Colic Clinical Presentation

  • Author: Prashant G Deshpande, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: May 11, 2012
 

History

Colic remains a diagnosis of exclusion.

Crying by infants with or without colic is mostly observed during evening hours and peaks at the age of 6 weeks. The cause of this diurnal rhythm is not known. The amount of crying is not related to an infant's sex; the mother's parity; or the parents' socioeconomic status, education, or ages.

On acoustic analysis, colicky crying differs from regular crying. Compared with regular crying, colicky crying is more variable in pitch, more turbulent or dysphonic, and has a higher pitch. Mothers of infants with colic, unlike mothers of infants without colic, rate the cries as more urgent, discomforting, arousing, aversive, and irritating than usual.

Obtain a detailed history about the timing, the amount of crying, and the family's daily routine. The benign nature of colic should be emphasized.

Rule out causes of excessive crying in an infant, such as having hair in the eye, strangulated hernia, otitis, and sepsis.

Next

Physical

Perform physical examination to confirm normalcy. Infants with colic often have accelerated growth. Weight gain is typical, whereas failure to thrive should make one suspicious about the diagnosis of colic.

Previous
Next

Causes

Causes include the following:

  • GI causes may include but are not limited to gastroesophageal reflux, overfeeding, underfeeding, milk protein allergy, and early introduction of solids. Parental anxiety and parental stress has been a subject of many studies. Postpartum depression may lead to stress in parents, which may be transferred to the infant, resulting in excess crying.
  • Other causes include inexperienced parents or incomplete or no burping after feeding. Incorrect positioning after feeding may contribute to excessive crying. Note that colic is not limited to the first-born child, casting doubt on the theory about inexperienced parenting as the etiologic factor. Recent epidemiologic evidence suggests that exposure to cigarette smoke and its metabolites may be related to colic. Maternal smoking during pregnancy may be associated with colic.[4]
  • Some evidence has linked persistent crying in young infants to food allegy.[5] An association between colic and cow's milk allergy (CMA) has been postulated.[6] Data from one study suggested an association between low birth weight and increased incidence of colic.[7]
  • Recently, some reports have focused on intestinal microflora and its association with colic.[8] Lower counts of intestinal lactobacilli were observed in infants with colic compared with infants without colic.[9]
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Prashant G Deshpande, MD  Attending Pediatrician, Department of Pediatrics, Christ Hospital Medical Center and Hope Children's Hospital, Oak Lawn, Illinois; Assistant Clinical Professor of Pediatrics, Midwestern University, Downers Grove, IL

Prashant G Deshpande, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and American Telemedicine Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Chris A Liacouras  MD, Director of Pediatric Endoscopy, Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania School of Medicine

Chris A Liacouras is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Stefano Guandalini, MD  Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Stefano Guandalini, MD is a member of the following medical societies: American Gastroenterological Association, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

  1. Wessel MA, Cobb JC, Jackson EB. Paroxysmal fussing in infancy, sometimes called "colic". Pediatr. 1954;14:721.

  2. Sondergaard C, Olsen J, Friis-Hasche. Psychological distress during pregnancy and the risk of infantile colic:a follo-up study. Acta Paediatrica. 2003;92(7):811-816. [Medline].

  3. Cohen-Silver J, Ratnapalan S. Management of infantile colic: a review. Clin Pediatr (Phila). Jan 2009;48(1):14-7. [Medline].

  4. Canivet CA, Ostergren PO, Jakobsson IL, Dejin-Karlsson E, Hagander BM. Infantile colic, maternal smoking and infant feeding at 5 weeks of age. Scand J Public Health. May 2008;36(3):284-91. [Medline].

  5. Heine RG. Gastroesophageal reflux disease, colic and constipation in infants with food allergy. Curr Opin Allergy Clin Immunol. Jun 2006;6(3):220-5. [Medline].

  6. Taubman B. Parental counseling compared with elimination of cow's milk or soy milk protein for the treatment of infant colic syndrome: a randomized trial. Pediatrics. Jun 1988;81(6):756-61. [Medline].

  7. Sondergaard C, Skajaa E, Henriksen T B. Fetal Growth and Infantile Colic. Arch Dis Child Fetal Neonatal Ed. 2000;83:F44-F47.

  8. [Best Evidence] Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics. Jan 2007;119(1):e124-30. [Medline].

  9. Savino F, Cresi F, Pautasso S, et al. Intestinal microflora in breastfed colicky and non-colicky infants. Acta Paediatr. Jun 2004;93(6):825-9. [Medline].

  10. Savino F, Cordisco L, Tarasco V, Palumeri E, Calabrese R, Oggero R. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. Sep 2010;126(3):e526-33. [Medline].

