Infant colic is a frequent cause of distress in early infancy affecting 5 to 20% of infants globally 1,2, the rate being consistent in the MENA region.
Clinical Presentation
- Prolonged crying and hard-to-soothe behavior in otherwise healthy infants, usually between 1 and 4 months of age (late afternoon/evening)
- Tense or bloated abdomen
- Legs flexion towards the abdomen
- Facial flushing
Diagnostic Criteria: Rome IV Criteria 3
The most widely accepted diagnostic tool is the Rome IV criteria, which require all of the following:
- The infant is younger than 5 months when symptoms start and stop.
- There are recurrent and prolonged periods of crying, fussing, or irritability reported by the caregiver, which occur without an obvious cause and cannot be prevented or resolved.
- There is no evidence of failure to thrive, fever, or underlying illness.
Possible Causes
- Gastrointestinal and neurodevelopmental factors
- Temporary lactase deficiency leading to gas production & bloating
Management Approach
- First-line: Parental reassurance & education
- Consider formula with adapted lactose content & carbohydrates profile, clinically proven efficient and nutritionally complete – as 1st choice besides parental education
- Limited data regarding effectiveness of partial hydrolysate with prebiotics & beta-palmitate or a synbiotic formula with reduced lactose and partially hydrolyzed protein
- Avoid pharmacological treatments
1.Steutel N.F., Benninga MA., Langendam MW., et al., Developing a coreoutcome set for infant colicfor primary, secondary andtertiary care settings: a prospective study. BMJ Open 7:e015418. doi:10.1136/bmjopen-2016-015418 (2017).
2.Vandenplas Y., et al., Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age, JPGN 61,531-537 (2015)
3. Benninga M.A., Nurko S., Faure C., Hyman P., St James Robert I., Schechter N., Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Gastroenterology 150:1443–1455 (2016)