Evening Colic
by Dr. Ramesh Bajaj M.D. (Pediatrics)
Colic is a symptom complex of paroxysmal abdominal pain, presumably of intestinal origin, and severe crying. It usually occurs in infants younger than 3 months of age. Attacks commonly occur late in the afternoon or evening and are hence known as Evening Colic. 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.
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. But sometimes these colics are severe enough to present as an emergency.
The etiology is usually not apparent, and many theories have been considered with regard to etiology. 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. In recent years, allergy to cow’s milk has been in the forefront. However, in the course of conducting a well-baby clinic, it was my personal observation that it is more prevalent in breast-fed babies. I therefore decided to check this impression by a small prospective study.
One hundred consecutive infants were considered, without any basis of selection, at a private city hospital. A history of colic and feeding habits was thoroughly recorded and analyzed. Sixty-one babies were purely breast fed, fourteen were fed on formula feed, and twenty-five on both breast milk and formula feed. Fifteen (15%) of the babies had a history of classical evening colic. Nine (9%) were among the breast fed and 6 (2% and 4% respectively) among those receiving only top feeds or mixed feeds.
Thus my impression that I was seeing more cases of colic among breastfed exclusively was repudiated numerically. However, this was to be computed with respect to incidence of feeding habits. This works out as follows: Nine out of sixty-one breastfed babies had colic, i.e. 14.5%, six out of thirty-nine receiving only top feeds suffered from this ailment, i.e. 15.2%.
Thus, it is seen that the incidence is equal among both groups. Breastfeeding does not provide any protection. This has been sought to be explained by the fact that cow’s milk allergens may pass through the breast milk, but this explanation is not convincing. It does not explain why a good number do not suffer or why the problem disappears at three months of age consistently.
A thorough and careful physical examination of the baby 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. 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 months of age.
Fortunately, the condition is more irritating than dangerous, is self-limiting, and amenable to relief with the help of appropriate treatment.
