Colic.
Colic is a symptom complex of paroxysmal abdominal pain, presumably of intestinal origin, and severe crying. It usually occurs in infants younger than 3 mo of age. The clinical manifestations are characteristic. The attack usually begins suddenly with a loud, more or less continuous cry. The so-called paroxysms may persist for several hours. The face may be flushed, or there may be circumoral pallor. The abdomen is usually distended and tense. The legs may be extended for short periods but are usually drawn up on the abdomen. The feet are often cold, and the hands are usually clenched. The attack may not terminate until the infant is completely exhausted. Sometimes, however, the passage of feces or flatus appears to provide relief.
Some infants seem to be particularly susceptible to colic. The etiology usually is not apparent, but, in some infants, the attacks appear to be associated with hunger or with swallowed air that has passed into the intestine. Overfeeding may also cause discomfort and distention; and some foods, especially those of high carbohydrate content, may be responsible for excessive intestinal fermentation. However, a change of diet rarely prevents further colic attacks.
Crying with intestinal discomfort occurs in infants with intestinal allergy, but colic is not limited to this group. Colic may mimic intestinal obstruction or peritoneal infection. Attacks commonly occur late in the afternoon or evening, suggesting that events in the household routine may be involved. Worry, fear, anger, or excitement may cause vomiting in an older child and may cause colic in an infant, but no single factor consistently accounts for colic and no treatment consistently provides satisfactory relief. Careful physical examination is important to eliminate the possibility of intussusception, strangulated hernia, or other disorders that cause abdominal pain.
Holding the infant upright or prone across the lap or on a hot water bottle or heating pad occasionally helps. Passage of flatus or fecal material spontaneously or with expulsion of a suppository or enema sometimes affords relief. Carminatives before feedings are ineffective in preventing the attacks. Sedation is occasionally indicated for a prolonged attack. If other measures fail, both the child and the parent may be sedated for a period of time. Temporary hospitalization of the infant, often with no more than a change in feeding routine and a period of rest for the mother, may help in extreme cases. Prevention of attacks should be sought by improving feeding techniques, including "burping," providing a stable emotional environment, identifying possibly allergenic foods in the infant's or nursing mother's diet, and avoiding underfeeding or overfeeding. Colic rarely persists after 3 mo of age. Although not serious, it can be particularly disturbing for the parents as well as the infant. Thus, a supportive and sympathetic physician can be particularly helpful, even if attacks do not resolve immediately.
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