Colic in Children

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Colic refers to episodes of excessive, frequent crying in an otherwise healthy infant. The crying typically starts within the first few weeks of life, peaks around six weeks, and improves by three to four months of age. Colic is often defined by the "rule of threes": crying for more than three hours a day, for more than three days a week, and for more than three weeks.

Aetiology

The exact cause of colic is unknown, but several factors may contribute, including:

• Gastrointestinal discomfort: Gas, food intolerances, or immature digestion.
• Feeding techniques: Overfeeding, underfeeding, or swallowing air during feeding.
• Parental stress: Stress in the home environment may exacerbate symptoms.
• Immature nervous system: Colic may be related to an infant's immature nervous system and their inability to self-soothe.

Pathophysiology

The underlying mechanisms are not fully understood, but it is believed that colic may involve gastrointestinal factors, such as increased gas production or gut motility, alongside behavioural factors such as an immature ability to self-soothe. The prolonged crying can lead to aerophagia (swallowing air), which may exacerbate discomfort.

Risk Factors

• First-born children are more commonly affected.
• Infants with mothers who smoke during pregnancy or postnatally may have a higher risk.
• Breastfeeding or formula-feeding issues, such as improper latching or intolerance to certain formulas.
• Parental stress or anxiety may increase colic episodes.

Signs and Symptoms

• Excessive crying that starts suddenly and lasts for prolonged periods.
• Crying often occurs in the late afternoon or evening.
• Clenched fists, arched back, or legs drawn up to the abdomen during episodes.
• Difficulty calming down, despite attempts to soothe.

Investigations

Colic is a diagnosis of exclusion, and typically no investigations are necessary if the child is otherwise healthy. However, the following may be considered to rule out other causes of distress:

• History and physical examination: Ensure there are no signs of infection, gastrointestinal obstruction, or other underlying conditions.
• Weight and growth monitoring: To ensure the child is thriving despite crying episodes.

Management

Management is primarily supportive, focusing on calming techniques and parental reassurance:

First-line management:

• Reassurance: Educate parents that colic typically resolves by 3-4 months and is not harmful.
• Comforting strategies: Rocking, swaddling, or using white noise may help calm the infant.
• Feeding techniques: Ensure proper latching and feeding position to reduce gas and air swallowing. Consider trialing a hypoallergenic formula if cow's milk intolerance is suspected.

Second-line management:

• Probiotics: Some studies suggest that certain probiotics (e.g., Lactobacillus reuteri) may reduce colic symptoms in breastfed infants.

References

1. NHS (2023). Colic in Babies. Available at: https://www.nhs.uk/conditions/colic/
2. NICE (2024). Colic in Infants: Guidelines for Diagnosis and Management. Available at: NICE
3. BMJ (2023). Colic in Infants: Management and Treatment. Available at: BMJ