Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Colic

  • Author: Prashant G Deshpande, MD; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: Sep 03, 2015
 

Practice Essentials

Colic is commonly described as a behavioral syndrome in neonates and infants that is characterized by excessive, paroxysmal crying. Colic is most likely to occur in the evenings, and it occurs without any identifiable cause.

Essential update: Study suggests that colic is a form of migraine headache

A recent meta-analysis indicated that colic may be a form of migraine headache rather than, as has been proposed, a gastrointestinal condition. The analysis utilized 3 studies (891 subjects total), one of which indicated that there is a greater likelihood of colic in infants whose mothers have migraine headaches and the other two of which indicated that infants with colic are more likely to experience migraine in childhood and adolescence. Using a pooled random effects model in their analysis, Gelfand and colleagues found the odds ratio for an association between migraine and colic to be 5.6.[1, 2]

In a secondary analysis, which included two additional studies (both of which also looked at the colic/migraine link but addressed a different primary research question), the odds ratio for the association between migraine and colic was 3.2.[1]

Signs and symptoms

In the setting of colic, a detailed history should be obtained regarding the following:

  • Timing of crying: Crying by infants with or without colic is mostly observed during evening hours and peaks at the age of 6 weeks
  • Amount of crying: The amount of crying is not related to an infant’s sex; the mother’s parity; or the parents’ socioeconomic status, education, or ages
  • Characteristics of crying: Compared with regular crying, colicky crying is more turbulent or dysphonic and has a higher pitch
  • Family’s daily routine
  • Possible other causes of excessive crying (eg, having hair in the eye, strangulated hernia, otitis, sepsis); colic remains a diagnosis of exclusion

On physical examination, the keys to the diagnosis are as follows:

  • Normal physical findings
  • Weight gain: Infants with colic often have accelerated growth; failure to thrive should make one suspicious about the diagnosis of colic
  • Exclusion of potentially serious diagnoses that may be causing the crying

Demonstrated and suggested causes of colic may include the following:

  • Gastrointestinal causes (eg, gastroesophageal reflux disease [GERD], over- or underfeeding, milk protein allergy, early introduction of solids)
  • Inexperienced parents (controversial) or incomplete or no burping after feeding
  • Exposure to cigarette smoke and its metabolites [3, 4]
  • Food allergy [5, 6]
  • Low birth weight [7]
  • Characteristic intestinal microflora [8, 9]

See Clinical Presentation for more detail.

Diagnosis

The following should be kept in mind in the workup of a patient with colic:

  • Laboratory studies are usually not indicated unless another condition is suspected
  • If the patient’s stools are excessively watery, testing them for excess reducing substances may be worthwhile; positive results may indicate an underlying GI problem
  • Stool may be tested for occult blood to rule out cow’s milk allergy
  • Irritability and crying may be associated with GERD because of the pain associated with esophagitis

See Workup for more detail.

Management

General management principles include the following:

  • Rule out common causes of crying
  • Recommend that the parents not exhaust themselves, and encourage them to consider leaving their baby with other caretakers for short respites
  • Drug treatment generally has no place in management of colic unless GERD appears likely; although the anticholinergic agent dicyclomine hydrochloride is effective against colic, it has rare but serious adverse effects and cannot be recommended
  • Consistent follow-up and a sympathetic physician are the cornerstones of management
  • Various benign but unproven treatment modalities are available, including the following:
  • Maternal low-allergen diet (ie, low in dairy, soy, egg, peanut, wheat, shell fish) may offer relief from excessive crying in some infants.
  • Lactobacillus reuteri
  • Simethicone
  • Oral hypertonic glucose
  • Spinal manipulation (to recommended with caution, if at all)
  • Behavioral management
  • Nutritional supplements and other complementary medicines

Dietary changes may include the following:

  • Elimination of cow’s milk protein in cases of suspected intolerance of the protein
  • In infants with suspected cow’s milk allergy (CMA), a protein hydrolysate formula is indicated
  • Uncommonly, amino acid–based formulas may be needed to manage suspected CMA, though evidence may be lacking for use in colic
  • Soy-based formulas are not recommended, because many infants who are allergic to cow’s milk protein may also become intolerant of soy protein

See Treatment and Medication for more detail.

