Colic in babies: What to do? When to worry? #CauseAchatter

Excessive cry in babies, especially when inconsolable, is a nightmare for parents and pediatricians.

A cry is a normal physiological response. It is an excellent indicator that a child is in need, but a very poor indicator of what actually they need.
The reason behind excessive cry can be as simple as diaper irritation to as dangerous as a brain infection like meningitis.

Whenever a baby cries, parents feel that either they are hungry or they are in pain.
What we have to remember that crying is a normal physiological thing. And a baby has a crying curve just like a growth curve.

What is colic?

As per updated ROME IV criteria:
An infant who is less than five months of age at the start and stop of symptoms. The infant has recurrent and prolonged periods of crying, fussing, or irritability reported by caregivers without a specific reason. Infant colic cannot be prevented or resolved by caregivers. There is no evidence of infant failure to thrive, fever or illness.

PURPLE Crying in Colic

Parents should know about the concept of P U R P L E crying in colic.
The peak of crying: a typical colicky baby starts crying at around 2 weeks and gets worse with time until 2 to 3 months. And then it gradually declines by the end of 5 months.
Unexpected: most of the time it is sudden
Resists soothing: it does not respond to usual baby calming methods
Pain like faces: baby will make pain like faces
Long-lasting: each episode can be as long as 4 to 6 hrs
Evening: it has a tendency to occur in the evening

Why should we know and manage excessive cry/colic better?

Although colic is considered to be benign

1. It is a severe burden for families. Mentally and physically.
2. The impossible burden on health professionals and the health system. Parents are anxious and visit health care facilities, fearing the worse. An overburdened system cannot cope with this. Repeated counseling helps in many cases. That’s why awareness is crucial.
3. Colic is strongly associated with maternal depression, guilt, and disharmony in the family.
4. It can lead to Doctor shopping, harmful medications.
5. It is a common cause of early breastfeeding cessation.
6. Crying beyond the usual colicky period can be linked to later sleep problems, allergic disorders, family dysfunction, and behavioral problems.

What is the suspected Etiology of colic?

Despite years of research, the etiology is still not clear, and there are many proposed theories :

1. Postulated gastrointestinal mechanisms have included increased intraluminal gas, gut dysmotility, and visceral pain, but none is proven. Gastro-oesophageal reflux, cow’s milk protein allergy, lactose intolerance, and overload can also contribute.
2. Mother related factors: Maternal age, smoking, alcohol consumption, antenatal maternal stress and anxiety, and poor feeding techniques
3. Baby related factors: Difficult infant temperament, immaturity of the central nervous system, or an early form of migraine.
4. Environment-related factor: Lack of family support, family stress, and altered parent-child interaction
   Perhaps infant colic can be best regarded as an exacerbation of normal infant behavior by a mixture of physiological and psychosocial factors.

When to worry about excessive cry?

If any of the underlying symptoms are noticed in a baby, then you should visit a doctor as soon as possible.

1. Fever: most of the time, crying associated with fever is an indicator of infection with a few exceptions like fever after vaccination.
2. Lethargic baby or not feeding well: if the baby is less active than usual and or not accepting feed as earlier there’s a strong possibility of a serious disease.
3. Not gaining weight: if the baby is not gaining weight as per his / her age.
4. Repeated vomiting or arching: which might indicate a GERD ( gastroesophageal reflux disease).
5. Explosive diarrhea with perianal excoriation: suggests underlying lactose intolerance.
6. Blood mixed stool with diarrhea and not thriving well: may indicate a Cow’s milk protein allergy.
   What to do? How to manage colic?
   There is no cure or definitive treatment of colic parents can do the following things
7. Exclude other causes of excessive cry: before labeling it, colic parents must visit a doctor to ensure that it is colic and nothing else.
8. Know in detail about the disease: parents and all caregivers must understand the nature of the disease and its course. PURPLE cry to be remembered
9. Learn methods to deal with periods of excessive cry: various techniques, also known as “5S”, can be applied to calm the baby like swaddling the baby, side positioning, gently swinging, suckle(feeding the baby ), shh.. sound. Sometimes it might not help.
10. Low allergy diet in exclusively breastfed baby: mothers excluded cow’s milk, eggs, peanuts, tree nuts, wheat, soy, and fish from their diet
11. Switching to a hydrolyzed preparation in formula-fed babies after consultation with a doctor.
12. Drugs/medicines: some probiotics, lactase drop supplementation, etc. can be tried with a doctor’s consultation.

Take home message:

• Infantile colic is a benign condition improving with time.
• There are no associated abnormality in most cases and no long term sequelae in both baby and mother.
• Learning about the disease and coping methods to deal with this temporary issue is the best way to manage it.

This is a series of posts to create awareness about common shild health concerns as a part of #CauseAchatter initiative by Blogchatter.

• Covid 19 in children
• Constipation in children: solution guide to parents
• Leprosy: a curable disease
• Paediatric Food Allergies: What Parents Must Know
• Newborn baby healthy or not? 6 things mother should check