Description

• Colic is defined as excessive crying in an otherwise healthy baby.
• A commonly used criteria is the Wessel criteria, or the Rule of Three: Crying lasts for:
  • >3 hours a day
  • >3 days a week
  • Persists >3 weeks
• Many clinicians no longer use the criterion of persistence for >3 weeks because few parents or clinicians will wait that long before evaluation or intervention.
• Some clinicians feel that colic represents the extreme end of the spectrum of normal crying, whereas most feel that colic is a distinct clinical entity.

Epidemiology

• Predominant age: Between 2 weeks and 4 months of age
• Predominant sex: Male = Female

• Probably between 10% and 25% of infants
• Range is somewhere between 8% and 40% of infants.

Pediatric Considerations
This is a problem during infancy.

Risk Factors

Physiologic predisposition in infant, but no definitive risk factors have been established. However, emerging data suggest maternal smoking or exposure to nicotine replacement therapy during pregnancy is associated with higher incidence of infantile colic (1)[B].

General Prevention

Colic is generally not preventable.

Etiology

The cause is unknown. Factors that may play a role include:

• Infant gastroesophageal reflux disease
• Allergy to cow’s milk, soy milk, or breast milk protein
• Fruit juice intolerance
• Swallowing air during the process of crying, feeding, or sucking
• Overfeeding or feeding too quickly; underfeeding also has been proposed
• Inadequate burping after feeding
• Family tension
• Parental anxiety, depression, and/or fatigue
• Parent–infant interaction mismatch
• Baby’s inability to console him- or herself when dealing with stimuli
• Increased 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) (2)[C]
• Tobacco smoke exposure
• Disorder of impaired synchronization between infant arousal and environment (3)[C]