Next

Background

Colic is commonly described as a behavioral syndrome characterized by excessive, paroxysmal crying. Colic is most likely to occur in the evenings, and it occurs without any identifiable cause. During episodes of colic, an otherwise healthy neonate or infant aged 2 weeks to 4 months is difficult to console. They stiffen, draw up their legs, and pass flatus. Colic is one of the common reasons parents seek the advice of a pediatrician or family practitioner during their child's first 3 months of life.

The most widely used definition of colic was used by Wessel et al.[10] Their definition is based on the amount of crying (ie, paroxysms of crying lasting >3 h, occurring >3 d in any week for 3 wk).

Colic is a poorly understood phenomenon. It is equally likely to occur in both breastfed and formula-fed infants. Although potential adverse sequelae have been described, the disorder is generally believed to be self-limited and benign. Different feeding practices and crying may result in large amounts of air entering the gastric lumen, which suggests that excessive aerophagia may be associated with colic. Colonic fermentation is the second proposed source of excessive intestinal gas in infants. However, no experimental evidence supports either theory.

Increased levels of certain biochemical markers, such as motilin, alpha lactalbumin, and urinary 5-hydroxy-3-indole acetic acid (5-OH HIAA) have been associated in infants with colic. Data from one study suggested that psychosocial stress during pregnancy is associated with babies who develop colic.[11] Further research is needed to establish a causal relationship of these factors to colic.

Although anticholinergic drugs have proven effective, they are not recommended because of their serious adverse effects. Parental anxiety can be minimized if the physician discusses colic, offers insight on future expectations, and answers the parents' questions. Reassure the parents about the generally benign and self-limiting nature of the illness. A caring and compassionate healthcare provider remains the cornerstone in the management of colic, a problem for which effective therapy remains elusive.[12]

Previous
Next

Pathophysiology

The term colic derives from the Greek word kolikos or kolon, suggesting that some disturbance is occurring in the GI tract. Researchers have also postulated nervous system, behavioral, and psychologic etiologies.

Previous
Next

Frequency

International

Colic affects 10-30% of infants worldwide.

Previous
Next

Mortality/Morbidity

Increased susceptibility to recurrent abdominal pain, allergic disorders and certain psychological disorders may be seen in some babies with colic in their childhood.

Sex

This condition is encountered in male and female infants with equal frequency.

Age

The colic syndrome is commonly observed in neonates and infants aged 2 weeks to 4 months.

Previous
 
 
Contributor Information and Disclosures
Author

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Founder and Medical 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, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, European Society for Paediatric Gastroenterology, Hepatology & Nutrition, North American Society for the Study of Celiac Disease

Disclosure: Received consulting fee from AbbVie for consulting.

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, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

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, MD is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

References
  1. Anderson P. Infant Colic May Be Early Migraine. Medscape Medical News. Jul 3 2014. [Full Text].

  2. Gelfand AA, Goadsby PJ, Allen IE. The relationship between migraine and infant colic: a systematic review and meta-analysis. Cephalalgia. 2014 May 22. [Medline].

  3. 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. 2008 May. 36(3):284-91. [Medline].

  4. Milidou I, Henriksen TB, Jensen MS, Olsen J, Søndergaard C. Nicotine replacement therapy during pregnancy and infantile colic in the offspring. Pediatrics. 2012 Mar. 129(3):e652-8. [Medline].

  5. Heine RG. Gastroesophageal reflux disease, colic and constipation in infants with food allergy. Curr Opin Allergy Clin Immunol. 2006 Jun. 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. 1988 Jun. 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. 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. 2007 Jan. 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. 2004 Jun. 93(6):825-9. [Medline].

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

  11. 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].

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

  13. Waknine Y. Colic preceded by gut flora differences. Medscape Medical News. Jan 14, 2013. Available at http://www.medscape.com/viewarticle/777658. Accessed: January 24, 2013.

  14. de Weerth C, Fuentes S, Puylaert P, de Vos WM. Intestinal Microbiota of Infants With Colic: Development and Specific Signatures. Pediatrics. 2013 Jan 14. [Medline].

  15. 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. 2010 Sep. 126(3):e526-33. [Medline].

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

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

  18. 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. 1999 Oct. 22(8):517-22. [Medline].

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

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

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

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

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

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

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

  26. 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. 2005 Nov. 116(5):e709-15. [Medline].

  27. 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].

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

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

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

  31. [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].

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

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

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

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

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

  37. 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].

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

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

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

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.