infant colic

Question 1

infant colic - definition

Answer 1

crying for > 3 hours per day, for > 3 days per week, for 3 weeks

Question 2

differential diagnosis for infant colic

Answer 2

TIMCRIESS
T trauma, NAI, bites and tumors
I infections in the ear, mouth (herpes stomatitis), UTI, meningitis, otitis media
M mom and dad are stressed, milk protein allergy, lactose intolerance
C cardiorespiratory disease
R - reflux, reaction to medications, reaction to formula, rectal or anal fissure
I - intracranial HTN, immunisation
E - eye issues; corneal abrasions, foreign body, glaucoma, retinal hemorrhage
S - surgical, volvulus, intussusception, inguinal hernia, testicular torsion
Strangulation - hair or fibre tourniquet

Question 3

management of infant colic thats not pathological (6)

Answer 3

Educate

• explain what’s normal to parents - PURPLE crying
• teach parents to recognise what signs of tiredness look like

Positive actions

• keep a sleep/cry diary
• set up routines for feeding, sleeping, settling baby

Negative actions

• avoid excessive stimulation
• rest breaks for parents

Question 4

infant colic - what is PURPLE crying

Answer 4

Peak - peak of crying occurs at 2 months, escalates every week, then slows down by 3-5 months
Unexpected - babies cry without reason, and settle spontaneously
Resists soothing - even if you do everything, might still be crying
Pain in face - does not correlate with actual pain
Long-lasting - crying sessions can feel like forever
Evening - babies cry in the afternoon and evening more

Question 5

neonatal reflux - red flag symptoms (7)

Answer 5

general
- bulging fontanelle

GI

• projectile vomiting immediately after a feed
• bilious vomiting
• acute abdo distension

systemic

• fever
• lethargy
• dehydration

Question 6

what is cow’s milk protein intolerance

• pathophysiology
• presentation (7)

Answer 6

an immune mediated reaction to cow's milk protein (can be IgE or non IgE )
symptoms
GI
- vomiting
- diarrhea
- proctocolitis
- perirectal bleeding
non-GI
- poor growth
- rash
- symptom improvement with dairy avoidance

Question 7

cow’s milk protein intolerance - management (7)

Answer 7

exclude dairy in patient diet for 1-4 weeks
exclude dairy in mother’s diet if she breastfeeds

replacement formulas

• extensively hydrolysed formula
• amino acid formula
• soy if >6mo age
• rice protein formula for short term

refer to paeds or allergy specialist