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Indian Pediatrics Nov 2018Infantile colic is self-limiting condition but it can be a cause of anxiety for parents and challenge for doctors. The challenge for the doctors lies in correct... (Review)
Review
CONTEXT
Infantile colic is self-limiting condition but it can be a cause of anxiety for parents and challenge for doctors. The challenge for the doctors lies in correct identification of the condition and appropriate management. The objective of this review article is to summarize the pathophysiology, treatment options and outcome in infantile colic so that clinicians can have a fair idea about the condition, recent updates and future prospects.
EVIDENCE
A search of the Cochrane Library, PubMed, and Google Scholar was made using the key words "Infant colic", Infantile colic", "excessive crying in infants". All the materials were analyzed and summarized.
RESULTS
At present, infantile colic is an area of clinical research both in terms of etiology and treatment. Various etiological theories have been proposed but none of them are strong enough to completely describe the condition. Various treatment agents are being tried for colic like counseling and behavioral modification, dietary modification, lactase and probiotic supplementation, pain relieving agents, and chiropathy. Proper counseling of the parents is the first line of management at present. Simethicone has no role in decreasing the symptoms of colic and Dicyclomine is not recommended in children younger than six months. No specific recommendations have been made on the use of pain relieving agents and manipulative therapies in colic. At present strong evidence is lacking regarding the use of probiotics, lactase supplementation and dietary modification.
CONCLUSIONS
Counseling of parents about the benign nature of the condition is considered first line for now until an effective treatment is established. Other treatment options are prescribed on a case-based manner, and based on the parental perception of the condition.
Topics: Behavior Therapy; Colic; Counseling; Crying; Diet Therapy; Humans; Infant; Infant, Newborn; Parasympatholytics
PubMed: 29941700
DOI: No ID Found -
American Family Physician Mar 2020Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When... (Review)
Review
Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing.
Topics: Abscess; Aortic Aneurysm, Abdominal; Appendicitis; Cellulitis; Clinical Competence; Colic; Female; Fractures, Bone; Hemorrhage; Humans; Intestinal Perforation; Intracranial Hypertension; Lung; Male; Pericardial Effusion; Point-of-Care Systems; Pregnancy; Prenatal Care; Respiratory Distress Syndrome; Retinal Detachment; Rotator Cuff Injuries; Soft Tissue Infections; Spermatic Cord Torsion; Stroke Volume; Ultrasonography; Ultrasonography, Interventional; Venous Thrombosis
PubMed: 32109031
DOI: No ID Found -
American Family Physician Oct 2015Infantile colic is a benign process in which an infant has paroxysms of inconsolable crying for more than three hours per day, more than three days per week, for longer...
Infantile colic is a benign process in which an infant has paroxysms of inconsolable crying for more than three hours per day, more than three days per week, for longer than three weeks. It affects approximately 10% to 40% of infants worldwide and peaks at around six weeks of age, with symptoms resolving by three to six months of age. The incidence is equal between sexes, and there is no correlation with type of feeding (breast vs. bottle), gestational age, or socioeconomic status. The cause of infantile colic is not known; proposed causes include alterations in fecal microflora, intolerance to cow's milk protein or lactose, gastrointestinal immaturity or inflammation, increased serotonin secretion, poor feeding technique, and maternal smoking or nicotine replacement therapy. Colic is a diagnosis of exclusion after a detailed history and physical examination have ruled out concerning causes. Parental support and reassurance are key components of the management of colic. Simethicone and proton pump inhibitors are ineffective for the treatment of colic, and dicyclomine is contraindicated. Treatment options for breastfed infants include the probiotic Lactobacillus reuteri (strain DSM 17938) and reducing maternal dietary allergen intake. Switching to a hydrolyzed formula is an option for formula-fed infants. Evidence does not support chiropractic or osteopathic manipulation, infant massage, swaddling, acupuncture, or herbal supplements.
