Infant colic: mechanisms and management

Abstract

Infant colic is a commonly reported phenomenon of excessive crying in infancy with an enigmatic and distressing character. Despite its frequent occurrence, little agreement has been reached on the definition, pathogenesis or the optimal management strategy for infant colic. This Review aims to delineate the definitional entanglement with the Rome IV criteria, which were published in 2016, as the leading, most recent diagnostic criteria. Moreover, neurogenic, gastrointestinal, microbial and psychosocial factors that might contribute to the pathophysiology of infant colic are explored. This Review underlines that a comprehensive medical history and physical examination in the absence of alarm symptoms serve as guidance for the clinician to a positive diagnosis. It also highlights that an important aspect of the management of infant colic is parental education and reassurance. Management strategies, including behavioural, dietary, pharmacological and alternative interventions, are also discussed. Owing to a lack of large, high-quality randomized controlled trials, none of these therapies are strongly recommended. Finally, the behavioural and somatic sequelae of infant colic into childhood are summarized.

The therapeutic efficacy of Bifidobacterium animalis subsp. lactis BB‐12® in infant colic: A randomised, double blind, placebo‐controlled trial

“…Distinct microbial patterns have been found in IC. A lower diversity and stability of the gut microbiota was reported in subjects with IC during the first 2 weeks of life . These alterations suggest that a state of gut dysbiosis might play a role in the expression of IC symptoms, modulating various neural, endocrine, immune and humoral signalling pathways …”

“…It is associated with maternal postpartum depression, early breastfeeding cessation, parental guilt and frustration, shaken baby syndrome, multiple physician visits, drugs use, formula changing, long‐term adverse outcomes such as allergy, behaviour and sleep problems . The incidence of IC seems to be the same between sexes, and no definitive correlation with type of feeding, gestational age, socioeconomic status and season of the year have been demonstrated . Despite decades of research, at present, the pathogenesis of IC remains poorly understood and is thought to be multifactorial; however, a growing body of evidence suggests that alterations of gut microbiota can contribute to the development of this condition .…”

“…The incidence of IC seems to be the same between sexes, and no definitive correlation with type of feeding, gestational age, socioeconomic status and season of the year have been demonstrated . Despite decades of research, at present, the pathogenesis of IC remains poorly understood and is thought to be multifactorial; however, a growing body of evidence suggests that alterations of gut microbiota can contribute to the development of this condition . Distinct microbial patterns have been found in IC.…”

“…Although IC is a benign and usually self‐limiting condition, it is a source of major distress for the infant, parents, family and health‐care givers . It is associated with maternal postpartum depression, early breastfeeding cessation, parental guilt and frustration, shaken baby syndrome, multiple physician visits, drugs use, formula changing, long‐term adverse outcomes such as allergy, behaviour and sleep problems . The incidence of IC seems to be the same between sexes, and no definitive correlation with type of feeding, gestational age, socioeconomic status and season of the year have been demonstrated .…”

“…3,4 Despite decades of research, at present, the pathogenesis of IC remains poorly understood and is thought to be multifactorial; however, a growing body of evidence suggests that alterations of gut microbiota can contribute to the development of this condition. 4,5 Distinct microbial patterns have been found in IC. A lower diversity and stability of the gut microbiota was reported in subjects with IC during the first 2 weeks of life.…”