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Infant colic: mechanisms and management

Abstract

Infant colic is a commonly reported phenomenon of excessive crying in infancy with an enigmatic and distressing character. Despite its frequent occurrence, little agreement has been reached on the definition, pathogenesis or the optimal management strategy for infant colic. This Review aims to delineate the definitional entanglement with the Rome IV criteria, which were published in 2016, as the leading, most recent diagnostic criteria. Moreover, neurogenic, gastrointestinal, microbial and psychosocial factors that might contribute to the pathophysiology of infant colic are explored. This Review underlines that a comprehensive medical history and physical examination in the absence of alarm symptoms serve as guidance for the clinician to a positive diagnosis. It also highlights that an important aspect of the management of infant colic is parental education and reassurance. Management strategies, including behavioural, dietary, pharmacological and alternative interventions, are also discussed. Owing to a lack of large, high-quality randomized controlled trials, none of these therapies are strongly recommended. Finally, the behavioural and somatic sequelae of infant colic into childhood are summarized.

Key points

  • Infant colic is a common phenomenon in infancy with an enigmatic and distressing character.

  • Infant colic is most often defined according to the Wessel criteria or according to the Rome criteria.

  • The pathogenesis of infant colic remains unclear and is thought to be multifactorial; however, a growing body of evidence suggests that the gut microbiome contributes to development of the condition.

  • The cornerstones in the management of infant colic are parental reassurance and education.

  • Owing to a lack of large, high-quality randomized controlled trials, none of the behavioural, dietary, pharmacological or alternative interventions are strongly recommended.

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Fig. 1: Crying amounts and patterns from three North American studies4,6,7 illustrating absence of a secular trend.
Fig. 2: Possible pathophysiological mechanisms contributing to the pathogenesis of infant colic.
Fig. 3: Mechanisms through which bacterial dysbiosis can contribute to excessive crying in infant colic.
Fig. 4: Hypothesized mechanisms possibly leading to bacterial dysbiosis in infants.
Fig. 5: Suggested diagnostic algorithm for infant colic.
Fig. 6: The vicious circle of infant crying and maternal fatigue and adverse events.

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J.Z., P.D.B., M.L.H., C.d.W. and M.A.B. researched data for this article and drafted the initial manuscript. All authors contributed equally to substantial discussions of content and reviewing and/or editing the manuscript before submission.

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Correspondence to Judith Zeevenhooven.

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Competing interests

M.A.B. was a member of the Pediatric Working Committee of the Rome Foundation that developed the Rome IV criteria for infants and toddlers discussed in this Review. M.A.B. is a scientific consultant for Shire, Sucampo, AstraZeneca, Norgine, Zeria, Coloplast, Danone, Friesland Campina, Sensus and Novalac. P.D.B. is a scientific consultant for CR2O and participated as a speaker for Winclove Probiotics. J.Z., M.P.L. and C.d.W. declare no competing interests.

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Zeevenhooven, J., Browne, P.D., L’Hoir, M.P. et al. Infant colic: mechanisms and management. Nat Rev Gastroenterol Hepatol 15, 479–496 (2018). https://doi.org/10.1038/s41575-018-0008-7

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