Excessive crying or colic in an inf...

Excessive crying or colic in an infant during the first small in number months of life can be alarming for physicians and parents. Estimates of the incident of infantile colic in community-based samples vary from 5 to 25 percent of infants, depending onward study design, definition of colic, and process of data collection. (1,2) Fussing and crying are normal aspects of unravelling during the first three month of life. During this time, infants exclaim an average of 2.2 hours for day, peaking at six weeks of age and gradually decreasing. (3) Parents who think their infant cries excessively may pursue a physician's help.

Physicians and parents use the bourn colic to describe an infant with excessive crying, irritability, or fussiness. The principally commonly accepted definition of colic, which originated in 1954 (4) describes using the "rule of three": crying for more than three hours by day, for more than three days by week, and for more than three weeks in an infant that is well-fed and otherwise healthy. This definition has been used repeatedly in clinical studies of colic. The motor behaviors of infants with colic also were first described in 1954 (4) Colicky infants have attacks of screaming in the evening with associated motor behaviors in the same state [i]or[/i] condition as flushed face, furrowed edge and clenched fists. The leg are haped up to the abdomen, and the infants emit a piercing, high-pitched scream. (5)

Behavior characteristics usually are classified by way of the timing of the issue paroxysmal crying, and associated behaviors. (6) Colic typically begins at pair weeks of age and usually unravels by four months of age. Crying is concentrated in the late afternoon and evening, present itselfs in prolonged bouts, and is unpredictable and spontaneous. It appears to be unrelated to environmental incidents The child cannot be soothed, equable by feeding.

Etiology

The cause of infantile colic remains unclear. Underlying organic causes of excessive crying must be considered during the evaluation. Organic causes account for les than 5 percent of infants presenting with excessive crying (Table 1) (67) Gastrointestinal, psychosocial, and neurodevelopmental disorders have been proposeed as the cause of colic.

GASTROINTESTINAL

Gastrointestinal disorders have been implicated in colic because of the infant's leg position and grimacing during a crying term Excessive crying or increased gas production from colon function can terminate in intraluminal gas formation and aerophagia. This mechanism does not appear to be the cause of colic, however, because radiographic images taken during a crying episode have shown a normal gastric outline. (8) There is conflicting evidence showing that colic is caused by means of allergy to human and cow's milk protein. It also has been speculated that abdominal cramping and colic may be a follow of hyper-peristalsis. The latter theory is supported by the agency of evidence that the use of anticholinergic agents decreases colic symptoms. embowel hormones such as motilin also may play a causative part in colic. Motilin is consideration to cause hyperperistalsis, leading to abdominal pain and colic. (9)

PSYCHOSOCIAL

Although studies have addressed possible psychosocial causes of colic, no evidence has been plant in support of this mechanism. unruffled when colicky infants are cared for according to trained occupational therapists, they call twice as long as infants without colic. (1011) The hypothesis that colic is an early manifestation of a difficult temperament is not supported through prospective longitudinal studies. (10)

Parents of a colicky infant may think that they have poor parenting skills. However, there is no evidence that maternal (or paternal) personality or anxiety causes colic. (11) In families with a colicky infant, there may be question s with communication and family functioning, as well as parental anxiety and fatigue. (12)

NEURODEVELOPMENTAL

Studies have refer toed that colic may lie at the upper conclusion of the normal distribution of crying in infants. The crying patterns of colicky infants (i.e., peaking around six weeks of age with crying late in the afternoon and evening) are the same in normal infants. However, colicky infants cry out longer and are more difficult to soothe formerly crying has begun. The fact that principally infants outgrow colic by four month of age accommodate withs support to a neurodevelopmental cause of colic. (6)

Diagnosis

When parents search for advice about a colicky baby, their troubles must be substantiated by the physician. The parents may be wrought up tired and inadequate, and be worried that their child has a serious medical disorder. There may indeed be an underlying organic cause in an infant presenting with excessive crying. A careful history and physical examination usually are sufficient to determine if there is an organic cause for crying or to relieve parental fears and allow for a diagnosis of colic. The physician should ask about the infant's behavior and the time of day and amplification of the crying episodes. Parents should be asked to document this information. A history of apnea, cyanosis, or struggling to breathe may insinuate previously undiagnosed pulmonary or cardiac conditions. Documentation of frequent occurrence and quantity of spitting up is necessary to empire out gastroesophageal reflux or pyloric stenosis. (13)