​Kembara Xtra - Medicine - Infantile Colic

​Kembara Xtra - Medicine - Infantile Colic 
Introduction 

When a baby cries for longer than three minutes, according to the Wessel criteria or the Rule of Three, it may be experiencing colic.
More than three hours per day, three days per week, and longer than three weeks.
Colic typically peaks at 6 weeks of age, however many doctors do not rigorously adhere to the criterion of persistence for >3 weeks because few parents or professionals will wait that long before examination or intervention.
While the majority of clinicians believe that colic is a unique clinical entity, some believe that colic reflects the extreme end of the spectrum of normal weeping.

Incidence and prevalence in Epidemiology 
The age range between 2 weeks and 4 months has the highest incidence.
Equal distribution of boys and females, formula-fed versus breast-fed, and full-term versus preterm births
Prevalence
Wide range from 8% to 40% of infants, but more commonly affects 10-25% of infants. Accounts for 10-20% of pediatric visits in the first few weeks of an infant's life.
This is a concern for infants.

Pathophysiology and Etiology 
There is no known cause. Factors like the following could be involved:
Gastroesophageal reflux disease in children

 Fruit juice intolerance Breathing air while crying, sucking, or nursing Overfeeding, underfeeding, or feeding too soon, has also been suggested.
● Inadequate burping after feeding ● Family tension and/or stress ● Parental anxiety, depression, and/or fatigue ● Parent–infant interaction mismatch ● Infant’s inability to console him or herself when dealing with stimuli ● Hypersensitivity after exposure to prolonged environmental stimuli ● Possible early manifestation of childhood migraine ● Intolerance to cow’s milk, soy milk, or breast milk protein ● Increases in the gut hormone motilin, causing hyperperistalsis ● Functional lactose overload (i.e., breast milk that has a lower lipid content can have faster transit time in the intestine, leading to more lactose fermentation in the gut and hence gas and distension) ● Intestinal immaturity leading to incomplete absorption of carbohydrates in the small intestine resulting in excessive gas when the unabsorbed carbohydrate is fermented by colonic bacteria ● Alterations in fecal microflora ● Tobacco smoke exposure ● Prenatal exposure to maternal smoking or nicotine replacement therapy ● Immature motor regulation ● Increased serotonin concentration

Risk Elements 
Infant physiological predispositions may be a factor, although no clear risk factors have been identified.
Recent research indicates a higher frequency of infantile colic is linked to mother smoking or exposure to nicotine replacement therapy during pregnancy.
Infants who suffer colic are twice as likely to have a mother who has experienced migraines.
Typically, it is impossible to avoid colic.


Introducing History Evaluation using the Wessel criterion Crying lasts longer than three hours per day, three days per week, and for longer than three weeks.
The beginning and end of an episode are often distinct.
The crying is frequently different from normal crying and is usually unprovoked by anything that occurred before the episodes.
Colicky sobbing might seem more like screaming since it can be louder, more tumultuous, and vary in pitch.
Hypertonia, which includes facial flushing, circumoral pallor, rigid abdomen, arching of the back, tightening of the arms, clenching of the fingers, or pulling up of the legs, may accompany episodes of colic.
Despite the parents' best efforts, it could be challenging to calm or console the baby.
If the baby is not colicky, they behave normally.
Assess the carers' and families' coping mechanisms and support network.

clinical assessment 

 Since frequent weeping may be a risk factor for abuse, take sure to carefully examine the kid for indications of shaken infant syndrome or other forms of child abuse. A thorough physical examination is normal.

Multiple Diagnoses 

Any organic reason for excessive crying or sobbing that differs in quality in newborns, such as:
Meningitis, sepsis, otitis media, or UTI are examples of infectious causes.
Causes related to the digestive system, such as strangulated hernia, lactose intolerance, intussusception, constipation, and gastroesophageal reflux disease

Trauma, which includes child abuse, digit or penile hair tourniquet syndrome, corneal abrasion, occult fracture, or foreign bodies


Diagnostic tests and laboratory results 

Initial examinations (lab, imaging)
Clincial diagnosis of infantile colic. Unless clinical symptoms (UTI, weight loss, etc.) indicate additional reasons, testing is normally not done.
Other/Diagnostic Procedures
To rule out alternative reasons, a comprehensive history and physical examination should be conducted. Otherwise, neither diagnostic tests nor imaging are recommended.

General Management Measures 
Calm the child by holding and rocking him or her.
Utilize a pacifier.

 The use of light, rhythmic motion (such as in strollers, baby swings, and automobile rides)
White noise (such as that produced by a vacuum, clothes dryer, or white noise machine)
The effectiveness of vehicle ride simulators or crib vibrators has not been established.

 Offering a hot bath

It has not been demonstrated that more carrying or using an infant carrier may reduce colic.

