infantile colic Flashcards
What is infantile colic and at what age does it typically occur?
Infantile colic is a benign condition seen in young infants, typically occurring in those less than 3 months old. It is characterized by excessive crying and the infant pulling up their legs, often worsening in the evening.
What is the prevalence of infantile colic?
Infantile colic occurs in up to 20% of infants.
What is the cause of infantile colic?
The cause of infantile colic is unknown.
What does the NICE Clinical Knowledge Summaries recommend for the treatment of infantile colic?
NICE Clinical Knowledge Summaries do not recommend the use of simeticone (such as Infacol) or lactase (such as Colief) drops for the treatment of infantile colic.
A couple presents to their GP with their 2-month-old daughter, concerned about her excessive crying every night for the past month. During these episodes, she pulls her knees up to her abdomen, clenches her fists, and becomes red in the face. Despite attempts at soothing, she remains inconsolable.
The parents report that the infant is primarily formula-fed with one breast milk feed per day. They have not observed any vomiting, diarrhoea, loss of appetite or fevers. The baby’s growth and developmental milestones are on track.
What is the most likely diagnosis?
Cow’s milk protein allergy
Infantile colic
Infantile spasms
Intestinal malrotation with volvulus
Intussusception
Infantile colic
Crying which most often occurs in the late afternoon or evening is a symptom of infantile colic
Infantile colic is correct. Given that this baby has no systemic features, is feeding and toileting normally, and is meeting all of their milestones, it is unlikely that there is any severe underlying pathology. The most likely diagnosis in this case is infantile colic, a benign condition of unknown aetiology that is characterised by recurrent crying in infants. Advice should be given to parents on soothing their baby, and reassurance that this is very common and will most likely improve by the time the baby is 4-6 months old.
Cow’s milk protein allergy is incorrect. IgE-mediated hypersensitivity to proteins found in cow’s milk results in an allergic response to cow’s milk. This presents with a combination of gastrointestinal symptoms, such as diarrhoea, vomiting, and bloating/wind, alongside general allergy symptoms, such as urticaria, wheezing, and watery eyes. They may have only a few, or a combination of many of these symptoms. Whilst this baby is drinking cow’s milk, they do not appear to be having any gastrointestinal or allergic symptoms as a result of this.
Infantile spasms is incorrect. Infantile spasms are a form of childhood epilepsy that presents most commonly between 3 and 8 months of age. The spasms are characterised by a sudden indrawing of the limbs, followed by limb extension, and are often followed by crying. These may cluster, repeating multiple times before the seizure is over. The description of the bouts in this scenario does not quite match that of infantile spasms, and the fact that this baby is meeting all of their developmental milestones makes it more likely for this to be infantile colic.
Intestinal malrotation with volvulus is incorrect. As the foetus develops, the bowel is a straight tube. As the foetus grows, the gut rotates into its normal configuration. Errors in this rotation can result in a predisposition for a midgut volvulus to occur. This typically presents before the age of 1 with sudden onset bilious vomiting, severe abdominal pain, and bowel obstruction, which is not the case for this patient.
Intussusception is incorrect. This occurs when the bowel telescopes in on itself, often during a concurrent viral illness, leading to severe abdominal pain, ‘redcurrant jelly’ stool, and vomiting. The child will appear very unwell and may have intestinal obstruction. Intussusception most commonly occurs in 6 month to 2-year-olds, but may occur in younger children. This is an emergency and requires prompt treatment. As the onset of symptoms is not acute, this baby is systemically well, has no history of viral illness, and has had no abnormal bowel movements, it is unlikely to be intussusception
A 2-month-old boy presents to the GP with his mother with a history of persistent crying episodes over the past two weeks. He appears irritable during these episodes, emitting a high-pitched cry and frequently drawing his legs up towards his abdomen. His mother reports that aside from these episodes, he is developing normally and is in good health, being regularly bottle-fed.
At what age would you typically expect the symptoms described to resolve completely?
12 months
18 months
24 months
6 months
9 months
6 months
Infantile colic normally improves around 3-4 months of age and resolves around 6 months of age
This patient exhibits numerous characteristics associated with infantile colic, a prevalent condition defined by episodes of inconsolable, high-pitched crying in an infant who is otherwise healthy and well-nourished. The experience can be exceedingly distressing for caregivers, making it imperative to exclude any other potential causes of the infant’s discomfort. While the aetiology of infantile colic remains unclear, it is thought that gastrointestinal or psychosocial factors may contribute to its development. Typically manifesting within the first few weeks postpartum, the condition is expected to improve around 3-4 months of age and resolve spontaneously by the age of 5 to 6 months. Consequently, 6 months is the correct answer.
