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, breast-fed 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 with 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, which result in excessive gas when the unabsorbed carbohydrate is fermented by colonic bacteria
• Alterations in intestinal or fecal microflora
• Tobacco smoke and nicotine exposure
• 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.