Infantile colic is a common, self-resolving condition. It has important adverse associations including maternal depression, child abuse and early cessation of breastfeeding.
There are many proposed causes of colic, however none is definitive.
Colic is likely to be an exacerbation of normal infant crying brought about by physiological and psychosocial factors.
There is no known single effective treatment for colic.
The mainstay of management is exclusion of organic causes, explanation of the natural history of colic, parental support, offering strategies to deal with the infant’s feeding and sleep, and exploration of settling techniques.
The probiotic Lactobacillus reuteri DSM17938 may be trialled for exclusively breastfed infants with colic. Its efficacy in formula-fed babies is unknown.
An allergy to cow’s milk protein accounts for a minority of cases.
Hypoallergenic formula, and dietary exclusion for breastfeeding mothers, should only be tried in infants with other clinical features of cow’s milk allergy.
Infantile colic describes excessive crying of unknown cause in otherwise well infants. Colic affects up to 20% of infants, and is one of the most common presentations to the primary health sector in early life.
It resolves spontaneously after the first three to four months of life.
Colic is traditionally defined by the Wessel’s criteria of crying or fussing more than three hours of the day for more than three days of the week.The new Rome IV criteria define it as ‘recurrent and prolonged periods of infant crying, fussing or irritability reported by caregivers that occur without obvious cause and cannot be prevented or resolved’. The diagnosis can be assumed after exclusion of potential organic causes.
Although colic is considered to be benign, it is a major burden to families, health professionals and the health system. Colic is strongly associated with maternal depression and is the strongest risk factor for shaken baby syndrome. It is also a common cause of early breastfeeding cessation.
Crying beyond the usual colicky period can be linked to later sleep problems, allergic disorders, family dysfunction, and behavioural problems.
Despite years of research, the aetiology of colic remains elusive and there are many proposed theories.
Does colic represent the most severe spectrum of normal infant distress, or is it a manifestation of underlying gastrointestinal, neurological or psychosocial disorders?
Perhaps infant colic can be best regarded as an exacerbation of normal infant behaviour by a mixture of physiological and psychosocial factors.
Colic should only be diagnosed after exclusion of organic causes. These occur in less than 10% of infants presenting with crying.
Most organic causes present with other associated features.
Organic causes to exclude in a crying infant
Cow’s milk protein allergy
Significant vomiting, Feeding difficulties
Diarrhoea with mucus or blood, Poor weight gain
Extensive eczema, First-degree family history of atopy
Gastro-oesophageal reflux disease
Lactose intolerance or overload
Vomiting, Lump in inguinal region
Acute onset of vomiting, pallor, irritability, Abdominal mass, rectal bleeding
Infection: urinary tract infection, meningitis, otitis media
Fever, Lethargy, Poor feeding, poor weight gain
Perinatal risk factors for sepsis
Foreign body in eye