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Wednesday, March 12, 2014
Newborn and Infant Care
My 3 month old daughter cries constantly. I believe that at times it is due to painfull gas. Other times I feel it is overtiredness. She will cry earpiercingly for hours, exhausting both her and I. I will give her colic tabs, symethicone drops, and tylenol to try to remedy the problem. Sometimes it will work, and other times she still won`t stop. Any suggestions? Please help. --Sleepless in Seattle
I can certainly relate to your situation. You are describing the classic syndrome of `colic` or `irritable baby syndrome`. Crying is a natural reflex to promote mother-infant proximity and to provide an opportunity for social interaction.
Colic is a self-limiting disorder characterized by intermittent, unexplained excessive crying for 3 or more hours per day for at least 4 days per week in a thriving child.
The average age of onset is within the first month of life. The general pattern of colic includes: 1. Early patterns of crying a. Gradual increase and a peak at ~6 weeks of age(median time of crying/day = 2 _ hours) b. Crying gradually declines until ~4 to 6 months of age
There are 3 Theories for the cause of colic
1. Interactional Model---failed attempt of infant to communicate with parents 2. Neural Model---immature central nervous system 3. Gut Dismotility Model 1. Motilin---increased levels of the gut hormone motilin -> increased intestinal peristalsis -> colic 2. Lactose Intolerance---lactose intolerance -> osmotic action of unabsorbed lactose -> increased intestinal peristalsis -> colic 3. Protein Intolerance---proteins in cows milk (82% casein, 18% whey) and soy formulas -> protein intolerance -> colic
There are generally 2 types of Colic:
1. Consolable 2. Inconsolable
The typical course of colic: The onset within the first month of life with spontaneous resolution by 4- 6 months of age; does not extend beyond 9 months of age. Typically presents with crying in late afternoon into early evening for greater than 3 hours for 3 or more days per week. Crying episodes may last from 30 minutes to 2 hours and are characterized by intense crying with knees brought up to abdomen and flatus expelled.
A diagnosis of colic should not be made until your baby has been thoroughly examined by your healthcare provider so that other physical causes can be ruled out. If colic is the cause, all other findings will be normal.
Management of a baby with colic can be trying for baby and parents. Management consists of parental support as well as management of the baby.
Parents should initially log the crying spells over a one week period (in order to define colic) and keep a running diary in order to record the response to therapy and to note when improvement begins. It is important to recognize that colic is a self-limiting disorder and will generally stop by 4 to 6 months of age (if the crying persists then consider another diagnosis). There are no known long term sequelae of colic. Keep in mind that you as parents are not responsible for the infant`s crying. By definition, the infant is healthy and thriving, despite the colic. Parents need relief from the infant during unbearable periods and should try to arrange alternate care periodically. Once you have assured that there is nothing physically wrong with the baby,you may find that you need to leave the baby in his/her crib and go outside. I`d recommend a baby monitor that you can turn the volume down. That way you can know the baby is okay, without being held captive. If the baby has `Consolable` Colic, some behavioural approaches may help. For example,feeding the baby, providing a pacifier, holding, patting the back, and putting down to sleep may work. If crying continues for more than 5 minutes with any one response try the next response, if all 5 responses fail try again or try combinations of the responses; i.e., feed and carry.
Other behaviours which may be tried: rhythmic sounds or motions - rocking, driving in the car, putting the infant in a car seat on top of the washer or dryer. DO NOT leave baby unattended while doing this however.
For `Inconsolable` colic,dietary changes may be helpful. Discuss with your health care provider the benefit of changing the baby`s formula to a casein hydrolysate formula.
If the baby is breast-fed, try eliminating all dairy products from mother`s diet Unfortunately there are no medications that have been shown to be effective in alleviating the symptoms of colic. Two drugs that are often used with limited success are simethicone and Bentyl. Simethicone (Mylicon, Phazyme)has been shown in some studies to be no more effective than placebo in treating colic. Dicyclomine HCl (Bentyl), another frequently prescribed has been associated with apnea and seizures in a small number of patients.
I would recommend that you discuss diagnosis and treatment options with your healthcare provider. Remember---the good news is that it will go away.
Judy Wright Lott, RNC, NNP, DSN
Associate Professor of Nursing
College of Nursing
University of Cincinnati