Patient's question:
When the child was 45 days old, there was a little swelling below the navel, and they often cried and fussed between 6 PM and 2 AM. Sometimes they cried very intensely, but their bowel movements and urination were normal.Doctor's answer:
Colic is a type of paroxysmal abdominal pain caused by intermittent strong contractions of the smooth muscles in the intestinal wall, and it is the most common cause of acute abdominal pain in children. In breastfed infants, colic is associated with the mother's diet.Recommendations: Treatment can be determined based on the results of a colic scoring system. The scoring considers the intensity and duration of crying, accompanying symptoms, parents' perception of the crying, and whether the crying is related to colic. However, for mild colic, first- and second-level treatment plans are used; for severe colic, third-level treatment is applied.
I. First-Level Treatment
- Provide comfort to the child, gently rock the child, reduce environmental noise, and use a warm compress on the infant's abdomen.
- Offer support and reassurance to parents.
- Consider herbal remedies or dimethicone.
Some herbal remedies have spasm-relieving effects. After taking a herbal mixture (composed of chamomile, horsetail, licorice, fennel, fragrant grass, and mint) for 7 days, colic improves, but nighttime waking frequency does not decrease.
Dimethicone is a non-absorbable drug that reduces intestinal gas by altering bubble surface tension, causing bubbles to merge or disperse, thereby promoting gas expulsion. It has no side effects on the body. It is used to reduce intestinal gas, but research results on its efficacy are inconsistent. A self-controlled crossover study comparing dimethicone with a placebo showed that 1/4 to 2/3 of the children experienced symptom improvement, but there was no significant difference compared to the placebo.
Other medications that reduce intestinal gas, such as activated charcoal and α-galactosidase, can adsorb gas or aid in digesting high-fiber foods to reduce fermentation gas. However, their efficacy in treating colic is still uncertain.
II. Second-Level Treatment
- Medication-based treatment.
Spasm-relieving drugs (e.g., scopolamine) can block muscarinic receptors in smooth muscles and directly act on smooth muscles to relieve spasms.
For ineffective cases, bismethamine hydrochloride can be used. As an anticholinergic drug, it has atropine-like spasm-relieving effects and some central calming effects, showing certain efficacy in treating infant colic. However, recent studies have found that this drug can cause apnea in infants under 6 months old, limiting its use.
To date, no completely effective drug has been found to treat colic.
III. Third-Level Treatment
- Dietary changes and/or medication.
Breastfeeding mothers should avoid dairy products, fish, and eggs. Formula-fed infants can be given soy milk or hydrolyzed casein formula, which can significantly improve infant colic.
For CMPI-induced colic, removing milk protein and switching to soy milk or hydrolyzed protein can improve symptoms in 71%-88% of children.
Due to the potential side effects of medication (e.g., bismethamine hydrochloride) and sometimes unsatisfactory efficacy, dietary changes may be more suitable than medication.