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A. Evaluation by system: 4. GI |
Colic: A Parent’s (and Pediatrician’s) NightmareDefinition of Colic: Persistent crying for more than 3 hours a day for more than three days/week for three weeks in a row in an infant 2 weeks to 3 months of age. Crying described as “paroxysmal, persistent, unpredictable, prolonged, hard to soothe and unexplained.” Incidence of Colic: 10%-20% of normal babies; overdiagnosed Cause of Colic: Unknown. It is clear that colic in a baby causes stress in a household; it is unclear whether stress in a household causes colic. Differential Diagnosis: Particularly if baby has symptoms after 3 mos, consider esophagitis. Treatment of Colic: Many remedies; some actually help. How you handle this problem has implications on how effective you can be handling other medical problems later on. If you give prescriptions for this, the expectations will exist that you give prescriptions for other things as well. You must remember that you don’t need to fix problems with the first visit. Possible treatments: 1. Home Remedies: Since colic is a physiologic process, there are many claims of cures for colic: Gripe water (bicarb of soda), certain teas and health food store remedies, as well as chiropractic treatments have been advertised as being effective (they are not). Music tapes helpful. 2. Real or simulated car rides: www.colic.com or call 1-800-no-colic and, for about $100-140 depending on what you request, you get a machine that goes on the crib that rocks it and another piece of equipment is a sound and motion device that simulates car noises. SleepTight is another name for this: works the same way as putting a baby in an infant seat on the washing machine. 3. Counseling: Several studies show this is effective, but the number of hours necessary to do this is excessive. Not a practical solution (Pediatrics 1984;74:998) unless have a dedicated person in your office to do this kind of thing. 4. Formula changes in the milk allergic baby: Frequent switching of formulas makes no sense, but switching to a predigested formula (whey=casein hydrolysate: Peds December 2000) can be quite helpful if the child is allergic. 5. Breast fed Infant: Stop mother’s milk intake for 10 days and then restart milk products for 10 days; if the reintroduction of milk products is tolerated, have mother go back on all milk and milk products. About two-thirds of babies with colic improve. Recent study showing that Neocate for 4-8 days exclusively helped when mothers avoided milk and dairy products (Acta Paed 2000) 6. Feeding technique changes: Make sure milk comes out of nipple of bottle easily; burp at least every 1/2 to 3/4 oz, keeping child upright after feeding. See discussion of bottles/nipples. 7. Medications: Should not be given before 1 month of age. Most of the prescription meds have serious side effects associated with them: eg never use paregoric because of severe side effects! Others include: Tylenol, Donnatal (Phenobarbital, Hyosyamine, atropine, scopolamine – controlled studies: no difference from placebo); Levsin (hyoscyamine sulfate: no difference – a number of bad side effects reported); Sucrose: 2 ml when child cries actually helps; Mylicon: controlled study: no help) Updated 10/01 |
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© Medical College of Georgia |
Department of Pediatrics |
Medical College of Georgia February 27, 2004 |