Description

• Colic is defined as excessive crying in an otherwise healthy baby.
• A commonly used criteria is the Wessel criteria or the Rule of Three, when crying lasts for:
  • >3 hr/day
  • >3 days/week
  • Persists >3 weeks
• Many clinicians do not strictly adhere to the criterion of persistence for >3 weeks because few parents or clinicians will wait that long before evaluation or intervention.
• Colic usually peaks at 6 weeks of life.
• Some clinicians feel that colic represents the extreme end of the spectrum of normal crying, whereas most feel that colic is a distinct clinical entity.

Epidemiology

Incidence

• Predominant age group is between 2 weeks and 4 months of age.
• Equal predominance among males and females, breastfed versus formula-fed, and full term versus preterm

Prevalence

• Wide range from 8% to 40% of infants; however, more likely affects 10–25% of infants
• Causes 10–20% of pediatric visits during the early weeks of an infant’s life

Pediatric Considerations
This is a problem during infancy.

Etiology and Pathophysiology

The cause is unknown. Factors that may play a role include the following:

• Infant gastroesophageal reflux disease
• Fruit juice intolerance
• Swallowing air during the process of crying, feeding, or sucking
• Overfeeding or feeding too quickly; underfeeding has also been proposed.
• Inadequate burping after feeding
• Family tension and/or stress
• Parental anxiety, depression, and/or fatigue
• Parent–infant interaction mismatch
• Infant’s inability to console him or herself when dealing with stimuli
• Hypersensitivity after exposure to prolonged environmental stimuli
• Possible early manifestation of childhood migraine
• Intolerance to cow’s milk, soy milk, or breast milk protein
• Increases in the gut hormone motilin, causing hyperperistalsis
• Functional lactose overload (i.e., breast milk that has a lower lipid content can have faster transit time in the intestine, leading to more lactose fermentation in the gut and hence gas and distension)
• Intestinal immaturity leading to incomplete absorption of carbohydrates in the small intestine resulting in excessive gas when the unabsorbed carbohydrate is fermented by colonic bacteria
• Alterations in fecal microflora
• Tobacco smoke exposure
• Prenatal exposure to maternal smoking or nicotine replacement therapy
• Immature motor regulation
• Increased serotonin concentration

Risk Factors

• Physiologic predispositions in an infant may play a role, but no definitive risk factors have been established.
• Emerging data suggest maternal smoking or exposure to nicotine replacement therapy during pregnancy is associated with higher incidence of infantile colic.
• Infants with a maternal history of migraine headaches are twice as likely to have colic.

General Prevention

Colic is generally not preventable.