Definition:
- Paroxysm of irritability, fussing or crying lasting more than 3 hours/day.
- For more than 3 days/week after R/o other causes for crying.
- Resolve by 3 month of age.
- Colic starts at two weeks of age and last till 3 month.
- In premature babies it starts two weeks after the due date.
- Incidence: 2 % to 12 %.

Diagnoses of Colic:
Colic is a diagnosis of exclusion; we need to obtain a detailed history of when and how long the baby cries.

- Continuous Irritability.
- Vomitting, Diarreaha, Constipation.
- Rash.
- Respiratory Symptom.

A complete head to toe examination:
- Point tenderness in the extremity.
- Hair tourniquet.
- Eye examination, corneal abrasion.
- Anal fissure.
- Esophagitis,GERD.

Symptoms & signs that suggest a diagnosis other than Colic:
- Failure to thrive.
- Irritability that is almost continuous, rather than episodic.
- Irritability that lasts beyond 3 or 4 months.
- Vomiting, Diarrhea, constipation.
- Heme positive stool.
- Rash.
- Respiratory symptom.
- Point tenderness in an extremity.
- Anal fissures.
- Subtle dysmorphic facial features.

What is crying?
Crying is a normal reflex every newborn has, and one of the neonatal reflex babies are born with. It is a brilliant way of getting attention and it is a powerful connection between the baby and the mother.
It is estimated to be 80 - 100 db sound of prolonged period (most adult can’t do).
50% of infant ages 6 week cry almost 2h/day and at 12 weeks this cry decrease to 1h/day.
Crying of early infancy is an excellent signal of need. But poor signal of what is needed.

How Colic effect the Parents?
- Exhaustion: HR, skin conduction, nervous system.
- Breast feeding failure (Decrease Let down reflex, Decrease Milk supply, Decrease Women’s confidence in her milk).
- Marital Stress.
- Post partum depression.
- Child abuse.
- Shaken baby syndrome.

The four theories of Colic:
- GI disorders
Minor GI problem: like Gas in the gut, swallowed air, overfeeding and cramps can cause discomfort.
Major GI problem: cow's milk intolerance (10-15%), GERD (2-4%) peaks at 4m of age, food like (cola, chocolate, coffee, tea, cold medicine) can pass to the baby through breastfeeding and provoke crying.

- Maternal Anxiety
Actually colicky infant cause maternal anxiety, but not the other way around. But anxious mom can make babies crying worse by jumping from one calming intersection to another.

- Difficult infant temperament.
Studies found that the association between colic and specific temperament profile is small.

- Brain Immaturity
Brain immaturity is responsible for the frequent tremors, irregular breathing,
crossing of the eyes, poor state control (awareness), that’s why Colic diminishes after 3m.On the other hand premature babies are very immature but colic is delayed.

The missing fourth trimester

The four theories explain aspects of colic but overtook the root cause. Our babies cry because they are born 3 months too soon, they are very immature, more like fetuses than infants. It is not until after 3 months those babies truly (wake up) and begin smiling, waking up, rolling over, sucking their fingers and cooing.

This theory is compatible with all characteristics of colic:
1. Delayed onset in premature babies.
2. Evening predominance of crying.
3. Calming effect of relaxing and shushing.
4. Absents of Colic in certain cultures.
5. Cessation of colic after three month.

Calming the baby:
Before birth refuses get contentious stimulation they snuggled by the uterus.
Frequently jiggled plus rocking Surrounded by constant whoosh of blood.
At birth babies are suddenly deprived of the rhythmic sensation of the womb.
Some babies can handle this without difficulty others who has poor state control have persistence crying.

Calming reflex:
Group of reflexes: vestibular, Auditory, tactile, work together to calm the baby. There are five maneuvers (5 S’s).

- Swaddling.
It is the cornerstone of calming, lower baby’s HR, decrease Startling.

Notes:
- Allows baby to sleep, about 12-20 h / day.
- Loose swaddling should be avoided (SIDS)
- Avoid over heating.
- Never to swaddle a baby over aboard (Hip dysphasia).

- Shushing.
The shush sound imitate the shish sound in the womb that fetuses hear, it is measured as 75-88 db.

- Stomach position.
In the womb babies are in the fetal position getting contact ventral stimulator.

- Swinging.
Motion in soothing to a new born. To calm the baby it require fast movement, low amplitude, 120-180 time/minute but not to jiggle the baby when the head is not supported ( Shaken baby syndrome ).

- Sucking.
Sucking has a soothing effect, babies can suck breast, or pacifiers.

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