Topics: Colic; Education, Medical, Continuing; Female; Gastrointestinal Agents; Humans; Infant; Infant, Newborn; Male; Pediatrics; Practice Guidelines as Topic; Probiotics; United States
PubMed: 26447441
DOI: No ID Found -
Gastroenterology Clinics of North... Dec 2018Infant colic is a characteristic group of behaviors seen in young infants. The most prominent feature is prolonged crying. Additional characteristics, including... (Review)
Review
Infant colic is a characteristic group of behaviors seen in young infants. The most prominent feature is prolonged crying. Additional characteristics, including clenching of the fists and flexion of the hips, have led to the suggestion that these behaviors are related to abdominal discomfort. In this article, we show emerging evidence to support the concept that infant colic could represent gut inflammation and microbial dysbiosis that impacts brain function and even brain development.
Topics: Colic; Crying; Humans; Infant; Infant, Newborn
PubMed: 30337035
DOI: 10.1016/j.gtc.2018.07.008 -
BMC Complementary and Alternative... Mar 2019This systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found,...
BACKGROUND
This systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report.
METHODS
Six databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study.
RESULTS
Of the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity.
CONCLUSIONS
Fifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition's overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.
TRIAL REGISTRATION
PROSPERA registration number: CRD42018091835.
Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Colic; Constipation; Humans; Infant; Infant, Newborn; Musculoskeletal Diseases; Musculoskeletal Manipulations
PubMed: 30866915
DOI: 10.1186/s12906-019-2447-2 -
American Family Physician Sep 2015The Centers for Disease Control and Prevention estimates that each year, one in six Americans will experience a foodborne illness. The most common causes in the United...
The Centers for Disease Control and Prevention estimates that each year, one in six Americans will experience a foodborne illness. The most common causes in the United States are viruses, such as norovirus; bacteria, such as Salmonella, Escherichia coli, Campylobacter, and Listeria; and parasites, such as Toxoplasma gondii and Giardia. Resources are available to educate consumers on food recalls and proper handling, storage, and cooking of foods. Diagnosis and management of a foodborne illness are based on the history and physical examination. Common symptoms of foodborne illnesses include vomiting, diarrhea (with or without blood), fever, abdominal cramping, headache, dehydration, myalgia, and arthralgias. Definitive diagnosis can be made only through stool culture or more advanced laboratory testing. However, these results should not delay empiric treatment if a foodborne illness is suspected. Empiric treatment should focus on symptom management, rehydration if the patient is clinically dehydrated, and antibiotic therapy. Foodborne illnesses should be reported to local and state health agencies; reporting requirements vary among states.
Topics: Anti-Infective Agents; Antidiarrheals; Antiemetics; Blood Chemical Analysis; Colic; Diagnosis, Differential; Diarrhea; Disease Outbreaks; Feces; Fluid Therapy; Food Contamination; Foodborne Diseases; Humans; Microbiological Techniques; Parasitology; Polymerase Chain Reaction; Population Surveillance; United States; Vomiting
PubMed: 26371569
DOI: No ID Found -
The Cochrane Database of Systematic... Mar 2019Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. Infantile colic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. Infantile colic affects a large number of infants and their families worldwide. Its symptoms are broad and general, and while not indicative of disease, may represent a serious underlying condition in a small percentage of infants who may need a medical assessment. Probiotics are live microorganisms that alter the microflora of the host and provide beneficial health effects. The most common probiotics used are of Lactobacillus, Bifidobacterium and Streptococcus. There is growing evidence to suggest that intestinal flora in colicky infants differ from those in healthy infants, and it is suggested that probiotics can redress this balance and provide a healthier intestinal microbiota landscape. The low cost and easy availability of probiotics makes them a potential prophylactic solution to reduce the incidence and prevalence of infantile colic.
OBJECTIVES
To evaluate the efficacy and safety of prophylactic probiotics in preventing or reducing severity of infantile colic.
SEARCH METHODS
In January 2018 we searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, 10 other databases and two trials registers. In addition, we handsearched the abstracts of relevant meetings, searched reference lists, ran citation searches of included studies, and contacted authors and experts in the field, including the manufacturers of probiotics, to identify unpublished trials.
