Infantile Colic Overview

Infantile Colic

• Characterized by prolonged periods of irritability, fussiness, or crying in healthy infants, specifically for more than 3 hours a day, 3 days a week, for over 3 weeks.
• Peaks around 3 months of age, following the "Rule of Three" established by Wessel and colleagues.
• Affects 10-30% of infants globally, making it a primary cause for pediatric visits in the first three months.

Theories on Causes of Infantile Colic

• Possible origins include an underdeveloped mucosal barrier, imbalanced gut microbiota, lactase insufficiency, and altered gut motility.
• Higher levels of ghrelin and motilin found in colicky infants suggest a link to abnormal gut hormone signaling.

Gut Hormones

• Motilin: Stimulates muscle contractions for gut clearance. Abnormal signaling in colicky infants may disrupt this function.
• Ghrelin: An appetite stimulant with elevated levels in colicky infants, possibly increasing hunger and discomfort.

Lactase Insufficiency

• Occurs when lactose exceeds the intestinal absorptive capacity (3.5g/100ml or above 4.5g/Kg/day), leading to fermentation and gas in the colon.
• Infant lactase activity is typically low at birth (only 25% active), complicating lactose digestion.

Diagnosis

• Diagnosis of infantile colic focuses on excluding other potential causes and understanding its differential diagnosis.

Treatment Approaches

• Reassurance and guidance provided to parents using the "5 S" approach.
• Probiotics: Lactobacillus reuteri strains shown to improve colic symptoms in breastfed infants.
• Dietary Formulas: Partially hydrolyzed whey protein formulas serve as a first-line dietary approach.

GENTLE+ PLUS Formula

• Designed specifically for infants (0-12 months) with colic and gas issues, containing low levels of lactose to alleviate symptoms.
• Contains 14% reduced lactose, 85% maltodextrins for easier digestion, and HMOs for gut health.

Biological Effects of HMOs

• Support infant gut maturation, immune function, and promote the development of healthy gut microbiota, leading to reduced colic and fussiness.

Milk Fat Globule Membrane (MFGM)

• Contributes to intestinal health and reduces episodes of colic, enhancing gut immunity and development of healthy microbiota.

Role of Beta-palmitate

• Associated with reduced crying time, improved growth, and better tolerability for infants.

Long-Chain Polyunsaturated Fatty Acids (LC-PUFAs)

• DHA & ARA sources are important for infant growth, found in various foods, including fish and plant oils.

Importance of Lactose

• Essential for supplying 40% of energy needs and aiding in the absorption of calcium and iron.
• Prolonged absence of lactose in an infant's diet can lead to growth issues and potential future lactose intolerance due to decreased lactase activity.

Lactose Free Formulas and Colic

• Not suitable for managing colic as colic relates to excess lactose, not lactose itself.
• Long-term use can lead to a decline in lactase production, risking future lactose intolerance in infants.

Diarrhea

• Defined as the passage of three or more loose or watery stools per day, can result from lactose intolerance or secondary factors like infections or mucosal injury.
• Hydrogen breath test can diagnose lactose intolerance by measuring breath hydrogen after lactose ingestion.

Villous Atrophy

• Commonly caused by infections (e.g., rotavirus), allergies (e.g., cow milk protein allergy), or autoimmune disorders (e.g., celiac disease).

This quiz covers the essential aspects of infantile colic, including definitions, symptoms, and the 'Rule of Three' criteria established by Wessel and colleagues. It's crucial for those studying early childhood care, as it addresses common concerns in infant health.