  11. Akcam M, Yilmaz A. Oral hypertonic glucose solution in the treatment of infantile colic. Pediatr Int. Apr 2006;48(2):125-7. [Medline].

  12. Olafsdottir E, Forshei S, Fluge G, Markestad T. Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child. Feb 2001;84(2):138-41. [Medline].

  13. Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther. Oct 1999;22(8):517-22. [Medline].

  14. Perry R, Hunt K, Ernst E. Nutritional supplements and other complementary medicines for infantile colic: a systematic review. Pediatrics. Apr 2011;127(4):720-33. [Medline].

  15. Balon AJ. Management of infantile colic. Am Fam Physician. Jan 1997;55(1):235-42, 245-6. [Medline].

  16. Barr RG. The 'Colic' enigma: Prolonged episodes of a normal predisposition to cry. Infant Mental Health Journal. 11:340.

  17. Bergeson PS. Herbal teas for infantile colic. J Pediatr. Oct 1993;123(4):670; author reply 670-1. [Medline].

  18. Berkowitz D, Naveh Y, Berant M. "Infantile colic" as the sole manifestation of gastroesophageal reflux. J Pediatr Gastroenterol Nutr. Feb 1997;24(2):231-3. [Medline].

  19. Forsyth BW, McCarthy PL, Leventhal JM. Problems of early infancy, formula changes, and mothers' beliefs about their infants. J Pediatr. Jun 1985;106(6):1012-7. [Medline].

  20. Frodi A. When Empathy Fails: Aversive Infant Crying and Child Abuse. New York, NY: Plenum Publishers; 1985:263.

  21. [Best Evidence] Hill DJ, Roy N, Heine RG, et al. Effect of a low-allergen maternal diet on colic among breastfed infants: a randomized, controlled trial. Pediatrics. Nov 2005;116(5):e709-15. [Medline].

  22. Kurtoglu S, Uzum K, Hallac IK. 5-Hydoxy-3-indole acetic acid levels in infantile colic:Is serotoninergic tonus responsible for this problem?. Acta paediatrica. 1997;86:764-765. [Medline].

  23. Loethe L, Lindberg T, Jakobsson I. Macromolecular Absorption in Infants with Infantile Colic. Acta Paediatr Scand. 1990;79:417-21. [Medline].

  24. Lucassen PL, Assendelft WJ, Gubbels JW. Effectiveness of treatments for infantile colic: systematic review. BMJ. May 23 1998;316(7144):1563-9. [Medline].

  25. Miller AR, Barr RG. Infantile colic. Is it a gut issue?. Pediatr Clin North Am. Dec 1991;38(6):1407-23. [Medline].

  26. [Guideline] National Collaborating Centre for Primary Care. Postnatal care. Routine postnatal care of women and their babies. London (England): Royal College of General Practitioners; 2006 Jul. [Full Text].

  27. O'Donovan JC, Bradstock AS Jr. The failure of conventional drug therapy in the management of infantile colic. Am J Dis Child. Oct 1979;133(10):999-1001. [Medline].

  28. Pinyerd BJ. Strategies for consoling the infant with colic: fact or fiction?. J Pediatr Nurs. Dec 1992;7(6):403-11. [Medline].

  29. Raiha H, Lehtonen L, Korhonen T. Family life 1 year after infantile colic. Arch Pediatr Adolesc Med. Oct 1996;150(10):1032-6. [Medline].

  30. Rao MR, Brenner RA, Schisterman EF, Vik T, Mills JL. Long term cognitive development in children with prolonged crying. Arch Dis Child. Nov 2004;89(11):989-92. [Medline].

  31. Ruiz-Contreras J, Urquia L, Bastero R. Persistent crying as predominant manifestation of sepsis in infants and newborns. Pediatr Emerg Care. Apr 1999;15(2):113-5. [Medline].

  32. Savino F, Castagno E, Bretto R. A prospective 10-yaer study on children who had severe infantile colic. Acta Paediatrica. 2005;94 ( S 449):129-132. [Medline].

  33. Shenassa E D, Brown Mary-Jean. Maternal Smoking and Infantile Gastrointestinal Dysregulation:The Case of Colic. Pediatr. 2004;114(4):e497-e505.

  34. St James-Roberts I. What is distinct about infants' "colic" cries?. Arch Dis Child. Jan 1999;80(1):56-61; discussion 62. [Medline].

  35. Weissbluth M. Colic. In: Gellis and Kagan's current pediatric therapy. 14th ed. Philadelphia, Pa: WB Saunders.

  36. Weizman Z, Alkrinawi S, Goldfarb D. Efficacy of herbal tea preparation in infantile colic. J Pediatr. Apr 1993;122(4):650-2. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.