Infantile Colic: Recognition and Treatment

 


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Am Fam Physician. 2015 Oct 1;92(7):577-582.

  Patient information: A handout on this topic is available at http://familydoctor.org/familydoctor/en/diseases-conditions/colic.html.

Author disclosure: No relevant financial affiliations.

Infantile colic is a benign process in which an infant has paroxysms of inconsolable crying for more than three hours per day, more than three days per week, for longer than three weeks. It affects approximately 10% to 40% of infants worldwide and peaks at around six weeks of age, with symptoms resolving by three to six months of age. The incidence is equal between sexes, and there is no correlation with type of feeding (breast vs. bottle), gestational age, or socioeconomic status. The cause of infantile colic is not known; proposed causes include alterations in fecal microflora, intolerance to cow's milk protein or lactose, gastrointestinal immaturity or inflammation, increased serotonin secretion, poor feeding technique, and maternal smoking or nicotine replacement therapy. Colic is a diagnosis of exclusion after a detailed history and physical examination have ruled out concerning causes. Parental support and reassurance are key components of the management of colic. Simethicone and proton pump inhibitors are ineffective for the treatment of colic, and dicyclomine is contraindicated. Treatment options for breastfed infants include the probiotic Lactobacillus reuteri (strain DSM 17938) and reducing maternal dietary allergen intake. Switching to a hydrolyzed formula is an option for formula-fed infants. Evidence does not support chiropractic or osteopathic manipulation, infant massage, swaddling, acupuncture, or herbal supplements.

Infantile colic is a benign, self-limited process in which a healthy infant has paroxysms of inconsolable crying. The standard diagnostic criteria—known as the “rule of three”—is crying more than three hours per day, more than three days per week, for longer than three weeks.1 Symptoms typically resolve by three to six months of age.

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Parents should be educated about the benign and self-limited nature of infantile colic.

C

13

The probiotic Lactobacillus reuteri (strain DSM 17938) may reduce crying in breastfeeding infants with colic.

B

22, 23

L. reuteri DSM 17938 should not be given to formula-fed infants with colic.

B

8

Elimination of allergens (e.g., cow's milk, eggs, fish, peanuts, soy, tree nuts, wheat) from the diet of breastfeeding mothers may relieve colic symptoms.

A

15, 27

Switching formula-fed infants to a hydrolyzed formula may improve colic symptoms.

A

27


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Parents should be educated about the benign and self-limited nature of infantile colic.

C

13

The probiotic Lactobacillus reuteri (strain DSM 17938) may reduce crying in breastfeeding infants with colic.

B

22, 23

L. reuteri DSM 17938 should not be given to formula-fed infants with colic.

B

8

Elimination of allergens (e.g., cow's milk, eggs, fish, peanuts, soy, tree nuts, wheat) from the diet of breastfeeding mothers may relieve colic symptoms.

A

15, 27

Switching formula-fed infants to a hydrolyzed formula may improve colic symptoms.

A

27


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Colic affects approximately 10% to 40% of infants worldwide,2 typically peaks at about six weeks of age, and can be associated with significant parental guilt and frustration, as well as multiple physician visits. Colic has been associated with postpartum depression and shaken baby syndrome.3,4 Parents typically report that paroxysms occur in the evening and are unprovoked. The incidence is equal between sexes, and there is no correlation with type of feeding (breast vs. bottle), gestational age (full term vs. preterm), socioeconomic status, or season of the year.2,5,6

Etiology

Despite decades of research, the cause of infantile colic is not known. Proposed causes include alterations in fecal microflora, intolerance to cow's milk protein or lactose, gastrointestinal immaturity or inflammation, increased serotonin secretion, poor feeding technique, and maternal smoking or nicotine replacement therapy.710 Two studies have demonstrated higher levels of fecal calprotectin, a marker of colonic inflammation, in infants with colic.11,12

Evaluation

When evaluating a crying infant, physicians

The Authors

show all author info

JEREMY D. JOHNSON, MD, MPH, is deputy chief of the Department of Family Medicine at Tripler Army Medical Center, Honolulu, Hawaii....

KATHERINE COCKER, DO, is a faculty physician at the Family Medicine Residency Program at Tripler Army Medical Center.

ELISABETH CHANG, MD, is a third-year resident at the Family Medicine Residency Program at Tripler Army Medical Center.

Address correspondence to Jeremy D. Johnson, MD, MPH, at jeremy.d.johnson68.mil@mail.mil. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

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