Infantile Colic: Diagnosis and Treatment

Diagnosis

A detailed history is important, along with questions to determine the social factors at play with the parents and how they respond to their crying baby. It is essential to consider the possibility of parental abuse.

A complete physical exam should be performed, and colic should be a diagnosis of exclusion. Routine laboratory tests, stool samples, and imaging may help rule out malabsorption, intussusception, and bowel obstruction.

Treatment

Colic is self–limiting and will resolve with time. Offering reassurance to the family is helpful, and all interventions should be individualized to the family’s needs. In addition to dietary factors described below, the following interventions may help decrease the severity and length of illness, although most evidence is inconclusive.

Parental counseling and support may be an effective strategy for reducing parental anxiety and infant crying.¹

Feeding techniques that may reduce air–swallowing include breast–feeding at 1 breast (as opposed to equal feeding time at each breast);² using a curved bottle with a plastic bag for feeding with formula or pumped breast milk; and keeping the infant in an upright position.

Two studies show the potential benefit of herbs. Fennel seed oil³ and a tea containing chamomile, fennel, licorice, vervain, and balm–milk⁴ both significantly improved colic with reference to the Wessel criteria. However, prolonged tea consumption at 32 ml/kg/d could adversely affect infants’ nutrient intake,⁵ and caution is advised.

Reduction of stimulation may be helpful. Neurobehavioral assessments have shown that infants with the greatest responsiveness to external stimuli are more likely to be colicky, compared with other infants.⁶ This may explain the finding of a systematic review that stimulation reduction was a beneficial strategy for colicky infants.⁷

Lactase and simethicone have not generally been shown to be helpful. Sucrose is not sufficiently calming to justify its use.

Dicyclomine should not be used to treat infantile colic due to risk of serious adverse effects, including seizures and death.