Infant Colic Flashcards
What is colic
– Infant is <5 months of age
– Recurrent & prolonged periods of infant crying, fussing, or irritability reported by caregivers that occur without obvious cause and cannot be prevented or resolved by caregivers
– no failure to thrive, fever, illness
What is the Wessel “rule of three” definition of colic (historical, not used anymore)
– Unexplained paroxysmal bouts of fussing and crying in an otherwise healthy infant that last:
> 3 hours a day for
> 3 days a week and for
> 3 weeks straight
When does colic occur and when does it stop
2-16 weeks of age
uncommon beyond 4 months
What are signs/symptoms of colic
- 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
What are NORMAL crying patterns
- Less frequent bouts
- Shorter episodes
- Consolable
- Occurs throughout day
What are COLIC crying patterns
- More excessive: increased intensity & duration
- Abrupt onset and conclusion; inconsolable
- Diurnal – evening peaks
What is the cause of colic
unknown
What are definitive risk factors for colic
- age of infant
- parental smoking
What are possible risk factors for colic
- Parental stress
- Caucasian race
- Residence in developed nations
- Feeding practices
- Nutritional contributors?
What are unrelated factors of colic
- Gender
- Genetic predisposition
- Breast or Bottle-fed?
- Gestational age at birth
Infantile colic is a diagnosis of exclusion and is considered when the following have been ruled out…
Other causes: Hunger, Need to suck, Lack of stimulation, Overstimulation, Overheating, Clothing discomfort, Food sensitivities
Medical conditions: Infections, Teething, Pain +/- Trauma, Metabolic disorders, Foreign bodies, GI, CV, Nervous system
What are diagnostic questions for colic?
- When does crying occur and how long does it last? (evening)
- 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? (loud, miserable cry)
- 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?
What are psychological proposed causes of colic
- difficulties with parent-child interaction
- maternal anxiety and stress
What are organic proposed causes of colic
Intolerance to carbohydrates Gas, GERD Allergy to milk/dairy or food Immature CNS Immature autonomic nervous system Altered intestinal flora (have different composition of bacteria)
What are behavioural proposed causes of colic
Improper feeding
Improper feeding technique
Smoking in the home or close to the infant
What are RED FLAGS
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 to start treatment for colic
– No red flag symptoms present
– Ruled out any other potential causes/conditions
– Symptoms are consistent with colic
What is the 1st line treatment for colic
Nonpharm measures
What are goals of 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
For Caregiver(s):
- Minimize parental stress and frustration
- Provide information, support, coping strategies and reassurance
What are the 5 nonpharm therapies
- Parental support
- physical
- behavioural
- environmental
- dietary
Why is parental support important
mothers have aggressive thoughts, experience marital tension, have physical and psychological symptoms
RPh: offer support, education, acknowledgement, reassureance
- absolve guilt and taking a break
What are physical methods
- Movement – Rocking, “Bicycle”
- Carrying
- Skin-to-skin contact
- Swaddling
- Gentle pressure to the abdomen
- Infant Massage
- Chiropractic
What are behavioural methods
- Colic Diary
- Reduce stimulation
- Caregiver rest breaks
- Counseling
What are environmental methods
• Change of scenery • Auditory stimulation – White noise machines – caution due to damage to auditory development • Swinging simulators • Rocking simulators
What are dietary manipulation methods
Breastfeeding should be continued (weaning can worsen symptoms)
- avoid milk and gas producing food from mothers diet (cow’s milk protein and dairy products, soy, wheat, eggs, peanuts, tree nuts and fish, cabbage, broccoli, caffeine, citrus fruit and chocolate)
Formula feeding:
- switch to hypoallergenic formula (have allergy to milk protein), soy protein, or lactose reduced formulas
- frequent formula changes are not recommended
Feeding manipulation methods
To reduce the 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
What is dose and mechanism of action for probiotic agents (ex. BioGaia drops)
5 drops 30 minutes after feeding, once daily
Replenishes inadequate levels of intestinal lactobacilli
1-2 weeks to see improvement
(refrigerate)
What is the dose and MOA for carbohydrates (ex. sugar water)
2 ml of 16% solution (v/v)
analgesic effect (pain relief)
response lasts <30 mins
(refrigerate)
What is the dose and MOA of carminatives (ex. Ovol)
0.25-0.5 mL with or after feeding
Lowers intestinal gas
Placebo effect? (ineffective)
What are therapies that are NOT recommended
❌Alcohol
❌Sedatives
❌Gripe water (no evidence supporting efficacy)
❌Dicyclomine syrup
❌Diphenhydramine
❌Combinations of sedatives and anticholinergics
❌Other NHPs
Monitoring for excessive crying: desired outcome and follow-up time
reduction in crying frequency/duration
parent monitors daily, RPh 3 days or next visit
Monitoring for agitated infant or inability to fall asleep: desired outcome and follow-up time
Infant able to fall asleep and is calm before bedtime or naptime
parent monitors daily, RPh 3 days or next visit
Monitoring for refusal to eat: desired outcome and follow-up time
Reduced or diminished fussiness after eating and no weight loss or signs of dehydration
parent monitors daily, RPh 3 days or next visit
Monitoring for parental anxiety: desired outcome and follow-up time
Reduction in anxiety and frustration; improved coping skills
