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Key Features

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  • An otherwise healthy infant aged 2–3 months seems to be in pain, cries for more than 3 hours a day, for more than 3 days a week, for more than 3 weeks ("rule of threes")

  • Characterized by severe and paroxysmal crying that occurs mainly in the late afternoon

  • Colic is a behavioral sign or symptom that begins in the first few weeks of life and peaks at age 2–3 months

  • In about 30–40% of cases, colic continues into the fourth and fifth months

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Clinical Findings

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  • Infant's knees are drawn up

  • Fists are clenched

  • Flatus is expelled

  • Face has a pained appearance

  • Minimal response to attempts at soothing

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Diagnosis

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  • Gastroesophageal reflux is often suspected as a cause of colicky crying in young infants

  • Undetected corneal abrasion, urinary tract infection, and unrecognized traumatic injuries, including child abuse, must be among the physical causes of crying considered in evaluating these infants

  • Another factor to be considered in evaluating the colicky infant is the feeding and handling behavior of the caregiver

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Treatment

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  • Parent education about the developmental characteristics of crying behavior and made aware that crying increases normally into the second month and abates by the third to fourth month

  • Parents need reassurance, based on a complete history and physical examination, that the infant is not sick

  • Rhythmic stimulation such as gentle swinging or rocking, soft music, drives in the car, or walks in the stroller may be helpful, especially if the parents are able to anticipate the onset of crying

  • Another approach is to change the feeding habits so that the infant is not rushed, has ample opportunity to burp, adaptive nipple if bottle fed, and, if necessary, can be fed more frequently so as to decrease gastric distention

  • For colic that is refractory to behavioral management, a trial of changing the feedings and eliminating cow's milk from the formula or from the mother's diet if she is nursing may be indicated

  • A trial of ranitidine hydrochloride or other proton pump inhibitor may be helpful if gastroesophageal reflux has been proven to be contributing to the child's discomfort

  • Simethicone has not been shown to ameliorate colic

  • Dicyclomine has been associated with apnea in infants and is contraindicated

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