Overview
Also known as baby colic, infantile colic describes a self-limiting condition characterised by recurrent episodes of inconsolable crying, irritability, or fussing (distressed vocalisation that is not entirely crying but not awake or content either) in an infant <5 months old with no evidence of failure to thrive, illness, or fever.
Aetiology
Overview
Infantile colic is thought to be due to abnormal gastrointestinal motility and pain signals from sensitised pathways in the gut, excess gas production, and possible gut inflammation mediated by the microbiome-gut-brain axis.
Epidemiology
- Infantile colic generally presents between weeks 2-3 of life and peaks at around 6 weeks
- It affects males, females, breastfed, and formula-fed infants equally
- Infantile colic is one of the most common reasons for parents/carers to seek help in the first 3 months of their baby’s life
Presentation
Overview
Infantile colic is a diagnosis of exclusion. Features include:
- Inconsolable crying that is worse in late afternoon or evening
- Drawing up of the knees
- Facial redness
- Flatus
Differential Diagnoses
Gastro-oesophageal reflux (GOR)
- Reflux after larger feeds with no troublesome features (e.g. distressed behaviour, unexplained difficulties feeding, cough, hoarseness etc.)
Gastro-oesophageal reflux disease (GORD)
- Reflux after larger feeds with troublesome features (e.g. distressed behaviour such as excessive crying when feeding, unexplained difficulties feeding, cough, hoarseness etc.)
Intussusception
- Intermittent colicky abdominal pain
- During episodes of pain, the infant may draw their knees up and turn pale
- A sausage-shaped mass may be felt in the upper abdomen
- There may be passage of ‘redcurrant jelly’ stools – usually a late sign
Pyloric stenosis
- Vomiting that is forceful, ‘projectile’-like, and non-bilious
- Usually seen in the first 6 weeks of life
- A palpable upper abdominal mass may be felt
Diagnosis
Rome IV diagnostic criteria
Infantile colic is diagnosed if all of the following are met:
- The infant is <5 months old when symptoms start and stop
- Recurrent and prolonged episodes of crying, fussing, or irritability that cannot be resolved or prevented with no obvious cause
- No evidence of failure to thrive or illness
If there are atypical features, failure to thrive, or diagnostic doubt, then refer the infant to secondary care either as an emergency or on an outpatient basis depending on clinical presentation.
Management
Overview
Parents/carers should be reassured that infantile colic is common and usually resolves by 5 months of age. Infants are reviewed depending on clinical judgement.
NICE does not recommend the use of Simeticone (Infacol®), lactase (Colief®), maternal diet modification, changing formula preparations, probiotics, herbal supplements, or manipulative strategies (e.g. spinal manipulation or cranial osteopathy).
Prognosis
- In most cases, infantile colic improves by 3-4 months of age and resolves by 5-6 months
