Management of Infantile Colic
For children with infantile colic, parental education, reassurance, and support are the primary recommended management strategies, as colic is a self-limiting condition with no proven pharmacological interventions that significantly improve outcomes. 1
Definition and Diagnosis
Infantile colic is characterized by:
- Paroxysms of inconsolable crying for more than 3 hours per day
- Occurring more than 3 days per week
- Persisting for longer than 3 weeks
- In an otherwise healthy, well-fed infant 1
Colic typically:
- Affects 10-40% of infants worldwide
- Peaks at around 6 weeks of age
- Resolves spontaneously by 3-6 months of age
- Has equal incidence between sexes
- Shows no correlation with feeding type, gestational age, or socioeconomic status 1
Diagnostic Approach
Colic is a diagnosis of exclusion. A thorough evaluation should rule out:
- Gastrointestinal disorders (gastroesophageal reflux, constipation)
- Infections
- Trauma (including corneal abrasions, fractures)
- Formula intolerance
- Other causes of persistent crying 1, 2
Management Strategies
1. Parental Support and Education
- Provide reassurance about the benign, self-limiting nature of colic
- Explain that colic has no long-term adverse effects
- Acknowledge parental stress and anxiety
- Monitor for signs of family distress, particularly in families with limited resources 2
2. Feeding Interventions
For breastfed infants:
- Consider probiotic Lactobacillus reuteri DSM 17938, which may be effective in breastfed infants with colic 3, 1
- Consider maternal dietary modification with reduction of potential allergens 1
For formula-fed infants:
- Consider switching to a hydrolyzed formula 1
- Note that L. reuteri cannot be recommended for formula-fed infants based on current evidence 3
3. Behavioral Interventions
- Respond promptly to infant's crying
- Use gentle motion (rocking, infant swing)
- Provide white noise or other calming sounds
- Consider swaddling techniques, though evidence is limited 1, 2
4. Ineffective or Contraindicated Treatments
The following should NOT be used for colic management:
- Simethicone (ineffective) 1
- Proton pump inhibitors (ineffective) 1
- Dicyclomine (contraindicated due to safety concerns) 1
- Cough suppressants and other over-the-counter medicines (may cause significant morbidity and mortality) 4
5. Unproven Interventions
Evidence does not support:
- Chiropractic or osteopathic manipulation
- Infant massage
- Acupuncture
- Herbal supplements 1
Follow-up and Monitoring
- Schedule regular follow-up to reassess symptoms
- Monitor for development of concerning symptoms that might suggest alternative diagnoses
- Assess parental coping and provide additional support as needed 2
- Reevaluate for emergence of specific etiologic factors if colic persists 4
Common Pitfalls and Caveats
Overtreatment: Avoid unnecessary medications that have no proven benefit and potential harm.
Missing organic causes: Ensure thorough evaluation to rule out pathological causes of persistent crying.
Neglecting parental wellbeing: Parents of colicky infants often experience significant stress, anxiety, and exhaustion that requires acknowledgment and support.
Environmental factors: Address potential exacerbating factors such as exposure to tobacco smoke 4
Unrealistic expectations: Set appropriate expectations about the natural course of colic and the limited effectiveness of available interventions.
Remember that while colic is distressing, it is temporary and does not indicate poor parenting or an unhealthy infant. The primary goal of management is supporting families through this challenging period while ensuring infant safety.