Colic in Children
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Colic is a self-limiting condition characterised by excessive, unexplained crying in an otherwise healthy infant, typically occurring in the first few months of life.
Aetiology
- Unknown exact cause; likely multifactorial.
- Gastrointestinal immaturity and excessive gas production.
- Altered gut microbiota composition.
- Increased sensory sensitivity and overstimulation.
- Parental stress and feeding practices.
Pathophysiology
- Immature digestive system may lead to inefficient gut motility.
- Increased intestinal gas production causing discomfort.
- Potential transient lactose intolerance or altered gut microbiome.
Risk Factors
- First-born infants.
- Exposure to maternal smoking during pregnancy.
- Formula feeding (although also seen in breastfed infants).
- Parental anxiety and stress.
Signs and Symptoms
- Excessive crying, typically >3 hours per day, >3 days per week, for >3 weeks.
- Episodes commonly occur in the evening.
- Infant appears distressed but is otherwise healthy.
- Clenched fists, flushed face, and drawing up of legs.
- Unpredictable crying episodes unrelated to hunger or nappy changes.
Investigations
- Clinical diagnosis: based on history and exclusion of other causes.
- Physical examination: normal findings suggest colic rather than organic pathology.
- Consider further investigation: if symptoms are atypical, associated with vomiting, weight loss, or altered stool patterns.
Management
1. Reassurance and Parental Support:
- Educate parents about the self-limiting nature of colic.
- Encourage soothing techniques (rocking, white noise, warm baths).
- Advise on responsive feeding and avoiding overstimulation.
2. Feeding Adjustments:
- Ensure appropriate burping after feeds.
- Trial of smaller, more frequent feeds.
- Consider a hydrolysed formula if cow’s milk protein intolerance is suspected.
3. Pharmacological Interventions (Limited Evidence):
- Simethicone drops (limited efficacy but safe).
- Probiotics (Lactobacillus reuteri) may be considered in breastfed infants.
4. Referral:
- Paediatrics: if symptoms are severe, persist beyond 4 months, or are associated with red flag symptoms (vomiting, poor growth, abnormal stools).
- Dietitian: if a cow’s milk protein allergy is suspected and dietary modification is needed.