Infant colic

Specialty: Pediatrics.

• Excessive crying of the infant of non-organic cause
• infantile colic
• Wessel's rule of three

Why it occurs

• Immaturity of the gastrointestinal tract (hypermotility and transient intestinal dysbiosis with gas accumulation)
• Transient allergy or intolerance to cow's milk proteins (CMPA not mediated by IgE, which generates low-intensity mucosal inflammation)
• Inappropriate feeding techniques (massive aerophagia due to ineffective suction or inadequate bottle feeding)
• Environmental overstimulation or hypersensitivity of the infant (difficulty in sensory self-regulation and the autonomic nervous system)
• Altered family dynamics (maternal or paternal anxiety that exacerbates the infant's stress response)

Initial workup

The clinical diagnosis is based on the Rome IV Criteria (recurrent and prolonged episodes of crying, complaining or irritability without apparent cause, beginning and ending without obvious reason, lasting 3 or more hours a day, at least 3 days a week). In case of warning signs, a thorough physical examination should be performed looking for inguinal hernias, anal fissures, corneal erosion (fluorescein staining) or tourniquet due to finger hair. If organic pathology is suspected, request: complete blood count, PCR, urine sediment and urine culture (ruling out silent urinary infection), abdominal ultrasound to rule out intestinal intussusception, and therapeutic exclusion test for dairy proteins (exclusion diet in the nursing mother or highly hydrolyzed formula for 2 weeks).

Standard management

• Simethicone — surfactant agent that reduces the surface tension of gas bubbles, facilitating their elimination; doses of 9 to 15 mg orally before each dose, with limited clinical evidence but a wide margin of safety
• Lactobacillus reuteri DSM 17938 — probiotic that modulates the microbiota and reduces crying time in exclusively breastfed infants; dose of 5 drops daily orally for at least 21 days
• Lactase enzyme in drops — added to breast milk or formula to reduce the lactose load in cases of suspected transient functional deficiency; 4 to 5 drops per dose
• Hydrolyzed protein formulas (reserved exclusively for clinical suspicion of protein allergy, under medical supervision and prescription).