What Is Colic In An Infant?
The “rule of 3s” can help identify colic in your baby because colic is defined as crying that lasts for at least 3 hours per day, at least 3 days a week, for at least 3 weeks. Your infant may have colic if they are 1 to 6 months old and have intense crying that doesn’t respond to calming techniques such as feeding, diaper changing, rocking, burping, or holding. The crying tends to happen at the same time every day, most often in the late afternoon or evening. Episodes of colic usually start at 2 to 6 weeks old, and decline in strength by 3 to 4 months old.
What Are The Symptoms Of Colic In My Baby?
It’s normal for an infant to cry, but how do we determine what is normal and what is not? Infants normally cry when they’re hungry, need a diaper change, or are tired. However, colicky infants cry for no apparent reason. The crying is often so intense that it seems like screaming or that they are in pain. The intense crying causes body tension, which leads to an arched back, clenched fists, legs and arms that alternate between flexion and extension. The infant will not respond to your calming techniques, but the crying will start and stop suddenly. Your infant may have a bloated tummy from the air it swallowed while crying, then suddenly stop crying after passing gas or having a bowel movement as the air in their tummy is relieved.
What Causes Colic?
There is no clear single cause of colic, instead it is a diagnosis of exclusion. Meaning there is no underlying organic problem with your infant, but other causes of crying must be ruled out before one is diagnosed with colic. Instead of a true problem, colic is likely caused by a combination of gastrointestinal discomfort, psychosocial influences, and nervous system immaturity. Gastrointestinal causes include milk protein intolerance, gassiness, immature digestive system, an imbalance of healthy bacteria in the digestive system, and overfeeding or underfeeding. Try to minimize family stress and anxiety about caring for your infant, as this will only contribute to colic. Your infant may cry because they are in their early stages of development with a nervous system that is unable to provide self-regulation and self-calming. Also, environmental overstimulation with noise, light, and handling can exacerbate your baby’s crying.
What To Do If My Infant Has Symptoms Of Colic?
Do not worry, colic is a common phenomenon and is not due to poor parenting. Colic is so common that it affects up to 40 percent of children, but less than 5 percent of infants with intense crying actually have an underlying organic disease. If your infant shows signs of excessive inconsolable crying make an appointment with your doctor. Your doctor will perform a thorough exam to rule out any illness or condition that may cause pain and excessive crying. If the diagnosis of colic is established, treatment is aimed at conservative care. Try comforting your baby with soothing music, swaddling, or massaging. Feed your baby in an upright position with frequent burping to minimize gastrointestinal discomfort. Reduce extra environmental stimulation. A trial of medication may be used, but there is no evidence to support their efficacy and safety. Both antacids and simethicone are safe, but little evidence supports their effectiveness.
What Is Gastroesophageal Reflux (GER) & What Are The Symptoms f Reflux?
Gastroesophogeal Reflux (GER), also known as Infant Reflux is when stomach contents leak backward into the esophagus. The stomach contents may leak backwards all the way up to your infant’s mouth causing them to spit up. This is not vomiting as there is no violent ejection of food. GER is a normal physiologic process that occurs multiple times a day in healthy infants. GER is commonly referred to as “happy spitters” as the infant has no irritability or distress. Infants with GER feed well, weight gain remains normal, and there are no long term consequences.
What Causes GER Or Reflux?
GER is caused by an immature Lower Esophageal Sphincter (LES), a muscle between your infant’s esophagus and stomach. Once the muscle is fully matured, it opens to allow passage of food and closes when food passes to keep food in the stomach. However, an immature muscle doesn’t open in coordination with swallowing, when your infant swallows the muscle isn’t fully open and food refluxes backwards out of their mouth instead of into their stomach. Or the muscle remains open when food is in your infant’s stomach and the stomach contents reflux upwards. Generally, the refluxed contents never reached your infants stomach or weren’t completely broken down, so the reflux contents are not acidic and not damaging to your infant’s esophagus or mouth.
What To Do If My Infant Has Symptoms Of Reflux?
