evaluation
Diagnosis of infantile colic is usually made by excluding more sinister causes (1).
A careful generic paediatric history should be taken.
- should focus on identifying the relationship between an infant’s behaviour and time of day and duration of crying episodes
- identify red flag features which may indicate a more uncommon but serious causes e.g. - intussusception and pyloric stenosis (1,2)
The following should be carried out in an infant suspected of having infantile colic:
- pulse, respiratory rate and temperature
- weight should be plotted and compared against previous measurements
- if serial measurements of weight is not available, follow up measurements may be necessary to recognise any abnormality in growth
- physical examination
- expose child from head to bottom and look for bruises or trauma and identify any visible evidence of non-accidental injuries (1)
Red flag signs and symptoms which may indicate an uncommon cause include:
- signs
- irritability, tachycardia, pallor mottling, poor perfusion
- petechiae, bruising, tachypnoea, cyanosis, nasal flaring
- hypotonia, meningism, full fontanelle
- weight<4th centile for age (or decreasing on the centile chart)
- head circumference >95th centile (or increasing in the centile charts)
- symptoms
- bilious or projectile vomiting, bloody stools
- fever, lethargy, poor feeding
- perinatal risk factors for sepsis (premature rupture of membranes, maternal fever or infection, group B streptococcus) (1).
Biochemical and radiological examinations are usually not required if history and examination reveal no abnormalities (except for inconsolable crying) (1)
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