eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Colic

Author: Prashant G Deshpande, MD, Attending Pediatrician, Department of Pediatrics, Christ Hospital Medical Center and Hope Children's Hospital, Oak Lawn, Illinois; Chairman, Department of Pediatrics, Palos Community Hospital, Palos Heights, Illinois; Assistant Clinical Professor Of Pediatrics, University Of Illinois at Chicago
Contributor Information and Disclosures

Updated: Oct 7, 2009

Introduction

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.1 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.2 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.3

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.

Frequency

International

Colic affects 10-30% of infants worldwide.

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 neonates and infants with equal frequency.

Age

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

Clinical

History

  • Colic remains a diagnosis of exclusion.
  • Crying by infants with or without colic is mostly observed in 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.

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.

Causes

  • 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

More on Colic

Overview: Colic
Differential Diagnoses & Workup: Colic
Treatment & Medication: Colic
Follow-up: Colic
References
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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. Akcam M, Yilmaz A. Oral hypertonic glucose solution in the treatment of infantile colic. Pediatr Int. Apr 2006;48(2):125-7. [Medline].

  11. 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].

  12. 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].

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

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

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

  16. 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].

  17. 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].

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

  19. [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].

  20. 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].

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

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

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

  24. [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].

  25. 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].

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

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

  28. 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].

  29. 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].

  30. 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].

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

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

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

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

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Further Reading

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Keywords

colic syndrome, evening colic, infantile colic, 3-month colic, incessant crying, nonstop crying, periodic crying, episodic crying, sepsis, otitis, strangulated hernia, maternal smoking, cow's milk allergy, CMA, treatment, diagnosis

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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; Chairman, Department of Pediatrics, Palos Community Hospital, Palos Heights, Illinois; Assistant Clinical Professor Of Pediatrics, University Of Illinois at Chicago
Prashant G Deshpande, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Chris A Liacouras, MD, Director of Pediatric Endoscopy, Department of Pediatrics, Division of Gastroenterology and Nutrition, Associate Professor, Children's Hospital of Philadelphia and University of Pennsylvania
Chris A Liacouras, MD is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Stefano Guandalini, MD, Director, University of Chicago Celiac Disease Program, Section Chief of Gastroenterology, Hepatology and Nutrition; Professor, Department of Pediatrics, University of Chicago Comer Children's Hospital
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.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-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: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, 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.

 
 
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