Colic, Infantile

Colic, Infantile is a topic covered in the 5-Minute Clinical Consult.

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Basics

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.
  • 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

Prevalence
Wide range between 8% and 40% of infants, however, more likely affects between 10% and 25% of infants

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
  • Allergy to cow’s milk, soy milk, or breast milk protein
  • 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 stess
  • Parental anxiety, depression, and/or fatigue
  • Parent–infant interaction mismatch
  • Infant’s inability to console him- or herself when dealing with stimuli
  • Possible early manifestation of childhood migraine
  • 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)
  • Alterations in fecal microflora
  • Tobacco smoke exposure
  • Prenatal exposure to maternal smoking or nicotine replacement therapy

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.

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