Colic is commonly described as a behavioral syndrome in neonates and infants that is characterized by excessive, paroxysmal crying. Colic is most likely to occur in the evenings, and it occurs without any identifiable cause. In the setting of colic, a detailed history should be obtained regarding the following: Timing of crying: Crying by infants with or without colic is mostly observed during evening hours and peaks at the age of 6 weeks, Amount of crying: The amount of crying is not related to an infant’s sex; the mother’s parity; or the parents’ socioeconomic status, education, or ages, Characteristics of crying: Compared with regular crying, colicky crying is more turbulent or dysphonic and has a higher pitch, Family’s daily routine, Possible other causes of excessive crying (eg, having hair in the eye, strangulated hernia, otitis, sepsis); colic remains a diagnosis of exclusion.
In United Kingdom simple obstructions of the large colon, such as impaction, have a low case fatality rate (less than 10%), whereas simple obstructions or impactions of the small intestine are somewhat higher (13%, although lower than for strangulating lesions). Impactions of the cecum have a higher case fatality rate than impactions of the large colon, but overall, the survival is relatively high (8.5%). Small intestinal volvulus, incarcerations in mesenteric rents and the epiploic foramen have the highest case fatality rate (7.5%-9.5%). Large colon volvulus also has a high case fatality rate, although in some locales where this is recognized and treated early, the case fatality rate is less than 5.0%. The following should be kept in mind in the workup of a patient with colic: Laboratory studies are usually not indicated unless another condition is suspected, If the patient’s stools are excessively watery, testing them for excess reducing substances may be worthwhile; positive results may indicate an underlying GI problem, Stool may be tested for occult blood to rule out cow’s milk allergy, Irritability and crying may be associated with GERD because of the pain associated with esophagitis. Dietary changes may include the following: Elimination of cow’s milk protein in cases of suspected intolerance of the protein, In infants with suspected cow’s milk allergy (CMA), a protein hydrolysate formula is indicated, Uncommonly, amino acid–based formulas may be needed to manage suspected CMA, though evidence may be lacking for use in colic, Soy-based formulas are not recommended, because many infants who are allergic to cow’s milk protein may also become intolerant of soy protein. Researchers used behavior data to treat colic — along with information about levels of maternal depression and paternal involvement — to develop a care plan for each baby who came to the clinic. They offered strategies for helping babies sleep better: if babies cried after feedings, researchers would consider whether reflux was a possibility. For catnappers who couldn’t seem to consolidate their sleep, researchers might suggest stricter schedules to help encourage a more defined sleep/wake cycle.