Infantile colic

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Infantile colic is a disorder of unknown aetiology causing excessive crying in babies. It mainly affects infants from one month to three months of age, but can start in the first week of life and persist to six or twelve months.

It is a significant cause of parental anxiety and upset, and indeed has been cited as a factor in NAI (non-accidental injury, known to laypersons as 'child abuse') and SIDS (Sudden Infant Death Syndrome), in that parents can sometimes be driven to injuring their child because of the constant crying.

The cause and mechanisms are poorly understood, and no single treatment has been shown to be highly effective.

Symptoms

The principal feature of colic is inconsolable crying. The baby may appear 'angry'. This is often associated with drawn up legs, passing wind, vomiting, and restlessness. Colic is often worse in the evening.

Since crying is the baby's only form of communication, it is often difficult for parents to differentiate colic from other causes of crying, such as hunger, tiredness, or discomfort.

Proposed Causes of Infantile Colic

• Lactase deficiency

• Cow's Milk Allergy

• Air swallowing

• Insufficient physical contact

• Regulated (instead of baby-led) breastfeeding (due to overgrowth of bacteria that could be prevented by more frequent nursing)

Treatments for Infantile Colic

No treatment has been shown to be particularly effective although many have been tried. Many treatments provide partial or temporary relief. Infantile colic seems to be a multifactorial disease and so it is unlikely that a single treatment would help in all cases.

• Breast feeding - breast fed babies have a lower incidence of colic.

• Lactase enzyme supplements - Some colic is thought to be caused by transient lasctase deficiency in early life. Undigested lactose is then fermented by bacteria in the lower gut producing large amounts of gas, which causes the cramping abdominal pains of colic. Lactase supplementation acts by pre-digesting the lactose in the milk.

• Low-Lactose milk - these milks have a lower initial lactose content (2-3% as compared to around 7% for a 'typical' formula milk)

• Soya Milks

• Massage

• Cooled Boiled Water

• Simethicone - this reduces the tendency of gastic contents to foam, allowing small bubbles to coalesce. This is purported to aid burping and reduce the amount of air that enters the gut.

• Warm baths

• Herbal remedies - these include fennel seed oil and other herbs.

• Gripe Water - Various manufacturers produce a medicine called Gripe Water, most contain ginger, fennel, sugar and sodium bicarbonate in various quantities. Historically, some gripe waters contained up to 20% ethanol (alcohol) by volume, which may have contributed to their efficacy. Modern preparation do not generally contain ethanol.

• Sucrose - has an analgesic (pain-killing) effects in babies.

• Antispasmodics - drugs such as dicycloverine (dicyclomine), hyoscine butylbromide, and cimetropium bromide have been suggested for colic, and indeed are in routine use in some countries. However, drug therapy is limited by side-effects of some of the drugs (hypotonia, muscle weakness, breathing difficulty), and the fact that many drugs are not licensed or approved for use in the relevant age group (under 6 months).

• Chiropractic therapy - this has been suggested as a treatment for colic.