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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, as 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
  • Parental anxiety, depression, and/or fatigue
  • Parent–infant interaction mismatch
  • Baby’s inability to console him- or herself when dealing with stimuli
  • 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)
  • Tobacco smoke exposure

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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Citation

Stephens, Mark B., et al., editors. "Colic, Infantile." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116138/all/Colic__Infantile.
Colic, Infantile. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116138/all/Colic__Infantile. Accessed April 25, 2019.
Colic, Infantile. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116138/all/Colic__Infantile
Colic, Infantile [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 25]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116138/all/Colic__Infantile.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Colic, Infantile ID - 116138 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116138/all/Colic__Infantile PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -