• functional gastrointestinal disorder of infancy
  • In 5-20% healthy infants
  • Selflimiting
  • Resolve by 5mo of age

The most accepted definition of colic uses the ROME IV criteria:

  • less than 5 months of age
  • recurrent and prolonged episodes of unexplained crying, irritability or fussiness
  • cannot be resolved or prevented by caregivers
  • has no apparent failure to thrive, fever or illness.

Pathophysiology

  • The exact etiology of colic is unknown
  • organic (neurodevelopmental and gastrointestinal) and psychosocial components
  • alterations in the intestinal microbiome (lactobacillus)
  •  Increased levels of pathogenic Gram-negative organisms
  • presence of lactose-fermenting organisms

Red Flag Signs and Symptoms in Assessment of Infant Colic​

  • Fever (medical emergency in infants <3 months) or lethargy
  • Weight loss, dehydration or failure to thrive
  • Diarrhea, blood-streaked or mucousy stools
  • Frequent regurgitation, vomiting, abdominal distension
  • Extreme or high-pitched crying
  • Parental mood disorders (anxiety or depression)
  • Maternal drug ingestion (illicit or pharmacologic)
  • >5 months of age
  • Lack of predictable diurnal rhythm
  • Family history of migraine or atopy
  • <2w of age (colic unlikely) see algorithm

**excessive infant crying has been associated with an increased risk of physical child abuse.

Non Pharmaco :

  • Depends on the cause + Lack of evidence
  • Management strategies for crying babies
  • Physical methods:

       **carrying, rocking..etc

       ** bicycle motion

       **warm bath (no heating pads!)

     **white noise NOT recommended (can damage ear)

**increased carrying, swings are NOT effective

  • Behavioural Management:

     **document crying and fussing help Dr to establish patterns

     **routine schedule for feeding, playing ..etc

  • Dietary Manipulation : require specialized follow up

**Breastfeeding :

           *empty one breast at each feed

           *dietary modification should be approached with caution

foods noted to aggravate colic:  cabbage, broccoli, caffeine, citrus fruit and chocolate.

**Formula Feeding:

         *Substituting standard formulas with hypoallergenic (casein hydrolysate, whey hydrolysate or amino acid–based) formula (but only if there is confirmed allergy to cow milk Potein)

         * soy protein–based , low iron, lactose reduced formulas are NOT recommended.

         * if formula change made and no improvement in Sx after 1w, stop

**Feeding Techniques: vertical, burped, use correct bottle and nipple size

Pharmaco:

  • Weak evidence
  • Probiotics:

**specifically Lactobacillus reuteri (first choice)

**alternative : Bifidobacterium animalis

**** Products available : BioGaia

  • Sucrose (saccharose):

**2nd line after probiotics

**useful but short acting (1-45min) : 12% and titrate to 24% after 7days if innefective

** Products available : DandleLion Kisses

  • Simethicone:

 **only drug approved (placebo effect?) safe option

 **Dicyclomine is NOT recommended (cause apnea)

 **** Products available : Ovol

              Dosing simethicone from lexicomp:

Neonate (including newborn) and <2 years weighing <10.9 kg: :

20mg 4 times daily as needed after meals and at bedtime;

maximum daily dose: 240 mg/24 hours

<2 years weighing ≥10.9 kg and Children ≥2 to <12 years:

40 mg 4 times daily as needed after meals and at bedtime.

Maximum daily dose: 480 mg/24 hours

Children ≥12 years and Adolescents:

40 to 125 mg 4 times daily as needed after meals and at bedtime;

with some formulations, may administer a single 250 mg dose if needed;

maximum daily dose: 500 mg/24 hours

  • Fennel preparations

exp:fennel oil

NOT recommended because lack of standarized products

Products: Kolik (the green box: fenouil + bicarb, the blue has dft ingredients+alcohol)

                  for 0 age and over

Reference: eCPS Aug 2022, lexicomp, RxVigilence