INFANT COLIC

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INFANT COLIC

• Dr.Maysoun Majanni
  

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Definition

• Paroxysm of irritability, fussing or crying
  lasting more than 3 hours/day
• For more than 3 days/week after R/o other causes
  for crying .
• resolve by 3 month of age.
• Colic starts at two weeks of age and last till 3
  month
• In premature babies it starts two weeks after the
  due date.
• Incidence 2 to 12

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Diagnoses of colic

• Colic is a diagnosis of exclusion
• We need to obtain a detailed history of when and
  how long the baby cries
• Continuous irritability
• Vomitting,diarreaha,constipation,
• Rash
• respiratory symptom

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A complete head to toe examination

• Point tenderness in the extremity
• Hair tourniquet
• Eye examination, corneal abrasion
• Anal fissure
• Esophagitis,GERD

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Symptoms signs that suggest a diagnosis other
than colic

• Failure to thrive
• Irritability that is almost continuous, rather
  than episodic
• Irritability that lasts beyond 3 or 4 months
• Vomiting, Diarrhea, constipation
• Heme positive stool
• rash
• Respiratory symptom
• Point tenderness in an extremity
• Anal fissures
• Subtle dysmorphic facial features

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What is Crying?

• Crying is a normal reflex every newborn has , and
  one of the neonatal reflex babies are born with.
  It is a brilliant way of getting attention and it
  is a powerful connection between the baby and the
  mother.
• It is estimated to be 80 - 100 db sound of
  prolonged period (most adult cant do)
• 50 of infant age 6 week cry almost 2h/day and at
  12 weeks this cry decrease to 1h/day
• Crying of early infancy is an excellent signal of
  need. But poor signal of what is needed.

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How Colic effect the Parents

• Exhaustion HR,skin conduction, nervous system
• Breast feeding failure
• Decrease Let down reflex
• Decrease Milk supply
• Decrease Womens confidence in her milk
  
• Marital Stress
• Post partum depression
• Child abuse
• Shaken baby syndrome

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Colic etiology

• Dr Harney Carp
• Tribe of south Africa was colic free
• The happiest baby on earth
• The missing fourth trimesters

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The four theories of Colic

• 1- GI disorders
• 2- Maternal anxiety
• 3- Difficult infant temperament
• 4- Brain immaturity

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GI disorders

• Minor GI problem like Gas in the gut, swallowed
  air, overfeeding and cramps can cause discomfort
• Major GI problem
• cows milk intolerance 10-15
• GERD 2-4,peaks at 4 m of age
• (food like cola, chocolate, coffee, tea, cold
  medicine) Can passes to the baby through
  breastfeeding and provoke crying.

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Maternal Anxiety

• Actually colicky infant cause maternal anxiety,
  but not the other way around.
• But anxious mom can make babies crying worse by
  jumping from one calming intersection to another
• Difficult infant temperate
• Studies found that this association between colic
  and specific temperament profile is small.

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BRAIN IMATURITY

• Is responsible for the frequent tremors,
  irregular breathing, crossing of the eyes, poor
  state control (awareness)
• Colic diminishes after 3m.
• premature babies are very immature but colic is
  delayed.

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• So if none of the four theories explain colic,
  what does?

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The missing fourth trimester

• The four theories explain aspects of colic but
  overlook the root cause.
• Our babies cry because they are born 3 months too
  soon, they are very immature, more like fetuses
  than infants
• It is not until after 3 months those babies truly
  (wake up) and begin smiling, waking up, rolling
  over, sucking their fingers and cooing.

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This theory is compatible with all
characteristics of colic

• 1- Delayed onset in premature babies
• 2- Evening predominance of crying
• 3- Calming effect of relaxing and shushing
• 4- Absents of colic in certain cultures
• 5- Cessation of colic after three month

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Calming the baby

• Before birth refuses get contentious stimulation
  they snuggled by the uterus
• Frequently jiggled plus rocking
• Surrounded by constant whoosh of blood
• At birth babies are suddenly deprived of the
  rhythmic sensation of the womb .
• Some babies can handle this without difficulty
  others who has poor state control have
  persistence crying.

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Calming reflex

• Group of reflexes vestibular, Auditory,
  tactile, work together to calm the baby. There
  are five maneuvers (5 Ss)
• - Swaddling
• - Shushing
• - Stomach position
• - Swinging
• - Sucking

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SWADDLING

• It is the cornerstone of calming, lower babys
  HR, decrease Startling
• - sleep,about 12-20 h / day
• - loose swaddling should be
  avoided ( SIDS )
• - Avoid over heating
• - never to swaddle a baby over aboard
• ( hip dysplasia )

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stomach position

• In the womb babies are in the fetal position
  getting contact ventral stimulator

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shushing

• The shush sound imitate the shish sound in the
  womb that fetuses hear, it is measured as 75-88
  db.

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4. Swinging

• motion in soothing to a new born . To calm the
  baby it require fast movement, low amplitude,
  120-180 time/minute but not to jiggle the baby
  when the head is not supported ( Shaken baby
  syndrome )

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5. Sucking

• It has a soothing effect
• Breast
• Pacifier