Case story – A healthy 2 months old infant has episodes of crying for hours, usually in late afternoon. After the episode the baby is normal and feeds well. The baby passes stool and urine normally. This has been going on for 4 weeks and parents are concerned. Stool tests done repeatedly were normal.
What do you know about evening colic? How do you manage a baby with colic?
Definition : Intermittent episodes of abdominal pain and severe crying in young infants who are otherwise well. Usually begins at 2-3 weeks age and can persist up to 3 months. Usually in the late afternoon or evening.
- Exact cause? –Not known
- Overactive infant, overanxious parents
- Speculations are: •Manifestation of hunger, aerophagia, Cow’s milk intolerance, intestinal immaturity, over feeding, intake of food with high carbohydrate, change in bowel flora.
- Sudden loud crying
- Continuously for hours
- Face becomes red and legs are drawn up
- Abdomen becomes tense
- Attack terminates after infant is exhausted or with passage of flatus or feces.
Rule of 3 –Diagnosis is confirmed when the infant cries, •For more than 3 hours per day •For more than 3 days per week •For more than 3 weeks in otherwise well Baby
Red flag signs 1.Fever , poor feeding 2.Tachypnea, mottling 3.Blood in stool/Loose stool 4.Vomiting- bilious 5.Palpable lumps on abdomen 6.Increased head circumference 7.Weight < 3rd centile. ● •Management
1. Counseling –More effective for helping parents cope –Reassurance- not an illness –Unburden parents with guilt and unjustified worries. –Soothe more ( sound, whistle) and Stimulate less ( picking, feeding on each cry)
2. Burping- natural way to expel gas after each feed. Two techniques
Drugs –Simethicone – Antiflatulent, Foaming agent •Studies have shown no value. •Use should be discouraged
Antimotility agents •Dicyclomine : Contraindicated in less than 6 months
Enema, Carmitives- not useful.
Probiotics •Lactobacillus reuteri –Under study –Shown to have beneficial results in reducing episodes of evening colic.
Evening colic is benign condition occurring in infants less then 3 months of age.Counseling is more important since drugs have no role.