Update on infantile colic and management options

Abstract

Infant colic is a common but poorly defined and understood clinical entity and, while several causative factors have been suggested, a unifying theory of its pathogenesis is still required. Food hypersensitivity/allergy and gut dysmotility are the lead contenders for causative factors of infantile colic. Additional confounders and covariables include psychological and social factors. Although the available data fail to provide insight into the exact triggers of infantile colic, these do allow for the hypothesis that certain infants are predisposed to dietary protein intolerance and disturbed gut motility, such as visceral hypersensitivity/ hyperalgesia, in the first few weeks of life. These processes lead to distress and altered perceptions, where normal stimuli (ie, intestinal distension) are misinterpreted as painful events. This review discusses a number of interventions, including pharmacological agents, which are based on the perceived pathogenesis; however, it is likely that infants with colic will require a multifactorial management strategy. Healthcare providers must offer support, reassurance and empathy to the caregiver, and adopt a biopsychosocial approach to the infants and their families by considering any underlying medical diseases in addition to examining the family unit. In a small subset of infants with colicky behavior, a specific medical disorder such as gastroesophageal reflux or milk protein allergy may be identified. While the vast majority of infants with colic will recover uneventfully, some may be at risk for the later development of behavioral problems and atopy/allergy.