Infantile Colic

Infantile Colic

Infantile colic is a common, self-resolving condition. It has important adverse associations including maternal depression, child abuse and early cessation of breastfeeding.

There are many proposed causes of colic, however none is definitive.

Colic is likely to be an exacerbation of normal infant crying brought about by physiological and psychosocial factors.

There is no known single effective treatment for colic.

The mainstay of management is exclusion of organic causes, explanation of the natural history of colic, parental support, offering strategies to deal with the infant’s feeding and sleep, and exploration of settling techniques.

The probiotic Lactobacillus reuteri DSM17938 may be trialled for exclusively breastfed infants with colic. Its efficacy in formula-fed babies is unknown.

An allergy to cow’s milk protein accounts for a minority of cases.

Hypoallergenic formula, and dietary exclusion for breastfeeding mothers, should only be tried in infants with other clinical features of cow’s milk allergy.

Infantile colic describes excessive crying of unknown cause in otherwise well infants. Colic affects up to 20% of infants, and is one of the most common presentations to the primary health sector in early life.

It resolves spontaneously after the first three to four months of life.

Colic is traditionally defined by the Wessel’s criteria of crying or fussing more than three hours of the day for more than three days of the week.The new Rome IV criteria define it as ‘recurrent and prolonged periods of infant crying, fussing or irritability reported by caregivers that occur without obvious cause and cannot be prevented or resolved’. The diagnosis can be assumed after exclusion of potential organic causes.

Although colic is considered to be benign, it is a major burden to families, health professionals and the health system. Colic is strongly associated with maternal depression and is the strongest risk factor for shaken baby syndrome. It is also a common cause of early breastfeeding cessation.

Crying beyond the usual colicky period can be linked to later sleep problems, allergic disorders, family dysfunction, and behavioural problems.

Causes of colic

Despite years of research, the aetiology of colic remains elusive and there are many proposed theories.

Does colic represent the most severe spectrum of normal infant distress, or is it a manifestation of underlying gastrointestinal, neurological or psychosocial disorders?

Perhaps infant colic can be best regarded as an exacerbation of normal infant behaviour by a mixture of physiological and psychosocial factors.

Colic should only be diagnosed after exclusion of organic causes. These occur in less than 10% of infants presenting with crying.

Most organic causes present with other associated features.

Organic causes to exclude in a crying infant

Cow’s milk protein allergy

• Significant vomiting, Feeding difficulties

• Diarrhoea with mucus or blood, Poor weight gain

• Extensive eczema, First-degree family history of atopy

Gastro-oesophageal reflux disease

• Frequent significant vomiting (>5 times per day)

• Haematemesis, Feeding difficulties

• Poor weight gain

Lactose intolerance or overload

• Watery, frothy, explosive diarrhoea AND perianal excoriation or ulcerations

Inguinal hernia

Vomiting, Lump in inguinal region

Intussusception

• Acute onset of vomiting, pallor, irritability, Abdominal mass, rectal bleeding

Infection: urinary tract infection, meningitis, otitis media

• Fever, Lethargy, Poor feeding, poor weight gain

• Perinatal risk factors for sepsis

Hydrocephalus

• Increasing head circumference/macrocephaly ,Vomiting, Lethargy

Hair tourniquet

• Hair tourniquet around fingers or toes

Foreign body in eye

• Acute distress, history of foreign body penetration in eye

Non-accidental injury

• Bruising or petechiae, Other features of physical injury

嬰兒腸絞痛之中醫療法

Pediatric Gassy

寶寶在晚上會突然哭得聲嘶力竭，那是「腹內絞痛」，可以使用中醫藥的方法－外敷吳茱萸粉，簡單又有效！

中醫是講究辨證論治，有出現頭痛、胃痛乾嘔、手腳冰冷、腸絞痛、脈沉等症可用吳茱萸研末，調米酒敷足心湧泉穴，睡前敷，可引火下行，治口舌生瘡。

吳茱萸粉，攪拌糯米醋更天然更溫和，腳底不會脫皮(適合小朋友)－ 敷湧泉穴將藥沾在小塊紗布上，再用透氣膠布貼住在腳底中央(湧泉穴)，每日1-2次。

吳茱萸主治嘔吐吞酸，胃脘痛，腹內絞痛，泄瀉，寒疝痛，寒濕腳氣，藥效是走足厥陰肝經，能溫散肝胃之寒。所以用這帖藥，第二天開始寶寶就不會半夜亂哭，紓解腸絞痛的痛苦 ，運用中醫簡單藥方，還滿有效的！

清朝驗方新編

吳茱萸四錢，好醋調敷兩足心，日換數次，過一夜即癒。此法最妙。

嬰兒脹氣中醫療法

只要使用麻油或薄荷油以掌心搓熱，在嬰兒肚臍周圍。

以順時鐘方向按摩，自能排除小兒脹氣消化不良。

嬰兒便秘中醫療法 Pediatric Constipation

用中醫的方法－外敷麻子仁丸粉及乙字湯，簡單又有效！

麻子仁丸粉及乙字湯，攪拌糯米醋，腳底不會脫皮(適合小朋友)－ 敷足三里。

將藥沾在小塊紗布上，再用透氣膠布貼住足三里穴，每日1-2次。

按壓足三里，支溝，天樞，上巨虛，下巨虛，內關。

關於《吳茱萸》，民間有一個有趣的傳說。春秋戰國時代，吳茱萸原生長在吳國，稱爲吳萸，有一年，吳國將吳萸作爲貢品進獻給楚國，楚王見了大爲不悅，不聽吳臣解釋，將其趕了出去，幸虧楚國有位精通醫道的朱大夫追去留下了吳萸，並種在自家的院子裏。

一日，楚王受寒而舊病復發，胃疼難忍，諸藥無效；此時朱大夫將吳萸煎湯治好了楚王的病，當楚王得知此事後，立即派人前往吳國道歉，並號召楚國廣爲種植吳萸，爲了讓人們永遠記住朱大夫的功勞，楚王把吳萸更名爲《吳茱萸》