Infantile colic is marked by excessive and unsoothable crying, resulting from a multifactoral genesis. Suspected factors are the immaturity of the intestinal and nervous system, but also microbial dysbiosis. Several management options are available for colic, which include complementary and pharmacological solutions (Benninga et al. 2016; Zeevenhooven et al. 2018).
Infantile colic describes an infant with excessive, unsoothable crying, irritability or fussiness and is often associated with unexplained and acute abdominal pain (Benninga et al. 2016; Zeevenhooven et al. 2017).
Until release of the Rome IV criteria in 2016, the most commonly accepted diagnostic criteria was the “rule of three” or Wessel’s criteria. According to the rule of three, an infant who is otherwise well-fed and healthy but crying more than three hours per day, for more than three days per week, and for more than three weeks experiences colic (Zeevenhooven et al. 2018). New insights on infantile colic and other functional gastrointestinal disorders (FGID) resulted in broader diagnostic criteria. The more refined criteria specific to neonates and toddlers and also children and adolescents are summarized within Rome IV (Zeevenhooven et al. 2017). Here, diagnostic criteria for infantile colic must include all of the following (Benninga et al. 2016):
Infantile colic affects up to 25% of infants in the first six weeks of life (Wolke et al. 2017). Its pathophysiology is not yet fully understood and is assumed to be of multifactorial genesis. It has been postulated that infantile colic is caused by various factors, which include (Zeevenhooven et al. 2017; Savino et al. 2014):
Coping with a colicky infant can lead to the caregiver's frustration and insecurity. One important goal of the management of infantile colic is to help caregivers cope with their infant’s symptoms and to strengthen the infant-family relationship (Zeevenhooven et al. 2018; Salvatore et al. 2018). It is important for healthcare professionals to recognize this and offer the family continuous support. The general recommendation is to continue with breastfeeding. Some treatment options are available to help manage infantile colic, such as:
Specific dietary advice
Next to the continuation of breastfeeding also assurance of the infants' good latch while feeding to reduce intake of air is recommended. Mothers are encouraged to let the child reach the fat-rich hindmilk before switching breasts in one feeding to avoid lactose overload which can lead to colic-like symptoms (WHO 2009; WHO und UNICEF 1993). For formula-fed infants, a switch to hydrolysed protein formulas, use of probiotics also for breastfed children, or a low allergene diet for breastfeeding mothers have been suggested (Zeevenhooven et al. 2018; Savino et al. 2014).
Complementary and alternative approaches
These include manipulative or behavioural interventions such as carrying, massage, modification of infant care routines and herbal extracts. For the latter, extracts from chamomile, fennel and/or lemon balm have been mentioned (Zeevenhooven et al. 2018; Savino et al. 2014). Learn more in our infographic on infantile colic (→).
Pharmacological solutions aim to reduce gas production (Zeevenhooven et al. 2018; Savino et al. 2014).
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Salvatore S, Abkari A, Cai W, Catto-Smith A, Cruchet S, Gottrand F, Hegar B, Lifschitz C, Ludwig T, Shah N, Staiano A, Szajewska H, Treepongkaruna S, Vandenplas Y. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta paediatrica (Oslo, Norway : 1992) 2018; 107(9):1512–20. at: pubmed.ncbi.nlm.nih.gov/29710375
Savino F, Ceratto S, Marco A de, Di Cordero Montezemolo L. Looking for new treatments of Infantile Colic. Italian journal of pediatrics 2014; 40:53. at: pubmed.ncbi.nlm.nih.gov/24898541
WHO. Infant and Young Child Feeding. Model Chapter for textbooks for medical students and allied health professionals. Geneva, Switzerland: World Health Organization (WHO) press; 2009. at: https://www.who.int/maternal_child_adolescent/documents/9789241597494/en/
WHO, UNICEF. Breastfeeding counselling: a training course - Participant's Manual: Maternal, newborn, child and adolescent health: WHO; 1993. at: www.who.int/maternal_child_adolescent/documents/who_cdr_93_3/en/
Wolke D, Bilgin A, Samara M. Systematic Review and Meta-Analysis: Fussing and Crying Durations and Prevalence of Colic in Infants. The Journal of pediatrics 2017; 185:55-61.e4. at: pubmed.ncbi.nlm.nih.gov/28385295
Zeevenhooven J, Browne PD, L'Hoir MP, Weerth C de, Benninga MA. Infant colic: mechanisms and management. Nature reviews. Gastroenterology & hepatology 2018; 15(8):479–96. at: pubmed.ncbi.nlm.nih.gov/29760502
Zeevenhooven J, Koppen IJN, Benninga MA. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatric gastroenterology, hepatology & nutrition 2017; 20(1):1–13. at: pubmed.ncbi.nlm.nih.gov/28401050
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