GI - Colic

Question 1

Defintion

Answer 1

Excessive infants crying with no obvious trigger
Colic should be suspected if a baby cries > 3 hours a day, 3 days a week for more than 3 weeks but are otherwise healthy.

Question 2

Rules of 3

Answer 2

> 3 hours a day
3 times a week
3 weeks

Question 3

Epidemiology

Answer 3

First born status: slightly higher risk
Family history

Question 4

Pathophysiology

Answer 4

Exact pathophys is unclear by may be related to:
- Gastrointestinal discomfort
- Alterations in gut microbiota
- Food allergies
- Lactose intolerance
- Immature nervous system: leading to increased sensitivity to normal gut movements

Also speculate that environmental factors such as parental anxiety or inadequate parent-infant interaction may play a role

Question 5

Signs

Answer 5

• Healthy appearance despite distress
• Tense abdomen
• Normal growth and development

Question 6

Symptoms

Answer 6

Excessive crying:
- rule of 3
- difficult to soothe
- arched back with knees up their tummy
- red face and clenched fist
Fussiness: more in the evening
Flatulence

Question 7

Diagnosis

Answer 7

No investigations are typically necessary for a baby who is feeding well, growing normally and has a normal physical examination

Investigations to consider:
- growth chart assessment
- parental interview: detailed questioning about feeding, bowel habits, and parental copying strategies to rule out other causes of distress
- physical examination: confirm the baby’s overall health and rule out other causes of discomfort

Question 8

Management

Answer 8

Reassurance

Feeding changes:
- Bottle milk: trial of hypoallergenic formula considered
- Breast milk: mothers may be advised to avoid cow’s milk, caffeine, and spicy foods

Simethicone (Brand name: Infacol) can help some infants by breaking down gas bubbles in the gut, although its efficacy is unproven

Probiotics: some evidence suggests that certain probiotics, like lactobacillus reuteri, may help improve colic in breastfed babies

Applying gentle pressure to spine or skull: spinal manipulation and cranial osteopathy are alternative options to soothe colic symptoms.

Question 9

Complications

Answer 9

Family stress
Parental exhaustion
Increased risk of non-accidental injury: due to frustration or desperation, such as shaken baby syndrome
Potential disruption to infant-parent bonding