SELECTION CRITERIA
Randomised control trials (RCTs) of newborn infants less than one month of age without the diagnosis of infantile colic at recruitment. We included any probiotic, alone or in combination with a prebiotic (also known as synbiotics), versus no intervention, another intervention(s) or placebo, where the focus of the study was the effect of the intervention on infantile colic.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures of Cochrane.
MAIN RESULTS
Our search yielded 3284 records, and of these, we selected 21 reports for full-text review. Six studies with 1886 participants met our inclusion criteria, comparing probiotics with placebo. Two studies examined Lactobacillus reuteri DSM, two examined multi-strain probiotics, one examined Lactobacillus rhamnosus, and one examined Lactobacillus paracasei and Bifidobacterium animalis. Two studies began probiotics during pregnancy and continued administering them to the baby after birth.We considered the risk of bias for randomisation as low for all six trials; for allocation concealment as low in two studies and unclear in four others. All studies were blinded, and at low risk of attrition and reporting bias.A random-effects meta-analysis of three studies (1148 participants) found no difference between the groups in relation to occurrence of new cases of colic: risk ratio (RR) 0.46, 95% confidence interval (CI) 0.18 to 1.19; low-certainty evidence; I = 72%.A random-effects meta-analysis of all six studies (1851 participants) found no difference between the groups in relation to serious adverse effects (RR 1.02, 95% CI 0.14 to 7.21; low-certainty evidence; I not calculable (only four serious events for one comparison, two in each group: meconium plug obstruction, patent ductus arteriosus and neonatal hepatitis).A random-effects meta-analysis of three studies (707 participants) found a mean difference (MD) of -32.57 minutes per day (95% CI -55.60 to -9.54; low-certainty evidence; I = 93%) in crying time at study end in favour of probiotics.A subgroup analysis of the most studied agent, Lactobacillus reuteri, showed a reduction of 44.26 minutes in daily crying with a random-effects model (95% CI -66.6 to -21.9; I = 92%), in favour of probiotics.
AUTHORS' CONCLUSIONS
There is no clear evidence that probiotics are more effective than placebo at preventing infantile colic; however, daily crying time appeared to reduce with probiotic use compared to placebo. There were no clear differences in adverse effects.We are limited in our ability to draw conclusions by the certainty of the evidence, which we assessed as being low across all three outcomes, meaning that we are not confident that these results would not change with the addition of further research.
Topics: Bifidobacterium; Breast Feeding; Colic; Crying; Female; Gastrointestinal Microbiome; Humans; Infant; Infant, Newborn; Limosilactobacillus reuteri; Prebiotics; Pregnancy; Probiotics; Randomized Controlled Trials as Topic; Time Factors
PubMed: 30865287
DOI: 10.1002/14651858.CD012473.pub2 -
Seminars in Pediatric Neurology Feb 2016This article reviews the evidence for an association between infant colic and migraine. Infant colic, or excessive crying in an otherwise healthy and well-fed infant,... (Review)
Review
This article reviews the evidence for an association between infant colic and migraine. Infant colic, or excessive crying in an otherwise healthy and well-fed infant, affects approximately 5%-19% of infants. Multiple case-control studies, a cross-sectional study, and a prospective cohort study have all found an association between infant colic and migraine. Although infant colic is often assumed to have a gastrointestinal cause, several treatment trials aimed at gastrointestinal etiologies have been negative. Teaching parents how to respond best to inconsolable crying may be helpful and important for preventing shaken baby syndrome. Given accumulating evidence for a connection between infant colic and pediatric migraine, future studies should examine migraine-oriented treatments for infant colic. Infant colic should be moved into the main body of International Classification of Headache Disorders (ICHD-III beta) as one of the "Episodic syndromes that may be associated with migraine."
Topics: Colic; Cross-Sectional Studies; Humans; Infant; Migraine Disorders
PubMed: 27017027
DOI: 10.1016/j.spen.2015.08.003