Infantile Colic

Dr Nadia Khan (Paediatrician) at our Busamed Hillcrest Private Hospital shares insight into Infantile colic, Infant regurgitation and Gastro-oesophageal Reflux Disease (GORD).

Is it Colic or Reflux?

Up to 40% of infants get colic — high-pitched screaming and crying that lasts for over 3 hours a day on more than 3 days a week. It begins between 3 and 6 weeks of age and usually ends when the baby is 3 or 4 months old.
Colicky babies normally have predictable periods of fussiness and crying.  And aside for these periods they are usually happy and thriving.

Infant regurgitation (Posseting) or Gasto-oesophageal reflux (that is not Reflux DISEASE) is extremely common in healthy infants, in whom gastric contents may reflux into the esophagus 30 or more times daily. Many, but not all, of these reflux episodes result in regurgitation into the oral cavity. The frequency of reflux declines with increasing age.  Infant regurgitation or vomiting decreases toward the end of the first year of life and is unusual in children older than 18 months.

Gastro-oesophageal reflux disease (GORD) Refers to reflux that has pathologic consequences, such as esophagitis, nutritional compromise with weight loss, or respiratory complications.
Stomach acid can back up into the baby’s esophagus, causing painful reflux. Spitting up a lot and crying during feedings are signs. If your baby pulls away from a breast or bottle, isn’t eating well, is fussy a lot of the time, or has respiratory symptoms, talk to your doctor.

What are the signs and causes of Gastro-oesophageal Reflux disease rather than Infant Regurgitation or Colic?

A baby with poor weight gain
This can be a sign of an underlying food protein-induced enteropathy or food protein – induced enterocolitis.

Feed refusal
Irritability- Irritability is more likely to be caused by GORD if it occurs when the baby is regurgitating. Particularly suggestive is the symptom complex of arching of the back, torsion or twisting of the neck, and lifting up of the chin, known as Sandifer syndrome. This posturing can be confused with torticollis or seizures.

Rectal bleeding
A food protein-induced proctocolitis (or “intolerance”) can have a clinical presentation that mimics GORD.

Apnoeas / Respiratory symptoms
Reflux may be associated with respiratory disorders in infants, including recurrent stridor, chronic cough, recurrent pneumonia, and reactive airway disease (wheezing). It would be important to have a paediatrician assess the baby to ensure that there are no other causes of these respiratory symptoms.

The common causes of GORD include:
Food Protein Allergy (usually non IgE mediated Cow’s milk Allergy)
Tobacco smoke
Premature birth
Neurological diseases
Congenital abnormalities
Pyloric stenosis
Cystic fibrosis

Before even touching on treatment, it’s important to see your paediatrician if you suspect your baby may have GORD. This will allow for a proper assessment before any treatment can commence and will ensure the correct diagnosis is made.

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