by Maria Mosquera, MD LEARNING OBJECTIVES:
- Consider the differential diagnosis in an infant with episodes of inconsolable crying.
- Learn the definition of colic.
- Describe the typical progression of colic.
Understand that the cause of colic is unknown.
Explain the evaluation of an infant with suspected colic.
Be able to list the treatment options for colic.
Understand which treatment options for colic have been shown to be effective.
CASE 1:
A worried and tired mom brings her 2 month old baby to your continuity clinic for advice. You have been following Angel in your clinic since he was born at Term. He has been healthy up to now, growing well even up to today’s weight. But, mom is worried and has brought him in to clinic today as a walk-in because Angel has been crying every night from midnight until 5am for weeks. He started having these episodes when he was one month old and has been having them five days a week since then. During these crying episodes he turns “red in the face,” closes his eyes, tightens his fists, draws his legs up to his abdomen and cries with a loud and piercing cry that awakens mom from her sleep. Mom has tried feeding him, bathing him, changing his diaper, rocking him to no avail. Mom is 19 years old and this is her first child. She lives with dad, who is 22 years old, and who is helpful and supportive but has tried helping to make Angel stop crying, also to no avail. Maternal grandmother also lives in the household and has tried helping to soothe the crying with no success. Mom is worried that something is wrong with Angel.
QUESTIONS AND ANSWERS:
- What is the differential diagnosis in an infant with episodes of inconsolable crying? (Adapted from Barr and Roberts references below)
- What is the definition of colic?
- What is the typical progression of colic?
- What is the cause of colic?
- How do you evaluate an infant with suspected colic?
CASE 2: A 24-year old mom of a 6 week old girl comes to your clinic for a walk-in visit. Mom is both breastfeeding and formula-feeding and asks if she should avoid any foods in her diet, such as broccoli or cow’s milk, to help ameliorate the baby’s colic? Mom also wonders if she should change the formula as it may be “upsetting her stomach?”
CASE 3: An experienced 34-year old mother brings her 2 month old baby boy to see you for his 2 month well child check and immunizations. On conversing with her, she mentions that they are not getting much sleep at night, because the baby is fussy with “gas pain.” She has tried Simethicone drops and Gripe water and wonders if it actually works? or if there is any other medicine she can give him? She has been also feeding the baby chamomile tea once a day for his fussiness and colic, per grandmother’s recommendations, and wonders if that’s OK or helpful?
6. What are the treatment options for colic? Which treatment options for colic have been shown to be effective?
7. What reassurance can you provide the family about colic?
REFERENCES (in alphabetical order):
Barr RG. Management of Clinical Problems and Emotional Care: Colic and Crying Syndromes in Infants. Pediatrics. Supplement November 1998; 102(5): 1282-1286. http://pediatrics.aappublications.org/cgi/content/full/102/5/SE1/1282.
Fireman L and Serwint J. Colic. Pediatr. Rev. 2006;27;357-358. http://pedsinreview.aappublications.org/cgi/reprint/27/9/357.
Garrison MM, Christakis DA. A Systematic Review Of Treatments Forant Colic. Pediatrics Vol. 106 No. 1 Supplement July 2000, Pp. 184-190. http://pediatrics.aappublications.org/cgi/content/full/106/1/S1/184?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=colic&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT. Inf
Lawrence D. Rosen, Cecilia Bukutu, Christopher Le, Larissa Shamseer, Sunita Vohra. Complementary, Holistic, and Integrative Medicine: Colic. Pediatrics in Review. 2007;28:381-385. http://pedsinreview.aappublications.org/cgi/content/full/28/10/381?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=rosen&fulltext=colic&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
Roberts DM, Ostapchuk M, O'Brien JG. Infantile colic. American Family Physician. 2004;70(4): 735-40. http://www.aafp.org/afp/20040815/735.pdf.
Yale Curriculum in Primary Care Pediatrics. Week 27: Infantile Colic by Beth Liston, MD, PhD. http://courseinfo.med.yale.edu/webapps/login/.
