Colic = paroxysmal crying ≥ 3 h/day, ≥ 3 d/week, ≥ 3 weeks in a healthy thriving infant < 3 months. Diagnosis of exclusion — must rule out the differential of the inconsolable infant.
🚩 Red-flag clues (must not miss)
- •Bilious vomiting → malrotation
- •Bloody stool → intussusception, NEC, CMPA
- •Hair tourniquet, corneal abrasion
- •Fever, lethargy → sepsis / UTI
Exam
- Full undressing, fluorescein, head-to-toe
- Growth chart — well-thriving supports colic
Differential & next step
| Diagnosis | Clue | Next step |
|---|---|---|
| Colic (functional) | Rule of 3s, well, thriving | Reassurance, soothing techniques |
| GERD | Effortless regurg with discomfort | Trial PPI if pathologic |
| Cow milk protein allergy | Blood-streaked stool, eczema | Hydrolyzed formula × 2 wk |
| Lactose overload (functional) | Frothy, acidic stool, gassy | Adjust feeding pattern |
| Constipation | Withholding, hard stool | PEG/glycerin |
Management / next steps
- 5 S's: swaddle, side/stomach, shush, swing, suck
- Probiotic L. reuteri DSM 17938 — modest benefit, esp. breastfed
- Avoid empiric simethicone (no proven benefit) and PPIs without GERD evidence
- Caregiver support — colic is a known risk factor for shaken baby syndrome
Source: https://fprmed.com/fprmedcom/Pages/Pedi/Intestinal_Colic.html
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