infant colic Flashcards
what is infant colic
- Rome IV criteria (preferred definition)
- infants <5 motnhs age
- reccurent & prolonged periods of infant crying, fussing, irritabiltiy reported
- occurs wihtout obvious cause and cannot be prevented or resolved by caregivers
- no failture to thrive, fever or illness
- Wessel “rule of 3” (old way)
- unexplained paroxysmal bouts of fussing and cring in otherwise healthy infant
- crying that lasts
- 3 hours a dat for 3 dats and week, for 3 weeks straight
Signs and symptoms of infant colic
** occurs at 2-16 weeks of age
- • Excessive crying
- Increased motor activity
- Increased muscle tone : Clenched fists, facial flushing, Arching of back, drawing up of legs, Abdominal distention
- Altered patterns of sleeping and eating
*gradually imrpove, uncommon beyond 4 months of age
normal vs colic crying patterns
- Normal
- less frequent
- shorter episodes
- consolable
- occurs throughout day
- Colic
- more excessive, increased intensity and duration
- abrupt onset and conclusion; inconsolable
- diurnal evening peaks
definitive, possible and unrelated factors of colic
- Definitive
- Age
- parental smoking
- Possible risk factors
- Parental stress
- Caucasian race
- Residence in developed nations
- Feeding practices
- Nutritional contributors?
- Unrealted
- gender
- genetric predisposition
- breast vs bottle fed?
- gestational age at birth
- birth order status?
differential diagnosis of infant colic
* diagnosis of exclusion, need to rule out
- hunger, need to suck, lack of stimulation, overstimulation, over heating, clothing discomfort, food sensitvities
medical conditions; infections, teething, pain +/- trauma, metabolic disorders, foreign bodies, GI, C, nervous system
questions to ask when diagnosis colic
When does crying occur and how long does it last?
- Does the crying begin and occur at the same time every day?
- What seems to trigger an episode of crying? What helps stop the crying?
- What do you do when the baby cries?
- What does the cry sound like?
- How and what do you feed the baby?
- Is the crying getting better, worse, or is it about the same? • How do you feel when the baby cries?
- How has colic affected your family?
- Why do you think the baby cries?
*encourage to keep a colic diary
proposed causes of colic
- Psychological
- difficulties with parent/child interaction
- maternal anxiet and stress
- Organic
- intolerance to carbohydrates gas, GERD,
- allergy to milk/dairy or food
- immature CNS
immature autonomic NS - **altered intestinal flora
- Behavioual symptoms
- improper feeding
- improper feeding technique
- smoking in home or close to infant
Colic red falgs
Persists for >3 hours Occurs in infants <2 wks or >16 wks old
Accompanies a fever Is associated with weight gain or failure to thrive
Is associated with excessive vomiting or changes in stool/diarrhea or urination
Occurs alongside any signs of dehydration
Is associated with a change in behaviour, including lethargy or decreased responsiveness
Could be the result of an injury or fall or a somatic problem causing pain or itch
The caregiver is afraid he or she may hurt the baby
The caregiver has tried for >3 days to soothe baby but nothing works
When and how to treat colic
When: no red flags, ruled out other symptoms, symptoms are consistent with colic
how: non pharmacologic measures (1st line), OTC therapies
Goals of colic therapy for infant
- Crying episodes are reduced
- Infant is able to fall asleep
- Infant is thriving: eating & drinking well
- Reduced infant discomfort and fussiness after feeds
- AE’s of any treatments are minimized
goals of therapy for colic, for caregiver
- Minimize parental stress and frustration
- Provide information, support, coping strategies and reassurance
implication of colic on mothers
- 70% revealed explicit aggressive thoughts
- 26% admitted to thoughts of infanticide
- >90% experienced significant marital tension & disruption in their social contacts
- 100% experienced physical & psychological symptoms
RPh’s role in colic
Offer support, education, acknowledgement, reassurance
* colic does not mean that your baby is sick, your baby is mad at you, rejecting you or manipulating you
– Absolve guilt & recommend taking a break
– Offer tips on soothing: nonpharmacologic measures
physical methods to treat colic
Movement : Rocking, “Bicycle”
- Carrying
- Gentle pressure to the abdomen
- Skin to skin contact
- swaddling
- Infant Massag
- Chiropractic
behavioural colic treatments
Colic Diary • Reduce stimulation • Caregiver rest breaks • Counseling
Environmental colic treatment
Change of scenery •
Auditory stimulation: White noise machines, caution due to damage to auditory development
- Swinging simulators
- Rocking simulators
colic theries on dietary maniputlatio
- Breastfeeding
- should be continued
- weaing a colicky infant can result in symptoms worsening
- prolonged emptying of 1 breast at each feed
- eliminate common aggravators in mothers diet
- cow’s milk protein and dairy products
- soy, wheat, eggs, peanuts, tree nuts and fish
- cabbage, broccoli, caffeine, citrus fruit and chocolate
- should be continued
- Formula Feeding
- Switch to hypoallergenic (casein hydrolysate, whey hydrolysate) formula
- may reduce duration of crying
- more expensive and may be less palatable than trad infant form
- reserve for infants w/ confirmed cows milk allergies
- Switch to hypoallergenic (casein hydrolysate, whey hydrolysate) formula
* if formula is changed shoudl not be pursed if symptoms do not improve after 1 week -> freq forula changes nor recommended
how to manipulate feeding ti reduce amount of air swallowed during feeding and prevent regurgitation
Position infant vertically while feeding
– Use correct nipple size for infant’ s age
– Use curved bottles or collapsible bags
– Burp infant frequently in an upright position
Probiotic agents for colic treatment
*has most evidence for efficacy
- Class: probiotic agent, lactobacillus reuteri ( brand BioGaia drops)
- Dose: 108 CFU in 5 drops 30 min after feeding once daily
- MOA: replenishes inadequate levels of intestinal lactobacilli
- no ADR reported, avidence supports reduced crying time
*refrigerate
sucrose pharmacologic treatment for colic
- sugar water
dose: 2mL of 16% soln vv - analgesic effect
- no ADRs reported, must refridgerate
*short duration, repsonse only lasts 30 min
carminatives for colic treatment
ex: simethicone (40 mg/mL), brand name: oval
dose: 0.25-0.5 mL with or after feeding
- lowers production of intestinal fas
- probable only plaebo effect
safe: no ADRs due to lack of systemic absorption
anappropriate colic therapy
❌Alcohol
❌Sedatives
❌Gripe water
❌Dicyclomine syrup
❌Diphenhydramine
❌Combinations of sedatives and anticholinergics
❌Other NHPs
Mionitring colic
- Excessive crying
- desired outcome: reduced crying freq/duration
- time frame: 3 days
- parent to monitor daily, Rph follow up 3 days or next visit
- Infant agitated or unable to sleep
- disired outcome: infant able to fall asleep and is calm before bedtime/nap
- time frame: 3 days
- parent to monitor: daily, Rph to follow up 3 days or next visit
- Refual to eat/ fussiness after eating
- reduced or diminised fusiness after eating and no weight loss or signs of dehydration
- within 3 days
- parent to monitor daily, RPh to monitor/follow up 3 days or next visit
- Parental anxity
- want to reduce their anxiety and inc coping skills
- they should monitor daily, you should follow up 3 days or enxt visit and reassure ***
