Colic Infantile

8/14/2019 Colic Infantile

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MANAGEMENT OF

INFANTILE COLIC

Jeanette I. Ch. Manoppo

UKK Gastrohepatologi 2013


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Definition

Common problem (1 in six families) consulting healthcare professionals

Gastroenterology 2006;130: 1519

Infantile colic

Paroxysms of irritability, fussing or crying

that start and stop without obvious cause,

lasting > 3 hours per day and occurring > 3

days each week.

Without a failure to thrive

Rome III criteria


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Incidence

Affects 10-30% of infants worldwide

Occurs in =

Commonly observed in neonates and infants aged 2 weeks to4 months

The incidence of colic in breastfed and bottle-fed infants is

similar with no difference

Arch Pediatr Adolesc Med. 2002;156:1123-8


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Etiology

The cause of infantile colic remains unclear

Organic causes account


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Organic causes of infant

with excessive crying

Pediatrics. 1998;102(5 suppl E):1283

Pediatrics. 1991;88:452


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Pathogenesis

Poorly understood

Abnormal gastrointestinal motility and pain signals from

sensitised pathways in gut viscera Inadequate amount of lactobacilli and increased amount of

coliform bacteria in the intestinal microbiota influences gut

motor function and gas production

Curr Opin Pediatr. 2010;22:791-7


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Common Etiopathogenesis

Lactose intolerance

Dysmotility

Gastro-esophageal reflux

Gut hormones (motilin, ghrelin)

Gut microflora (Lactobacillus spp.)

Feeding disorders

Food hypersensitivity (cows milk

allergy)

Psychological factors (infantparent

interaction)


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Diagnosis

Exclusion of other causes especially organic causes

No abnormalities in history and examination, therefore noneed for biochemical and radiological examination


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Differential diagnosis

BMJ. 2013;347,f4102:1-5


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Differential diagnosis

BMJ. 2013;347,f4102:1-5


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Sri Lanka Journal of Child Health. 2012; 41:192-8

UTI (Urinary Tract Infection)

AOM (Acute Otitis Media)

Flow Chart


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Management

Reassurance of parents regarding the benign and self-limiting

nature of the illness as most of the babies improve by the age

of 3 to 4 month


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Management options

Diet modification

Based on theory that infantile colic results from excessive gas

production from poor gut digestion of cows milk proteins Hypoallergenic formula preparations for bottlefed infants

High fibre formula

Soy based formula

Hypoallergenic maternal diet for breastfed infants

Lactase therapy

Matern Child Health J. 2012;16:1319-31


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Diet modification

Hypoallergenic formula preparations for bottlefed infants

Where a suspicion of cows milk protein allergy exists there is some

evidence that the use of an empirical time limited trial of a completely

hydrolysed formula is a reasonable option

Partially hydrolysed formula would not be recommended because are

not hypoallergenic and therefore will not address colic symptoms caused

by protein allergy


Paediatr Child Health. 2011;16:47-9


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Diet modification

High fibre formula

No significant difference in symptoms vs standard formula

Soy based formula Not recommended because concerns about the level of phytoestrogens

and that soy protein may be an allergen in infancy

J Paediatr Child H. 2012;48:128-37


Soya based infant formula. 2003. www.sacn.gov.uk/pdfs/smcn_03_10.pdf


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Diet modification

Hypoallergenic maternal diet for breastfed infants

One systematic review suggest exclusion of milk product and other

possible trigger foods(peanuts, soy, fish) on the mother correlate

with >25 % reduction in cry/fuss vs baseline but did not separatedthe results for breastfed infants from hypoallergenic formula fed

infants

Limited evidence to suggest that hypoallergenic diets in mothers

may be helpful

They should also be advised not to discontinue breast feeding while

switching to the hypoallergenic maternal diet

J Paediatr Child H 2012;48:128-37

Matern Child Health J 2012;16:1319-31

Soya based infant formula. 2003. www.sacn.gov.uk/pdfs/smcn_03_10.pdf


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Diet modification

Lactase therapy

Lactase drops mixed with breast or bottle milk feeds up to 24

horus before feeding

May benefit but lack of evidence

J Paediatr Child H. 2012;48:128-37


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Pharmacological management

Anticholinergic Dicyclomine hydrochloride, cimetopium bromide

may benefit but adverse reaction noted to infant


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Complementary therapies

Herbal supplements

Fennel extract and mixed herbal tea

showed reduction in symptoms Adverse effect like vomiting, sleepines,

constpation and loss of appetite

Lack of standardisation of dosage and

formulations have also limited their use

Pediatrics. 2011;127:720-33

Curr Opin Pediatr. 2010;22:791-7


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Sucrose solutions

May be benefit but lack of evidence

There are concerns about potential nutritional effects and

formulation standardisation

Pediatrics 2011;127:720-33Curr Opin Pediatr 2010;22:791-7

J Clin Nurs.2008;17:1754-61


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Probiotics

Based upon the hypothesis that aberrant intestinal microflora affecting

gut function and gas production may contribute to symptoms, the use

of probiotics in infantile colic has become more common

One randomised double blind placebo controlled trial involving 46

infants used a suspension of freeze dried Lactobacillus reuteri. 50%

reduction in crying time from baseline and show good weight gain and

gastrointestinal tolerance


Pediatrics 2010;126:e526-33


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Massage

One study noted a positive effect in massage using aromatherapy

oils, however, the results were not separated between massage and

aromatherapy

While several other studies identified in a systematic review showed

some improvement on symptoms of colic, overall the quality of

these studies is poor


Int J Nurs Prac. 2012;18:164-9

Pediatrics. 2011;127:720-33

J Clin Nurs. 2008;17:1754-61


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Swaddling

Reduced crying symptoms but associated

with development hip dyslplasia,overheating, and sudden infant death

syndrome if placed in the prone position

Therefore not recommended


Pediatrics. 2007;120:1097-106


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Chiropractic

More controversial

Positive effects noted but bias with parents coping ability rather

that true effectiveness of chriopractic

Limited evidence to support this practice


FACT. 2012;17:22-6

N Z Med J. 2011;124:55-71J Explore. 2011;7:168-74


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Acupuncture

Two trials noted a shorter duration and intensity of infantile colic

symptoms

Another double blinded randomised controlled trial comparing

acupuncture with a sham needle insertion noted no major effect on

symptoms including feeding, bowel movement frequency, and sleep


Acupunct Med. 2010;28:174-9

Acupunct Med. 2008;26:171-82

BMC Complement Altern Med. 2011;11:93


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Behaviour modification

Family involvement using an integrated care model led to the

relief of infantile colic symptoms more than standard care

The use of contingent music was noted to decrease symptomsin another study

Infant Mental Health J. 2012;33:110-22


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Conclusion

Majority of cases only need simple reassurance

Many intervention only have poor evidence support

There are no effective and safe pharmacological management

options available over the counter or by prescriptions

Infantile colic is self limiting and benign but can cause distress

to parents. Therefore, parental support is important.


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Thank you,

for your attention

Documents

Colic Infantile