Infantile Colic Overview

Infantile Colic

• A condition that occurs in the second or third week of life.
• Key features include inconsolable crying, irritability, and screaming lasting for 3+ hours with no apparent cause.
• This condition accounts for 10%-20% of pediatric provider visits in the first few weeks of a baby's life.
• Symptoms often occur in the evening, with red-faced appearances and abdominal tension.
• Traditional soothing methods are often ineffective.
• Diagnosis is made through history and physical examination after ruling out other causes.
• Etiology is unknown but may be related to feeding techniques (overfeeding, underfeeding, insufficient burping, formula changes), maternal diet (especially cow's milk in breastfed infants), or gas from milk fermentation.
• No universal treatment guidelines exist.
• Healthcare providers may recommend a trial of feeding bottle-fed babies vertically, frequent burping, and using a bottle with a collapsible bag to reduce swallowed air.
• Soothing techniques include rides in car/stroller, pacifiers, rocking, swings, abdominal massage, white noise, warm baths, and swaddling.

Vomiting (Simple Functional Vomiting)

• Spitting up or regurgitation, common in the first few months.
• Possible causes include gastric distension from overfeeding, giving a hot formula, or not burping the child.
• Air swallowing during feeding or crying can also cause vomiting, especially in bottle-fed infants.
• Infants should be given the formula without overfeeding.
• Warm food and burping are recommended.

Constipation

• Typically occurs at the end of the first year.
• Possible causes include psychological reasons, diet (fiber-free or high in solid additives), or lack of physical activity.
• Treatment involves sufficient fluids and enough fiber, alongside increased fruit and vegetable consumption.
• Laxatives are not recommended unless prescribed by a physician.

Infantile Diarrhea

• Loose, watery stools leading to dehydration, loss of body fluids and electrolytes, and mineral depletion.
• Potential causes include bacterial infection, requiring treatment as it can be dangerous, or nutritional issues (e.g., too much fiber).
• Treatment is using antibiotics, if bacterial, and electrolyte replacement solutions (oral rehydration solutions containing NaCl, KCl, acetate, lactate, and bicarbonate).
• Other treatments may include use of certain gels or pectins to solidify feces, and a low-fiber diet.

Cleft Lip and Palate

• A birth defect where the lip and/or the roof of the mouth does not properly form or close.
• It's one of the most common birth defects.
• Causes are unknown, possibly genetic and/or environmental.
• Cleft palate involves an opening into the nose, while a cleft lip may extend into the nose and can be on one or both sides or in the middle.
• Signs include swallowing difficulties, breastfeeding challenges, underweight, and frequent respiratory infections.
• Treatment involves surgical repair for improved cosmetic and functional results — sometimes accompanied by nonsurgical approaches to optimize feeding, growth, and successful surgical outcomes.
• Feeding and nutrition goals for children with cleft lips/palates include effective feeding methods, expected growth patterns, introduction of complementary foods, and maximizing healing.

Inborn Errors of Metabolism (IEM)

• Genetic conditions affecting the metabolism of protein, carbohydrates, or fats.
• Dietary management is crucial, starting as early as possible to prevent brain damage.
• Strategies to manage IEM include dietary restrictions of certain substrates (e.g., amino acids in phenylketonuria) and replacement of essential nutrients when deficient.
• In some IEMs, co-factor therapy with high doses of vitamins may be necessary to stimulate enzyme activity, or to enhance excretion of toxic metabolites.

Phenylketonuria (PKU)

• The most common IEM.
• A genetic defect prevents the conversion of phenylalanine to tyrosine.
• This leads to phenylalanine accumulation in the blood and urine, causing potential issues for development.
• Diagnosis involves newborn screening (blood sample).
• Treatment is a strict, lifelong dietary management restricting phenylalanine and supplementing tyrosine.
• Symptoms of mental retardation, behavioral issues, seizures, tremors, hyperactivity, stunted growth, skin rashes (eczema), and small head size (microcephaly) can appear.
• There is a specific musty odor in the child's breath, skin, and urine.
• A crucial part of the treatment is a medical formula or food to satisfy nutritional needs and restrict the phenylalanine-containing foods.
• Maternal PKU requires strict blood level management during pregnancy to prevent fetal issues.

Maple Syrup Urine Disease (MSUD)

• A rare inherited metabolic disease affecting branched-chain amino acid (BCAA) metabolism.
• Untreated, it can lead to coma and death.
• Diagnosis may manifest with lethargy, vomiting, poor feeding, and hypertonia in the first days to weeks of life, and a distinctive maple syrup odor in the urine and sweat.
• Treatment focuses on maintaining appropriate blood amino acid levels (leucine) through dietary restrictions of BCAAs (leucine, isoleucine, and valine) and using a medical formula product.

Galactosemia

• A genetic disorder in galactose metabolism.
• It's characterized by the accumulation of galactose and its toxic by-products in blood and tissues.
• Diagnosis is done using routine blood tests.
• Infants can be diagnosed in the first weeks-months of life.
• Symptoms can include galactosemia in the urine, mental retardation, liver damage/enlargement, cataracts, and hypoglycemia.
• The treatment is to completely avoid all sources of galactose in infant's diet (breast milk, cow's milk and other dairy).