Systemic Physical Condition
A. Sahib El-Radhi in Paediatric Symptom and Sign Sorter, 2019
When crying is inconsolable and excessive, it can cause stress to parents, disrupt parenting and, in rare cases, place an infant at risk for abuse. It is common and normal for infants to cry up to 2 hours a day. Infantile colic is not a diagnosis; it is simply a term that describes healthy infants with paroxysmal excessive crying for no apparent reason, presumably of intestinal origin, during the first 3–4 months. It is defined as crying for over 3 hours a day, over 3 days a week and over 3 weeks. It usually begins aged 2 weeks and significantly improves by the age of 3–4 months. Characteristically, the attack begins suddenly, is continuous, with flushed face, tense abdomen, hands making fists and drawing up of legs. Around 5% of cases have organic causes. Crying may be a baby's way of communication; as children grow older, they find different ways to communicate.
The Afebrile Infant with Excessive Crying
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan in Diagnosing and Treating Common Problems in Paediatrics, 2017
Colic is a diagnosis of exclusion and should not be the first diagnosis, unless the infant has met the diagnostic criteria. Where a diagnosis of colic is likely, the following are suggested:acknowledge how difficult it is to deal with a crying infantassess the fatigue and sleep deprivation level of the parents – in particular, the motherdetermine if the parents have had respite from the cryingbe prudent in ordering investigationsgive a specific treatment plan and outline specific strategiesrecognise that not all treatment strategies are equally effectivewhen undertaking a treatment strategy, ensure that the parents log the crying, sleep and feeding pattern, to ensure that any improvement obtained can be objectively assessedexplain the natural history of colic to the parents.
Crying and colic
Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy in Primary Child and Adolescent Mental Health, 2019
Many parents feel that their inconsolable crying baby must be in pain and therefore ill. Colic will probably be implicated in the majority of these cases, and the child will be physically well. A common cause of colic is cow’s milk allergy. However, it is obviously important not to miss the less common causes of excessive crying, such as pain from acute infections (ear, nose and throat, or urinary tract) or from a strangulated inguinal (groin) hernia. Crying after a feed may be due to pain from gastro-oesophageal reflux, and this may be associated with unusual posturing of the baby’s head and neck. There will usually (but not always) be a history of vomiting. If suspected, this possibility should be investigated by a paediatrician. A rare but extremely important condition is infantile seizures, where the baby flexes the whole trunk in a so-called ‘salaam spasm and utters a brief cry. A child with possible infantile spasms should probably be referred as an emergency.
Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials
Published in Scandinavian Journal of Primary Health Care, 2018
Holgeir Skjeie, Trygve Skonnord, Mette Brekke, Atle Klovning, Arne Fetveit, Kajsa Landgren, Inger Kristensson Hallström, Kjetil Gundro Brurberg
Infantile colic is a painful and poorly understood ailment in early infancy. It is a self-limiting condition normally ending at 3–4 months of age. The definition still commonly used is Wessel’s symptom definition of 1954: ‘Paroxysmal, uncontrollable crying and fussing in an otherwise healthy infant under 3 months of age, with more than 3 h of crying per day in more than 3 days for more than 3 weeks’ [1]. A modified version, Rome III [2], has been in place since 2006 [3] and a further extension, ROME IV [2], since 2016 [4]. Persistent painful crying is a severe strain on both the child and parents [5]. There is no clear aetiology. According to the Rome IV criteria, infantile colic is in most cases regarded as a behavioural syndrome representing the high spectrum of normal developmental crying, rather than symptoms of abdominal pain [4]. Physiological factors such as altered gut motility, immature digestive functions, altered intestinal macrobiotics or food sensitivity might be involved [6–8]. Psychological factors like inadequate parent–infant interaction or family tension have also been proposed as important factors [6–8]. There is no consensus on treatment strategies for the condition [5,9]. Strategies include counselling on specific management techniques, reduced stimulation, herbal teas, sucrose, simethicone, hypoallergenic diet, chiropractic manipulation, probiotics and acupuncture [5,8,10].
Fabry disease – a multisystemic disease with gastrointestinal manifestations
Published in Gut Microbes, 2022
Malte Lenders, Eva Brand
FD is a multisystemic disorder (Figure 1). GI symptoms belong to the first manifestations already in affected pediatric FD patients.19 Abdominal pain and diarrhea are the most common symptoms, followed by constipation, nausea, and vomiting.13,20–23 In detail, registry data from the Fabry Outcome Survey (FOS) based on 1,453 patients reported a prevalence of 51% for GI symptoms24 mainly due to abdominal pain and diarrhea.20 Abdominal pain is the most frequently reported symptom in affected patients and includes the appearance of colic with pain in the mid- or lower abdomen, bloating, cramping, or mid-abdominal discomfort.25,26 Since these symptoms may increase during or after meals or are triggered by stress, it is conceivable that many FD patients are reluctant to food intake, which may result in lower body weight. However, this seems to be limited to patients with very severe symptoms, since most studies and reports did not show differences in body mass index between patients with and without GI symptoms.2 Frequency and severity of diarrhea as the second most GI symptom is more diverse. According to the FOS registry, 20% of FD patients reported diarrhea, which was more common in males (26%) than in females (17%), and very frequent in children (25%).20,27 However, the real frequency in classical FD patients seems to be much higher, since the reported frequency in females with FD manifestations justifying ERT from the Fabry Registry is reported as 39%.23
A review of dexketoprofen trometamol in acute pain
Published in Current Medical Research and Opinion, 2019
Magdi Hanna, Jee Y. Moon
A hallmark symptom of renal colic, and the prime reason for attendance at an emergency department, is intense/excruciating, intermittent acute pain that radiates from the flank to the groin or inner thigh, and it is frequently accompanied by nausea and vomiting63. Central to the pathogenesis of renal colic is obstruction of renal flow and increasing renal pelvic pressure. Increased pressure and local irritation by the stone stimulates prostaglandin synthesis and release, and this promotes arteriolar vasodilation and diuresis which further increase intrarenal pressure. Prostaglandins also act directly on the ureters to induce smooth muscle spasm. The involvement of prostaglandin pathways in the etiology of renal colic may explain why NSAIDs are so effective in this disorder, since their primary mechanism of action is via inhibition of the COX enzyme which regulates the synthesis of prostaglandins and autocoids such as thromboxanes64. Cochrane reviews relating to the use of NSAIDs in patients with renal colic confirm the efficacy of these agents compared with opioids65 and non-opioids66. Current recommendations indicate that in the majority of patients NSAIDs should be the first-line analgesia of choice, providing no contraindications exist, with opioids retained as second-line treatment and for rescue analgesia67,68.
Related Knowledge Centers
- Biliary Colic
- Perspiration
- Vomiting
- Gallstone
- Small Intestine
- Ureter
- Pain
- Gallbladder
- Large Intestine
- Baby Colic