Published on February 23, 2014
In the name of GOD COLIC By: Dr, Maryam Jamali Shirazi Neonatalogist
3 Definition Spasmodic pain in abdomen in infants accompanied by irritability and crying . Colic also refer to conditions of gas or other digestive irritability in infants up to 3months old. Colic is also refer to alkaline ,high-sodium conditions,but can be also caused by over feeding,swallowing of air or emotional upset
4 Colic itself is not a serious condition. Although colic is not a serious medical problem, it can cause a great deal of stress and anxiety within the family It should be certain, however, that the child does not suffer from any other medical conditions which could be producing colic-like symptoms
5 Etiology 5% organic Epidemiology 5-19% f=m
6 Infants and baby with colic cries vigorously for long periods, despite efforts to console has a hard, distended stomach, with knees pulled to the chest, clenched fists, flailing arms and legs, and an arched back shows signs of gas discomfort and abdominal bloating experiences frequent sleeplessness, irritability and fussiness symptoms occur around the same time each day or night, often after meal times, and usually ending as abruptly as they began
8 Infantile colic is most common in the first few weeks to four months of an infant's life "Rule of Three" to diagnose colic: "A baby that cries for three or more hours per day, at least three times per week, within a three month period".
9 causes Newborns have an immature digestive system that has never processed food newborns lack the benevolent bacterial flora (probiotics) that develop over time to aid digestion Infants often swallow air while feeding or during strenuous crying
12 Sodium bicarbonate is an alkali (antacid) which alters the naturally occurring pH of baby's stomach acid Do not use for more than 2 weeks Essential Oils and extracts (dill oil, clove oil, fennel extract, ginger extract, etc) are used by all other gripe water brands. There are known safety issues with herbal oils and extracts.
13 Breast feeding mom should avoid stimulants such as caffeine ,caffeine related compound in chocolates and nuts
15 Alternative treatment Applying gentle pressure to the webbed area between the thumb and index finger of either hand can calm a crying child. So can gently massaging the area directly above the child's navel and the corresponding spot on the spine. Applying warm compresses or holding your hand firmly over the child's abdomen can relieve cramping. Teas made with chamomile (Matricaria recutita), lemon balm (Melissa officinalis), peppermint (Mentha piperita), or dill (Anethum graveolens) can lessen bowel inflammation and reduce gas. A homeopathic combination called "colic" may be effective, and constitutional homeopathic treatment can help strengthen the child's entire constitution
16 Differential diagnosis Mechanical intestinal obstruction –Incarcerated inguinal hernia –Malrotation with volvulus –Intestinal atresia (newborns) –Imperforate anus (newborns) –Intussuception –Hirschsprung disease –Meconium ileus (in newborns, due to CF) –Left microcolon syndrome (typically in infants of diabetic mothers) –Fecal impaction (from chronic constipation) –Bezoars: Lactobezoars in premature infants
17 it is very important to exclude several other causes of sudden-onset screaming in a newborn. These conditions include intestinal blockage or obstruction, abdominal infection, a hernia, a scratch of the baby's eye, an ear infection, a bladder infection, and others.
18 Differential diagnosis Functional intestinal obstruction –Paralytic ileus, postoperative ileus, reflex ileus (from sepsis or acute infection) –Peritonitis/intestinal perforation –Severe hypokalemia –Gastroparesis –Necrotizing enterocolitis (NEC) –Toxic megacolon (IBD) –Dysmotility (pseudo-obstruction syndrome)
19 Differential diagnosis Renal enlargement –Hydronephrosis (most common cause of abdominal distension in the newborn) –Ureteropelvic junction obstruction –Bladder distension –Congenital polycystic kidney
20 Differential diagnosis Ascites Hepatomegaly –Budd-Chiari or Beckwith-Wiedemann –Glycogen storage disease –Amyloidosis –Congestive heart failure Splenomegaly Tumors/cysts –Wilms tumor, neuroblastoma, lymphoma, teratoma, sarcoma, ovarian cyst or tumor, omental cyst, dermoid cyst Pancreatic pseudocyst Obesity: Protuberant abdomen (common)
21 Differential diagnosis Aerophagia Pregnancy Hematometrocolpos Malnutrition (e.g., kwashiorkor, celiac) Abdominal abscess Prune-belly syndrome Poor posture
22 Work up Rapid recognition of obstruction is essential History: Age of onset, duration, fever, weight loss, vomiting (bilious/nonbilious), abdominal pain, last bowel movement, bloody or currant-jelly stools (intussuception), last menstrual period, respiratory distress, trauma Birth history, PMH, PSH, time of passage of meconium (delayed in Hirschsprung) Maternal history: Pregnancy (oligo- or polyhydramnious), labor/delivery, gestational diabetes Physical exam: Vital signs, general appearance, abdominal exam for presence of ascites (flank bulging, shifting dullness, fluid wave), masses and tympanic percussion, umbilicus sunken in obesity, herniated if tense ascites, perineum exam for inguinal hernia
23 Work up Labs: CBC, Serum electrolytes, LFT, UA, stool for occult blood, amylase, and lipase Studies –Obstructive series for air fluid levels, distended bowel loops, or pneumoperitoneum –Abdominal ultrasound for pancreatic pseudocyst, ascites, and masses –Upper GI series for proximal obstruction –Barium enema for distal obstructions –CT scan of the abdomen for better delineation of masses or anatomical anomalies –Surgical consult if obstruction or perforation suspected
24 Management Treatment is focused on underlying cause Management of intestinal obstruction –Make the patient NPO –Nasogastric tube placement for decompression –Correction of fluid and electrolyte imbalance –Antibiotic for cases of suspected perforation, NEC, or peritonitis –Laparascopy/laparatomy: Prompt relief of obstructions or repair of perforation is paramount Prokinetic for dysmotility or gastroparesis Surgical resection and subsequent reanastomosis for Hirschsprung disease (one-step or staged repair) Percutaneous, surgical, or endoscopic drainage of pancreatic pseudocyst if persistent Fecal disimpaction and treatment of constipation Correction of malnutrition Contrast or air enema for reduction of intussuception or flushing of meconium ileus Surgical resection of tumor
26 Reference Book Title: In A Page: Pediatric Signs and Symptoms Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Year of Publication: 2007 Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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