Frequent burping may actually increase the rate of regurgitation and does not appreciably reduce colic occurrences.
Use the 5 Ss (must be done simultaneously):
- Swaddling: a tight blanket wrap that may be especially good for newborns under 8 weeks old.

Laying the infant on its side. Shushing: making a lot of noise.
- Swinging: a jiggling, rhythmic motion
- Sucking: on a finger, pacifier, or nipple.
- (Bonus "S"): "Remain composed." The way that something is said, such as "Everything will be fine; I am here now," may be more important to the baby than the words themselves.

No medicine has been shown to be consistently effective in treating infantile colic. Probiotics are secure and useful.

Despite the possibility of major side effects such apnea, seizures, and syncope, dicyclomine (Bentyl) has been banned from use. Additionally, the drug is contraindicated in infants under the age of six months, according to the manufacturer.

Omeprazole and Simethicone have not been demonstrated to have any positive effects.

A Few More Reference Points 

Referral to a specialist is necessary in cases of excessive vomiting, low weight growth, recurring respiratory conditions, or bloody stools.


Additional Therapies 

There isn't enough proof to say that probiotics can prevent infantile colic better than a placebo, although they may lessen how much a baby cries on a daily basis (especially if they contain Lactobacillus reuteri).
In a 2020 systematic review, Lactobacillus reuteri DSM 17938 was discovered to reduce the amount of time spent sobbing, however acupuncture was not.

Bifidobacterium animalis subsp. lactis may be the most effective probiotic, according to a recent study.
But further information is required.
Anecdotal evidence that real and virtual automobile drives can be productive. 
generating "white noise," for as by using a vacuum, clothes dryer, sound machine for babies, or white noise generator. To reduce potential negative effects on hearing or auditory development, avoid excessively loud and/or prolonged noise. Herbal teas and supplements may be helpful but are not advised due to limited, inconclusive evidence.
Use up to TID of herbal teas containing blends of chamomile, vervain, licorice, and balm-mint may be advantageous. The study's large dosages, however, have led to clinical worries that this medication may hinder infants' demand for milk ingestion and make it difficult to provide. Additionally, it's possible that the study's preparations aren't commercially available in the US.
– There is proof that several fennel treatments, including oils, teas, and herbal components, are useful in treating infantile colic.

It has been proven that a home-based strategy that emphasizes parental support, lowering infant stimulation, and syncing infant sleep-wake cycles with the environment is successful.
Music use may be beneficial.
Chiropractic care hasn't outperformed a placebo in terms of effectiveness.

There is no evidence that baby massage is beneficial.


Follow-up Repeated outpatient visits as required for parental reassurance, education, and supervision, as well as to check on the baby's and parents' health.
patient observation
 Follow to ensure optimum nutrition, development, and growth.


Nutrition
If you are breastfeeding, keep going; switching to formula is not likely to be beneficial.
– Eliminating milk, eggs, wheat, nuts, soy, and/or fish from a breastfeeding mother's diet has a low possibility of having therapeutic benefits, although it might be helpful if the mother has atopic dermatitis or the baby exhibits signs of a cow's milk allergy.

● Using a curved bottle or a bottle with a foldable bag while feeding the baby formula may assist to reduce air swallowing.
– Consider a 1-week trial of hypoallergenic formulas like whey hydrolysate (such as Good Start) or casein hydrolysate (such as Alimentum, Nutramigen, Pregestimil) if no intervention or dietary adjustment has been successful. Additionally, adding fiber to formula has not been proven to be beneficial.

Sucrose solution supplementation could be beneficial, however the benefit might only last an hour or two.

It's doubtful that switching to soy protein formula will be beneficial.
The use of lactase enzymes in formula, breast milk, or administered directly to the newborn shows little therapeutic benefit, despite the postulated mechanism of functional lactose excess.


Assure parents that poor parenting is not the cause of their child's colic, and give them advice on taking appropriate breaks, getting enough sleep, and getting help with baby care.
To reduce the danger of injury to the baby, parents must establish their own unique coping mechanisms for colic episodes.
Explain the range of weeping expressions; abstain from over- or underfeeding.
Teach parents about healthy feeding practices including using better bottles (low air, curved) and burping enough after meals.


The condition often goes away by 3 to 6 months of age, frequently on its own.
Colicky newborns appear to have abdominal pain, but they feed normally and put on weight as they should.
Colic has little impact on the infant's intelligence or future development, but some research suggest that temper tantrums may be more frequent among formerly colicky infants as observed in toddlers up to 4 years old.

Complications Colic is self-limiting, and the newborn is not known to suffer any harmful long-term repercussions from it.
Possible links to early breastfeeding cessation, child abuse, higher risk or incidence of postpartum depression in one or both parents, and caregiver burnout