IN THE NAME OF GOD CRYING AND COLIC INTRODUCTION Incessant crying - PowerPoint PPT Presentation

IN THE NAME OF GOD CRYING AND COLIC

INTRODUCTION • Incessant crying is one of the frequent complaints for which young infants are brought to pediatricians. • Crying in young infants is a part of normal behavioral and neuronal development • Infants on an average, cry for about one and a half to two hours a day, this duration peaking up to 140 min by 6 weeks of age and gradually declining to 1 h per day by12wk. The crying follows a circadian pattern with the majority of episodes concentrated in the late afternoon and evening

CAUSES CON. • Colic • constipation • aerophagy • gerd • Cow ’ s milk allergy And lactose intolerance

HISTORY • The clinical assessment should include detailed history regarding the frequency, duration, timing and any precipitating or relieving factors for the crying spell noticed by the parents. Recurrent vomiting, fast breathing or cough during feeding should also be sought in history. Psychosocial background and parental understanding of the baby ’ s cues are important to determine if there is any threat to baby ’ s safety.

PHYSICAL EXAMINATION • A thorough head to toe examination of the baby is always warranted to pick up clinical clues pointing towards treatable causes. Close observation of the nature of cry, the posture and attitude of the baby while crying often points towards a specific diagnosis. One should also note the parents ’ way of holding the baby and the strategies used by them to calm the baby. Difficulties with breastfeeding like problems in positioning, attachment, oral motor dysfunction or cleft palate should be addressed by observing a feeding session. Abdominal examination may be difficult with a crying child and requires repeated assessments over time. Examination of genitalia, perianal region for diaper dermatitis, ulcers, skin lesions, inguinal hernia or torsion of the testis is vital. Extremities should be examined for finger tourniquets, skin lesions, occult fractures or dislocations. The ear should be examined for otitis

PHYSICAL EXAMINATION • media, furuncles or foreign body, eye for corneal abrasions and oral mucosa for aphthous ulcers and thrush. Specific history and clinical signs may provide a clue to the underlying diagnosis as listed in Table 2. B Red flags ^ that point towards an underlying serious illness are given in Table 3. The presence of any of these should prompt the clinician to provide immediate stabilization and arrange for referral to tertiary care centers equipped with emergency and inpatient care.

CAUSES • Infants cry for a variety of reasons which can range from simple ones like hunger, pain or need for attention to sinister ones like serious life-threatening illnesses.

COLIC

CAUSES OF COLIC

KEY POINTS IN COLIC • Infant colic is a common phenomenon in infancy with an enigmatic and distressing character. • Infant colic is most often defined according to the Wessel criteria or according to the Rome criteria. • The pathogenesis of infant colic remains unclear and is thought to be multifactorial; however, a growing body of evidence suggests that the gut microbiome contributes to development of the condition.

TREATMENT OF COLIC • The cornerstones in the management of infant colic are parental reassurance and education. • Owing to a lack of large, high- quality randomized controlled trials, none of the behavioral, dietary, pharmacological or alternative interventions are strongly recommended.