Treatment for GER is directed towards parental education. You should provide your baby smaller more frequent feedings, because a large volume of food ingested into your infant’s small stomach may cause food to reflux upwards. You should interrupt feedings by burping your baby to provide time for food to pass from the esophagus into your baby’s stomach. Hold your baby upright for 20 to 30 minutes after feedings, this will ensure gravity helps keep the food in your baby’s stomach. If you lie your infant on its back or stomach after feeding gravity can no longer help keep food in your infant’s stomach. If you are breastfeeding you may eliminate dairy, beef, or eggs from your diet to ensure your infant doesn’t have an allergy. If you use formulas, you can switch your infant formula to test for an allergy or sensitivity. Try different size nipples on your infant’s bottle to regulate the volume of food ingested, this will also ensure your infant isn’t swallowing unnecessary volumes of air. Since this is a normal physiologically process medications are not recommended. Medications increase the risk of respiratory and intestinal infections and promote malabsorption of important minerals and vitamins.
What Is Gastroesophageal Reflux Disease (GERD) In An Infant?
Similar to Gastroesophogeal Reflux (GER), Gastroesophogeal Reflux Disease (GERD) is when stomach contents leak backward into the esophagus. However, GERD is not a normal physiologically process, instead it is a “disease” as illustrated by its name. Infants with GERD are not happy, they are irritable and in pain. There are complications of GERD as the reflux has enough acid to damage the esophagus.
What Are Symptoms Of GERD In My Baby?
Symptoms of GERD include recurrent regurgitation or vomiting, weight loss or poor weight gain, and refusing to eat. Your infant will be irritable as the acidic stomach contents are damaging to your infants esophagus causing them pain. Your infant may experience heartburn or chest pain, pain while swallowing, difficulty swallowing, and vomiting blood. Respiratory symptoms are common as stomach contents may reflux into your baby’s airway. This will result in recurrent pneumonia, wheezing, a cough, or hoarseness.
What Causes GERD?
GERD reflects the leakage of food from the stomach past the Lower Esophageal Sphincter (LES) into the esophagus. However, this backwards flow of stomach contents is not caused by an immature LES as it is in GER. Instead, other factors contribute to the passage of stomach contents. Increased pressure within the abdomen from over eating, obesity, or straining due to constipation can increase pressure on the stomach and force food upwards. If your baby empty’s its stomach contents slower than normal, pressure will build up and eventually flow backwards. GERD may also be caused by problems affecting their nerves, brain, or muscles. Examples of neurologic impairment include Cerebral Palsy and Down Syndrome. Esophageal abnormalities such as Esophageal Atresia, Congenital Diaphragmatic Hernia, and Achalasia can predispose an infant to GERD.
What To Do If My Infant Has Symptoms Of GERD?
If your infant is experiencing symptoms of GERD see your doctor as soon as possible. Your doctor will perform a thorough exam and probably order a series of tests to establish the correct diagnosis. Treatment for GERD varies from parental education, pharmacological therapy, to surgery. Conservative management includes frequent small meals, monitoring your infant’s food to determine if a particular food aggravates their symptoms, and weight reduction if obesity is determined to be the cause. There are several medications that are used in a stepwise fashion depending on the severity of GERD. Simethicone is a medication to decrease gas. Acid suppression with antacids, histamine-2 (H2) blockers, or proton pump inhibitors (PPIs) may also be used. Antacids include Mylanta and Maalox. H2 blockers include Axid, Pepcid, Tagamet, and Zantac. PPIs include Protonix, Nexium, Aciphex, Prilosec, Prevacid, and Zegerid. Drugs that decrease gas or suppress acid are generally considered safe, but any side effects should be discussed with your doctor. Surgery is rarely needed to treat GERD in babies, but may be necessary if other treatment fails. The procedure performed is a fundoplication, this is when a surgeon wraps the top part of an infant’s stomach around the esophagus. When the stomach contracts it also contracts the esophageal-stomach junction preventing food from moving backwards. The risks and benefits of surgery should be discussed with your doctor before choosing a treatment.