[Management of infantile colics]

Infantile colic concerns about 10-30% of all newborns and has been defined as a condition characterized by paroxysmal episodes of unexplained full force crying for at least three days a week and continuing for one week or more in a thriving well-nourished infant. The disorder more likely occurs in the evening, without identifiable causes and resolves spontaneously by the fourth month of life. The several factors involved in the etiopathogenesis (food intolerance or allergy to cow's milk protein, intolerance to lactose, intestinal hyperperistalsis, neuro-hormonal immaturity, maternal anxiety and familial stress), make the management of infants with colics difficult. We propose a scoring system for the evaluation of colics in infants based on: 1) crying intensity and duration; 2) accompanying characteristics of crises (e.g. meteorism, family history for allergic disease, type of feeding, type of stools); 3) evaluation of parents' opinion of their infants' crying. Type of management is based on the score: a) crying that is unrelated to colics: treatments referred to specific diagnosis. b) crying that is related to colics but not severe: first and second step of management; c) crying that is related to colics and is severe: third step of management.

first step: pacifier, rocking, dull continuous background noise, hot water bottle on the abdomen, herbal tea, simethicone. Second step: pharmacological treatment and periodic controls. Pharmacological treatment include antispastic drugs (e.g. cimetropium bromide). Third step: dietary modification and/or pharmacological treatment: mothers of breast-fed infants are given a diet with no milk or products containing its proteins, or fish, or eggs. Infants who are not breast-fed receive soy milk and if symptoms continue soy milk is substituted with hydrolyzed casein milk formula. Pharmacological treatment include antispastic drugs (e.g. cimetropium bromide and in non responders dicyclomine hydrochloride). Dietary modifications appear more suitable than pharmacological treatment in resolving symptoms, since side effects of drugs have been described and our recent results indicate appropriate dietary modifications offer better results than pharmacological treatment in resolving crises. However, before interrupting dietary modifications and reintroducing cow's milk proteins, infant's tolerance to such proteins is tested. In any case because of the good prognosis and rapid regression of symptoms, dietary regimens or pharmacological treatment should only be applied if really necessary and for brief periods under medical supervision.