spectrum disorder, although this is rare and usually only recognized looking back. Other possibilities could include withdrawal symptoms in a baby born to a mother who was using certain drugs during pregnancy, hunger, glaucoma, or an anal fissure.

What to expect with Infantile Colic

Infantile colic, which is a common condition causing excessive crying in babies, typically goes away naturally by the time they reach 3 to 4 months old. This makes it a harmless condition that resolves on its own. Doctors often provide guidance to caregivers about this condition, help them create ways to cope, and provide practical advice for dealing with the excessive crying. This support helps families as their baby naturally outgrows this temporary condition.

Possible Complications When Diagnosed with Infantile Colic

Infantile colic is a condition in babies that, while not harmful and will generally go away on its own, can be stressful for caregivers. This stress can negatively affect the caregiver’s bond with the baby and may even lead to early discontinuation of breastfeeding. Recent studies have indicated that excessive crying in early life may be linked to problems with adapting to pre-school, attention-deficit hyperactivity disorder, and behavioral issues, although a clear cause-and-effect relationship hasn’t been proven. In the long term, babies with colic might face an increased chance of developing migraine headaches without any obvious causes by the time they reach 18 years old.

The problems arising from infantile colic can also contribute to depression in mothers and overall family stress. The most severe potential outcome is shaken baby syndrome. This is a significant risk for babies with colic, as overwhelmed caregivers might unintentionally harm them in an attempt to stop the excessive crying.

Important Points:

  • Infantile colic can stress caregivers and affect their bond with the baby.
  • Excessive crying in babies may be linked to future adaptation, behavioral issues, and attention-deficit hyperactivity disorder.
  • Babies with colic may have a higher chance of developing migraine headaches as they grow older.
  • Infantile colic can induce maternal depression and family stress.
  • There is a risk of shaken baby syndrome if caregivers are unable to cope with the baby’s excessive crying.

Preventing Infantile Colic

Colic pain is a term used to describe excessive crying in babies that are less than 3 months old, and it can be difficult for caregivers to deal with. The exact reason why colic happens isn’t fully understood, but thankfully, about 90% of babies stop showing signs of colic by the time they reach 3 to 4 months old. It’s characterized by infants who cry for more than 3 hours a day on more than 3 days per week. Somewhere between 1 in 4 to 1 in 3 babies experience colic, typically showing symptoms between their third and sixth week after birth.

Colic crying is different from normal crying in a few ways:

  • Colic episodes can last for more than 3 hours a day.
  • They can start abruptly, often in the evening.
  • The crying is intense, very loud, and high-pitched.
  • Babies with colic might show physical symptoms and are often hard to comfort, no matter what you try.

To diagnose colic, a healthcare provider will give the baby a thorough physical exam. At this time, there are no proven treatments specifically for colic, but a healthcare provider can provide advice and support. The goal of any treatment is to try to reduce the amount of crying, provide support to the family, and prevent any possible long-term problems tied to colic.

There are several tactics to help manage a baby’s colic, which include:

  • Asking for help when it’s needed.
  • If you’re feeling frustrated, safely put the baby in their crib and take a few minutes to yourself.
  • Talk about how you’re feeding the baby with a healthcare provider. This goes for babies that are breastfed and those that are given formula.
  • Try to soothe the baby by holding them or using a front carrier.
  • Consider the use of pacifiers, going for a car ride, or using a white noise machine.
  • Always speak with a healthcare provider before giving the baby any kind of medication or natural remedies for their colic, as there are currently no FDA-approved medications for infantile colic.
  • Massage can be offered to help soothe the baby, though there’s no proven evidence that this helps.

Remember, colic is temporary and it generally resolves itself. It can be tough for families, but there’s no evidence to suggest that it causes any long term problems in children.

Frequently asked questions

Infantile colic is a common condition in babies that causes persistent crying and belly discomfort, usually starting in the second or third week of life. It is responsible for 10% to 20% of visits to the child's doctor in the first few weeks of life.

Infantile colic is seen in approximately 3% to 28% of infants around the globe, with some research suggesting it could be as high as 40%.

Signs and symptoms of infantile colic include: - Loud and sudden crying due to abdominal discomfort - Red face - Pale area around the mouth - Back arching - Tightened tummy - Stiff arms - Pulled-up legs It's important to note that colic is usually harmless and goes away on its own. However, parents and caregivers should also be aware of other symptoms that may indicate more serious health issues.

The exact cause of colic is still unknown because the studies that have been done so far haven't been very clear, and their results have sometimes contradicted each other. That said, colic could be caused by many factors, such as issues related to the biology of the baby, problems with the baby's digestive system, and even certain social elements. Additionally, a combination of different factors could cause the signs and symptoms of colic to appear.

The doctor needs to rule out the following conditions when diagnosing Infantile Colic: - Conditions that can increase pressure in the brain, or conditions like sepsis or meningitis - Something in the baby's eye - Tongue-tie or other oral feeding issues - Ear infection - Conditions affecting the stomach and intestines, like pyloric stenosis, acid reflux or blockage - Heart conditions, such as fast heart rate - Allergy to cow's milk protein or inability to tolerate formula—though, this is experienced by less than 5% of infants - A hair wrapped too tightly around the penis, fingers, or toes - Twisted testes or an inguinal hernia - Any injury caused by mistreatment - Excessive crying potentially being an early sign of autism spectrum disorder (rare and usually only recognized looking back) - Withdrawal symptoms in a baby born to a mother who was using certain drugs during pregnancy - Hunger - Glaucoma - Anal fissure

Generally, diagnosing colic in infants does not require laboratory tests or scans. The diagnosis is based on a review of the baby's behavior and a physical examination. However, if the baby shows symptoms such as fever or abdominal distension, further investigations may be needed, including blood and urine tests, x-rays, ultrasound, and even a lumbar puncture to obtain a sample of spinal fluid. These additional tests are done to rule out other potential causes of the symptoms.

Infantile colic is treated by providing comfort and support to the caregiver while trying to ease the baby's crying. There are no universal guidelines for treating colic, so it is crucial to establish an environment where caregivers feel supported and confident. Doctors should express empathy for caregivers' feelings and validate their efforts. Techniques to handle the baby's fussiness may include safe practices like putting the baby in their crib and taking a break, sharing caregiving responsibilities, or accepting help. For bottle-fed babies, holding them upright during feeding and using a curved bottle or a bottle with a collapsible bag can help reduce discomfort. For breastfeeding moms, techniques can be customized to their needs. Adjusting the environment by decreasing room lighting, lowering music volume, avoiding strong odors, and feeding the baby in a dark room can also help soothe a colicky baby. If standard comforting measures don't work, doctors might suggest individualized strategies such as dietary modifications or probiotic supplementation.

The side effects when treating Infantile Colic include: - Stress on caregivers and potential negative impact on the caregiver's bond with the baby. - Possible future issues with adapting to pre-school, attention-deficit hyperactivity disorder, and behavioral issues. - Increased chance of developing migraine headaches as the baby grows older. - Potential for maternal depression and overall family stress. - Risk of shaken baby syndrome if caregivers are unable to cope with the baby's excessive crying.

Infantile colic typically goes away naturally by the time babies reach 3 to 4 months old. It is a harmless condition that resolves on its own. Doctors often provide guidance to caregivers about this condition, help them create ways to cope, and provide practical advice for dealing with the excessive crying.

A pediatrician.

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