Colic


Colic is one of the most common feeding problems in babies, and can occur in up to 1 in 4 babies1. It can be easy to recognise, but difficult to understand and solve, and can therefore be distressing for parents. Colic is defined by excessive crying  behaviour, but can be accompanied by flushing of the face, drawing in of the legs, a rumbling  stomach and flatulence. Reassurance and support are vital, and colic should ideally be managed within the primary care team2

Causes

The cause of colic is not fully understood. The debate about the causes of colic is ongoing, but the latest evidence suggests that it is most likely to be multi-factorial and could involve one of a number of digestive or behavioral problems3

Some useful indicators for identifying colic include:

  • Intense inconsolable crying
  • Flushing of the face
  • Retraction of the legs
  • Clenching of the fists with 2-3 hour spells of loud crying
  • Difficulty in passing stools

Diagnosing colic

For clinical purposes, must include all of the following4:

  • An infant who is <5 months of age when the symptoms start and stop
  • Recurrent and prolonged periods of infant crying, fussing, or irritability reported by caregivers that occur without obvious cause and cannot be prevented or resolved by caregivers
  • No evidence of infant failure to thrive, fever, or illness.

NICE clinical knowledge summary on colic5

The NICE Clinical Guidelines recognise the role nutrition plays in the management of FGIDs in infants and recommend conservative and nutritional approaches ahead of medical interventions5-7

The guidance states that:

  1. The most useful intervention is support for parents and reassurance that infantile colic will resolve
  2. Soothing strategies should be attempted first along with support and advice from public health nurses
  3. Medical treatments (simeticone or lactase drops) should only be tried if parents feel unable to cope despite advice and reassurance

NICE recognises that studies of interventions for infantile colic behind simeticone and lactase drops tend to lack methodological quality, making it difficult to evaluate the effectiveness of any treatment.

Practical advice

  • Parental reassurance
  • Comfort the infant
  • Wind the infant
  • Rub the infant’s back or stomach
  • Feed the infant in the upright position

Nutritional solutions for bottle-fed babies

Partially-hydrolysed formula with a patented blend of prebiotic oligosaccharides, structured vegetable oil and reduced lactose, e.g. Aptamil Comfort

References

  1. Garrison M & Christakis D. Early Childhood: Colic, Child Development, and poisoning prevention: A systematic review of Treatments for Infant Colic/ Pediatrics 2000; 106: 184-190.
  2. Food Safety Authority of Ireland 2011. Scientific Recommendations for a National Infant Feeding Policy, 2nd Edition.
  3. Savino F. Focus on infantile colic. Acta Paediatr 2007; 96(9): 1259-64.
  4. Benninga MA. et al., Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016; 150:1443-1455
  5. Clinical Knowledge Summary. Colic. Available at: http://cks.nice.org.uk/colic-infantile#!topicsummary (GB residents only: Accessed July 2016).
  6. Constipation in children and young people. 2010. Available at: https://www.nice.org.uk/guidance/cg99 (accessed November 2016)
  7. Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people. 2015. Available at: https://www.nice.org.uk/guidance/ng1/chapter/1 Recommendations#initial-management-of-gorand-gord(accessed November 2016)