From the Guidelines
The workup for an infant with colic should begin with a thorough history and physical examination to rule out other causes of excessive crying, as recommended by the most recent guidelines 1. The physical exam should focus on growth parameters, abdominal examination, and signs of infection or trauma. Parents should be asked about the timing and duration of crying episodes, feeding patterns, stool characteristics, and any associated symptoms like vomiting or fever. Laboratory testing is generally not necessary unless there are concerning features in the history or physical exam, such as poor weight gain, bloody stools, or persistent vomiting, in which case further investigations may include complete blood count, urinalysis, stool studies, or abdominal ultrasound 1. For typical cases of colic without concerning features, reassurance and supportive measures are the mainstay of management, including soothing techniques (swaddling, white noise, gentle motion), feeding adjustments (smaller, more frequent feeds, proper burping), and parental support. The use of probiotics, particularly Lactobacillus reuteri DSM 17938 at 10^8 CFU daily, has been shown to be effective in reducing crying time in breastfed infants with colic, as supported by recent studies 1. Medications like simethicone have limited evidence but are generally safe. Colic is a self-limiting condition that typically resolves by 3-4 months of age, and the workup should focus on excluding other pathologies while providing support to families during this challenging period. Some key points to consider in the workup and management of infant colic include:
- A thorough history and physical examination to rule out other causes of excessive crying
- Reassurance and supportive measures as the mainstay of management
- The use of probiotics, particularly Lactobacillus reuteri DSM 17938, in reducing crying time
- The limited evidence for medications like simethicone
- The importance of excluding other pathologies while providing support to families during this challenging period.
From the Research
Workup for Infant with Colic
The workup for an infant with colic typically involves a thorough medical history and physical examination to rule out any underlying medical conditions that may be causing the symptoms.
- A systematic review of 20 articles, including 15 randomized controlled trials and 5 meta-analyses, found that the oral administration of probiotics to breastfed infants with colic resulted in at least a 50% reduction in crying time compared with placebo 2.
- Another study found that Lactobacillus reuteri improved colicky symptoms in breastfed infants within 1 week of treatment, compared with simethicone 3.
Diagnostic Considerations
When evaluating an infant with colic, healthcare providers should consider the following:
- Food hypersensitivity/allergy and gut dysmotility as potential causative factors of infantile colic 4
- Psychological and social factors that may be contributing to the infant's symptoms 4
- The possibility of a specific medical disorder, such as gastroesophageal reflux or milk protein allergy, in a small subset of infants with colicky behavior 4
Management Options
The management of infant colic may involve a multifactorial approach, including:
- The use of oral probiotics, such as Lactobacillus reuteri, to reduce crying time and improve symptoms 2, 5, 3
- Dietary changes, such as a hypoallergenic formula or a low-allergen diet for breastfeeding mothers 6
- Reduced stimulation of the infant and a calm environment 6
- Support, reassurance, and empathy for the caregiver, as well as a biopsychosocial approach to the infant and their family 4