Intestinal Colic


Background

Pathophysiology

History

Key questions

  • When does the crying occur / how long does it last?
    • If right after feeding, consider
      • Aerophagia
      • GE reflux
  • What do you do when your baby cries?
    • May find unhelpful / harmful practices
  • What does the cry sound like?
    • A cry of pain or hunger?
  • How and what do you feed your baby
    • May find under / over feeding
    • May find inappropriate feeding
  • How do you feel when your baby cries?
    • May make family afraid
    • May make family members blame each other
  • How has the colic affected your family?
    • It's a family issue
    • Everyone has a different idea / opinion
  • Why do you think your baby cries?
    • Get their ideas / opinions / observations
  • Evaluate:
    • Diet
    • Stooling, urination, and sleeping patterns
  • Plot growth parameters
    • Look for failure to thrive
 

Physical exam

 

Differential Diagnosis

Treatment

  1. Consoling the infant
  2. If breast feeding, eliminate cow's milk from mother's diet
  3. Feeding
  4. Sucrose trial solution (table sugar to water to boil, then cooled)
  5. Emerging evidence for probiotics
  6. Majority outgrow this by 6 months
  7. Applying warmth to the abdomen, decreasing external stimulation, and rocking the infant have been advocated as useful interventions at various times.
  8. Reassuring the parents that colic is a common, self-limited problem in young infants and encouraging them to share caregiving responsibilities during this time can be helpful.
  9. The following suggestions may be beneficial:
  10. Administration of drugs (including sedatives) is contraindicated.
  11. Consult child's doctor


 

Conditions Associated with Uncontrollable Crying, Irritability, and/or Lethargy in Neonates
System Emergent Nonemergent
Central nervous system Intracranial hemorrhage (neonatal alloimmune thrombocytopenia, birth trauma, vitamin K deficiency)
Meningitis*  
Elevated intracranial pressure  
Eye, ear, nose, throat Nasal obstruction (choanal atresia or stenosis) Corneal abrasion, ocular foreign body
  Otitis media
  Nasal congestion (upper respiratory infection)
  Oral thrush
  Stomatitis
Pulmonary Pneumonia
Cardiac Supraventricular tachycardia
Heart failure  
GI Malrotation/Volvulus Gastroesophageal reflux disease (reflux)
Intussusception
Incarcerated hernia Gastroenteritis
  Anal fissure
  Intestinal Colic
GU Testicular torsion Urinary tract infection
Penile hair tourniquets Diaper rash
Paraphimosis  
Musculoskeletal Hair tourniquet of finger/toe Injuries (diaper pin, sharp or irritating objects from clothing)
Nonaccidental trauma
Infectious Sepsis* Upper respiratory infection
Pneumonia  
Meningitis*  
Metabolic Inborn errors of metabolism
Hypoglycemia  
Congenital adrenal hyperplasia