0622. Anything new in diagnosis and management of infantile colic?

Infant irritability or colic is quoted by some as being the most common paediatric problem in the first year of life; however prospective studies have found the incidence to be around 20-25%, making colic less common (certainly in a developing country such as South Africa) than conditions like upper respiratory tract infection or gastroenteritis.  The causes continue to be debated in the literature, and range from gastrointestinal dysfunction or an immature nervous system to anxious new parents.  With the lack of complete understanding of the cause of colic comes a lack of consensus on management strategies.  The condition, known by many as three-month colic (arising at around three months and usually resolving within a similar time frame) is commonly defined as crying for ≥ 3 hours per day for ≥ 3days per week for ≥ 3 weeks, but some authors accept the diagnosis after only 1 week of inconsolable crying.  Breastfeeding is not protective, and studies have shown similar rates of colic whether fully-, partially- or non-breastfed.  A 1998 systematic review of interventions identified 27 trials and found that elimination of cow’s milk protein was effective when substituted by hypoallergenic formula (95% CI 0.09-0.34).  Soy milks were not effective in reducing symptoms.  Dicyclomine was more effective, but concerns about side effects have largely removed this agent from use.  Reduced stimulation was also beneficial, in fact as effective as dicyclomine (CI 0.23 – 0.74).  Several studies have found simethicone to be ineffective.  Recent studies in breastfed infants have revolved around modifying maternal diet (i.e. strict elimination of potential allergens).  Significant reductions in symptoms were observed after elimination, although many infants still met criteria for diagnosis after one week of intervention.  Other modalities of treatment that are currently in vogue include spinal manipulation and reflexology. 

Read more:
J Paediatr Hlth Care 2004; 18: 115-122
BMJ 1998; 316: 1563-9
Pediatrics 2005; 116: 709-715
J Manipulative Physiol Ther 1999; 22: 517-22