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- 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.
- Predominant age group is between 2 weeks and 4 months of age.
- Equal predominance among males and females
Wide range between 8% and 40% of infants, however, more likely affects between 10% and 25% of infants
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
- 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.
Colic is generally not preventable.