1. In the name
of GOD
COLIC
By:
Dr, Maryam
Jamali Shirazi
Neonatalogist

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Definition
 Spasmodic
pain in abdomen in infants
accompanied by irritability and crying .
Colic also refer to conditions of gas or
other digestive irritability in infants up to
3months old. Colic is also refer to alkaline
,high-sodium conditions,but can be also
caused by over feeding,swallowing of air
or emotional upset

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 Colic
itself is not a serious condition.
 Although colic is not a serious
medical problem, it can cause a
great deal of stress and anxiety
within the family
 It should be certain, however, that
the child does not suffer from any
other medical conditions which
could be producing colic-like
symptoms

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 Etiology
 5%
organic
 Epidemiology
 5-19% f=m

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Infants and baby with colic
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cries vigorously for long periods, despite efforts to
console
has a hard, distended stomach, with knees pulled to
the chest, clenched fists, flailing arms and legs, and
an arched back
shows signs of gas discomfort and abdominal
bloating
experiences frequent sleeplessness, irritability and
fussiness
symptoms occur around the same time each day or
night, often after meal times, and usually ending as
abruptly as they began

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 Infantile
colic is most common in the first
few weeks to four months of an infant's life
 "Rule of Three" to diagnose colic: "A baby
that cries for three or more hours per
day, at least three times per week, within
a three month period".

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causes
 Newborns
have an immature digestive
system that has never processed food
 newborns lack the benevolent bacterial
flora (probiotics) that develop over time
to aid digestion
 Infants often swallow air while feeding or
during strenuous crying

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Treatment

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 Sodium
bicarbonate is an alkali (antacid)
which alters the naturally occurring pH of
baby's stomach acid
 Do not use for more than 2 weeks
 Essential Oils and extracts (dill oil, clove
oil, fennel extract, ginger extract, etc) are
used by all other gripe water brands.
There are known safety issues with herbal
oils and extracts.

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 Breast
feeding mom should avoid
stimulants such as caffeine ,caffeine
related compound in chocolates and
nuts

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Alternative treatment


Applying gentle pressure to the webbed area
between the thumb and index finger of either hand
can calm a crying child. So can gently massaging
the area directly above the child's navel and the
corresponding spot on the spine. Applying warm
compresses or holding your hand firmly over the
child's abdomen can relieve cramping.
Teas made with chamomile (Matricaria recutita),
lemon balm (Melissa officinalis), peppermint (Mentha
piperita), or dill (Anethum graveolens) can lessen
bowel inflammation and reduce gas. A
homeopathic combination called "colic" may be
effective, and constitutional homeopathic treatment
can help strengthen the child's entire constitution

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Differential diagnosis

Mechanical intestinal obstruction
–Incarcerated inguinal hernia
–Malrotation with volvulus
–Intestinal atresia (newborns)
–Imperforate anus (newborns)
–Intussuception
–Hirschsprung disease
–Meconium ileus (in newborns, due to CF)
–Left microcolon syndrome (typically in
infants of diabetic mothers)
–Fecal impaction (from chronic
constipation)
–Bezoars: Lactobezoars in premature infants

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
it is very important to exclude several
other causes of sudden-onset screaming
in a newborn. These conditions include
intestinal blockage or obstruction,
abdominal infection, a hernia, a scratch
of the baby's eye, an ear infection, a
bladder infection, and others.

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Differential diagnosis
 Functional
intestinal obstruction
–Paralytic ileus, postoperative
ileus, reflex ileus (from sepsis or acute
infection)
–Peritonitis/intestinal perforation
–Severe hypokalemia
–Gastroparesis
–Necrotizing enterocolitis (NEC)
–Toxic megacolon (IBD)
–Dysmotility (pseudo-obstruction
syndrome)

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Differential diagnosis
 Renal
enlargement
–Hydronephrosis (most common cause of
abdominal distension in the newborn)
–Ureteropelvic junction obstruction
–Bladder distension
–Congenital polycystic kidney

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Differential diagnosis
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Ascites
Hepatomegaly
–Budd-Chiari or Beckwith-Wiedemann
–Glycogen storage disease
–Amyloidosis
–Congestive heart failure
Splenomegaly
Tumors/cysts
–Wilms
tumor, neuroblastoma, lymphoma, teratoma,
sarcoma, ovarian cyst or tumor, omental
cyst, dermoid cyst
Pancreatic pseudocyst
Obesity: Protuberant abdomen (common)

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Differential diagnosis
 Aerophagia
 Pregnancy
 Hematometrocolpos
 Malnutrition
(e.g., kwashiorkor, celiac)
 Abdominal abscess
 Prune-belly syndrome
 Poor posture

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Work up
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Rapid recognition of obstruction is essential
History: Age of onset, duration, fever, weight loss, vomiting
(bilious/nonbilious), abdominal pain, last bowel
movement, bloody or currant-jelly stools (intussuception), last
menstrual period, respiratory distress, trauma
Birth history, PMH, PSH, time of passage of meconium (delayed
in Hirschsprung)
Maternal history: Pregnancy (oligo- or
polyhydramnious), labor/delivery, gestational diabetes
Physical exam: Vital signs, general appearance, abdominal
exam for presence of ascites (flank bulging, shifting
dullness, fluid wave), masses and tympanic
percussion, umbilicus sunken in obesity, herniated if tense
ascites, perineum exam for inguinal hernia

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Work up


Labs: CBC, Serum electrolytes, LFT, UA, stool for
occult blood, amylase, and lipase
Studies
–Obstructive series for air fluid levels, distended
bowel loops, or pneumoperitoneum
–Abdominal ultrasound for pancreatic
pseudocyst, ascites, and masses
–Upper GI series for proximal obstruction
–Barium enema for distal obstructions
–CT scan of the abdomen for better delineation of
masses or anatomical anomalies
–Surgical consult if obstruction or perforation
suspected

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Management

Treatment is focused on underlying cause
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Management of intestinal obstruction
–Make the patient NPO
–Nasogastric tube placement for decompression
–Correction of fluid and electrolyte imbalance
–Antibiotic for cases of suspected perforation, NEC, or peritonitis
–Laparascopy/laparatomy: Prompt relief of obstructions or
repair of perforation is paramount
Prokinetic for dysmotility or gastroparesis
Surgical resection and subsequent reanastomosis for
Hirschsprung disease (one-step or staged repair)
Percutaneous, surgical, or endoscopic drainage of
pancreatic pseudocyst if persistent
Fecal disimpaction and treatment of constipation
Correction of malnutrition
Contrast or air enema for reduction of intussuception or
flushing of meconium ileus
Surgical resection of tumor

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Reference
 Book
Title: In A Page: Pediatric Signs and
Symptoms
 Author(s): Jonathan E. Teitelbaum,
Kathleen O. Deantonis, Scott Kahan
 Year of Publication: 2007
 Copyright Details: In A Page: Pediatric
Signs and Symptoms, Copyright © 2007
Lippincott Williams & Wilkins.