Improving our understanding of the colicky infant: a prospective observational study

Aim. To investigate characteristics differentially associated with infants suffering from colicky-crying vs. other infants. Background. The crying baby is the most common presentation in every clinician's office in the first 16 weeks of life. As little agreement exists in the literature, attempts to establish differential diagnosis, aetiology, incidence, risk factors and natural progression in addition to appropriate intervention guidelines are urgently needed. Design. Prospective observational study. Subjects. Infants <= 12 months, 159 colicky and 27 non-colicky infants (n = 186) from whom complete data sets were collected. Methods. Parents of infants presented to the clinic completed questionnaires of their infant's characteristics. The data were analysed using logistic regression. Results. Symptoms supporting the diagnosis of colicky-crying infants included 'child flexes/curls legs', 'child has difficulty/ discomfort on bowel movement', 'child is more irritable postfeeding', 'child is more irritable when put into cot', 'child appears in pain', 'child wants frequent cuddling', 'family allergy/asthma' and 'child changes from happy to crying in an instant'. A nomogram illustrated if a mother suggests colic as a diagnosis and the infant has the symptoms supporting the diagnosis, then the chances of being a colicky infant rise from the initial prevalence 85% to approximately 98%. If the symptoms are not present, the chances of being a colicky infant drop from 85% to around 3%. Conclusion. Because the literature lacks consensus regarding a gold standard for the diagnosis of the colicky-crying infant, these findings may offer help to the health care practitioner when faced with an excessively crying infant. Relevance to clinical practice. It has been hypothesised that there may be multiple reasons for excessive crying in an infant. It is necessary to differentiate between the types of crying infants that present to the clinician to determine the best course of action.