Infantile Colic
Recognition and Treatment
October 1, 2015 Vol 92, No 7, p577
AFP Review NEIMEF
Shanna Elliott, DO R1
What is it?
• Episodes of inconsolable and unprovoked crying
• “Rule of 3” criteria - crying for:
▫ > 3 hours per day
▫ > 3 days per week
▫ > 3 weeks
•
•
•
•
10-40% infants worldwide
Benign
Self-limited, resolves at 3-6 mo.
Peaks at 6 weeks
Etiology
• No known cause
• Proposed causes:
▫
▫
▫
▫
Altered fecal microflora
Cow’s milk protein / lactose intolerance
GI immaturity
GI inflammation
 ↑ fecal calprotectin
▫ Increased serotonin secretion
▫ Poor feeding technique
▫ Maternal smoking / nicotine replacement therapy
▫ Shaken baby syndrome
▫ Post-partum depression
Evaluation: Red flags
Finding
Possible cause
Distended
abdomen
Mass, hepatosplenomegaly, Hirschprung disease, intestinal
malrotation with volvulus, necrotizing enterocolitis
Fever
AOM, appendicitis, bacteremia, endocarditis, meningitis,
osteomyelitis, pneumonia, sepsis, UTI, viral respiratory infection
Lethargy
Hydrocephalus, meningitis, sepsis, subdural hematoma
Treatment
Meets criteria
H&P
Organic causes ruled out
Reassurance and support
Symptoms persist and parents desire treatment
Treatment
Breastfed infant
Bottle-fed infant
• Continue breastfeeding
• Maternal allergen restricted
diet (A)
▫ Cow’s milk
▫ Eggs
▫ Peanuts / tree nuts
▫ Wheat
▫ Soy
▫ Fish
• Lactobacillus probiotic 5 drops
daily (B)
• Transition to hydrolyzed
formula for 2 week trial (A)
Evidence Rating: A = consistent, good quality patient oriented evidence; B = inconsistent
or limited quality patient oriented evidence; C = consensus, disease oriented evidence
Hydrolyzed infant formulas
Type
Brand
Formula
Cost
Partially hydrolyzed
Enfamil
Gentlease
$1.41
Gerber
Good Start Gentle
$1.30
Gerber
Good Start Soothe
$1.37
Similac
Similac Total Comfort
$1.58
Enfamil
Nutramigen
$1.97
Enfamil
Pregestimil
$2.06
Similac
Alimentum
$1.87
Elecare
Elecare
$3.05
Enfamily
Nutramigen AA
$2.34
Nutricia
Neocate
$3.19
Extensively hydrolyzed
Completely hydrolyzed
Other treatment options
• 12% sucrose solution BID
• “Gripe water”
• Herbal supplements
▫ Peppermint, teas
• Not recommended:
▫ Simethicone
▫ Dicyclomine
▫ PPI
CME quiz questions
• During a 2mo check-up for a healthy breast-fed
infant, parents ask if there is anything they can
do to reduce his lengthy nighttime crying spells.
The child spits up occasionally after feedings but
does not seem to be in distress, which one of the
following treatments should you recommend?
a)
b)
c)
d)
Simethicone
Dicyclomine
Lactobacillus
Omperazole
CME quiz questions
• During a 2mo check-up for a healthy breast-fed
infant, parents ask if there is anything they can
do to reduce his lengthy nighttime crying spells.
The child spits up occasionally after feedings but
does not seem to be in distress, which one of the
following treatments should you recommend?
a)
b)
c)
d)
Simethicone
Dicyclomine
Lactobacillus
Omperazole
CME quiz questions
• Which of the following interventions reduces
crying times in formula-fed infants with colic?
a)
b)
c)
d)
Switching to soy formula
Switching to hydrolyzed formula
Osteopathic manipulation
Infant massage
CME quiz questions
• Which of the following interventions reduces
crying times in formula-fed infants with colic?
a)
b)
c)
d)
Switching to soy formula
Switching to hydrolyzed formula
Osteopathic manipulation
Infant massage