What is the role of pharmacy staff in treating colic?

A short semi-structured interview with the parent or carer helps ensure that a colicky baby is otherwise healthy2. Parents should exclude common causes of crying that arise from discomfort, such as hunger or temperature12.

The rule-of-three can aid diagnosis. Colic usually lasts7:

  • For at least three hours a day
  • For at least three days a week
  • For at least three weeks

Possible questions to ask parents:

  • Is the baby eating normally?
  • Is the baby growing well?
  • Does the baby have a high temperature?
  • Is the baby producing normal stools?
  • Is the baby having colic-free periods?
  • Does the crying follow a pattern?

If parents cannot provide clear feedback on the pattern of crying, consider asking them to complete a cry diary. A cry diary will help parents identify whether their baby’s symptoms have changed or new ones have emerged, and post-diagnosis, a cry diary can assess whether existing techniques need to be tried for longer, amended, or if it’s time to try something different2. See the example below.

Differential diagnosis

The causes of colic are thought to be physiological/organic (gastrointestinal immaturity and cow’s milk allergy) or non-physiological/behavioural (parenting behaviours and response; temperament of the infant).

Considering the following may help the differential diagnosis:

  • Bowel habits: Constipation can often cause crying
    • Solid, pellet like stools may indicate constipation
    • A baby should pass soft stools of about five cm in diameter
  • Maternal diet: Some dietary components can pass through breast milk, including caffeine and some spices
  • Symptoms of gastro-oesophageal reflux disease (GORD): Symptoms such as vomiting, coughing, irritability, poor feeding and blood in stools can be a sign of GORD
    • Nearly half of babies experience reflux in the first three months of life16
    • GORD usually resolves between 12 to 24 months of age16
    • The most common complication is oesophagitis16

Parents should seek further medical attention if the baby experiences any red-flag signs or symptoms such as3,17,18:

  • Weak, high-pitched, continuous cry (crying associated with colic is usually strong, with a normal pitch)
  • Seems floppy when lifted
  • Takes less than a third of their usual amount of fluids or has passed much less urine than usual
  • Has vomited green fluid
  • Passed blood in their stools
  • Has a fever of ≥38°C (less than three months of age) or ≥39°C (three to six months of age)
  • Has a high temperature, but their hands and feet feel cold
  • Has a bulging fontanelle
  • Has experienced a seizure
  • Has turned blue, blotchy or very pale
  • Has breathing problems, such as breathing fast, or grunting while breathing, or they seem to be working harder than usual to breathe (for example, sucking in under the rib cage)
  • Has any signs associated with meningitis, such as a purple-red rash
  • Passed blood in their stools
  • Poor growth due to an inability to hold down enough food
  • Irritability or refusing to feed due to pain
  • Blood loss from acid burning the oesophagus

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