Infantile colic

Differential diagnosis

  • Acute
    • Bowel – Intussusception, Volvulus, Obstruction – green vomit, abdo distension, palpable mass
    • Testicular torsion
    • Strangulated hernia
    • UTI/other infections- fever
  • Chronic
    • GORD – crying while feeding, back arching, feeding difficulties, chronic cough, premature, ent/respiratory symptoms
    • CMPA – atopy, skin/GI/respiratory symptoms
    • Constipation
    • Hunger

 

Data gathering

  • Red flags – fever, faltering growth, jelly stool, apnoea, projectile vomiting, bile (green/yellow) vomit
  • Others – feeds, bowels, PU, rash, feeding aversion, tooth erosions
  • Examine – HR, RR, temp, CRT, abdo/cvs/resp/ENT, growth/centile chart, fontanelle

 

Clinical management

  • Explanation
    • <5 months of age
    • Recurrent, prolonged periods of infant irritability and difficult to console
  • Treatment
    • Conservative
      • Reassure – common, little evidence for medications, improves with age
      • Smaller, more frequent feeds
      • Thickened formulas
      • Raised beds
      • Support groups – CRY-SIS.org.uk
    • Medications
      • Trials of
        • Gaviscon
        • Ranitidine
          • 3mg/kg 3-4 times daily, tachyphylaxis so dose dictated by symptoms
        • Nutramigen
  • Follow-up / Safety-net
    • Review if symptoms persists after 4 months age
    • Come back if not putting on weight, blood in stools, feeding difficulties