Infant Colic

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This article reviews the evidence for an association between infant colic and migraine. Infant colic, or excessive crying in an otherwise healthy and well-fed infant, affects approximately 5%-19% of infants. Multiple case-control studies, a cross-sectional study, and a prospective cohort study have all found an association between infant colic and migraine. Although infant colic is often assumed to have a gastrointestinal cause, several treatment trials aimed at gastrointestinal etiologies have been negative. Teaching parents how to respond best to inconsolable crying may be helpful and important for preventing shaken baby syndrome. Given accumulating evidence for a connection between infant colic and pediatric migraine, future studies should examine migraine-oriented treatments for infant colic. Infant colic should be moved into the main body of International Classification of Headache Disorders (ICHD-III beta) as one of the “Episodic syndromes that may be associated with migraine.”

Introduction

A lay definition of infant colic is excessive crying in an otherwise healthy and well-fed infant. Given mounting evidence for an association between infant colic and migraine, infantile colic is now included in the appendix section of the most recent iteration of the International Headache Society’s Classification system, International Classification of Headache Disorders (ICHD-III beta), in the section on “Episodic syndromes that may be associated with migraine.”1 This article will review the epidemiology of infant colic, what is known about its cause, the evidence for a connection to migraine, and a proposed approach to management of infant colic from a migraine perspective.

Section snippets

Normal Infant Crying and How Infant Colic Differs

Although all babies cry, what distinguishes colicky babies is that they cry more, and they often cry inconsolably. There is typically a predictable diurnal pattern to colicky crying with more crying occurring in the evening hours. Normal infant crying peaks at 5-6 weeks of life (corrected for gestational age at birth) and declines by 3-4 months of age.2, 3 Colic is an amplified version of this developmental crying pattern. The prevalence of colic is thought to be in 5%-19% of infants.4, 5

What Causes Infant Colic?

Although Wessel et al6 first described infant colic in 1954, we still don’t know what causes it, or whether there is one cause or multiple. Although the term “colic” implies an abdominal etiology, there is little direct evidence for this localization. All that seems certain is that the babies are in distress. Wessel et al6 in fact seemed to recognize the uncertainty of colic’s underlying etiology and titled his article, “Paroxysmal Fussing in Infancy, Sometimes Called Colic.”

It is important

The Case for Infant Colic as a Migrainous Phenomenon

As migraine is a highly genetic disorder,21, 22 it is possible that children with migrainous genetics may express migrainous genes in one manner early in brain development and then as migraine headache later in childhood or adolescence.

An association between infant colic and childhood migraine has been reported in several retrospective case-control studies.23, 24, 25 In a cross-sectional study, mothers with migraine were more than twice as likely to have an infant with colic.26 In a

Treatment of Infant Colic From a Migraine Perspective

Educating parents about the association between infant colic and migraine may help them understand why their baby is crying so much, hopefully alleviating maternal guilt or concern about diet and breast milk–related causes. Educating parents about the developmental pattern of infant crying, and how it will generally improve by 3 months of age,3 may also help them to cope with it in the interim.

Although the prognosis of infant colic is generally good, it is important to educate the baby’s

Conclusion

Given the totality of the evidence, infant colic was introduced into the appendix section of ICHD-III beta under “Episodic syndromes that may be associated with migraine.”1 As further evidence of an association has emerged in the interim, it would seem sensible that infant colic be moved into the main body of the document in the final version of ICHD-III. Additional prospective cohort studies are needed to determine the natural history of children with infant colic, specifically whether they

Acknowledgments

Dr Gelfand was supported by a KL2 (NIH/NCATS 8KL2TR000143-09) while writing this article.

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