Infantile Colic
Doctor Information
Joan Dempsey, 27
Last seen by midwife 8 weeks ago:
G1p0 full term. Due date in 2/7. No problems so far, fed up of pregnancy, looking forward to birth.
Bp 110/60, pulse 70
Last seen by midwife 8 weeks ago:
G1p0 full term. Due date in 2/7. No problems so far, fed up of pregnancy, looking forward to birth.
Bp 110/60, pulse 70
Patient Information
Joan Dempsey, 27
PC: baby won't stop crying ( you have got your mum up today, and she has Jennie for the day)
Opening line: doctor I need help, I think there is something seriously wrong with my baby, she won't shut up, it's driving me insane!
Further information revealed only if asked:
You gave birth to Jennie around 8 weeks ago, and all was going so well initially, Jennie was quiet, and slept most of the time. But for the last 3 weeks she hasn't stopped crying, nothing settles her. She cries for at least 4 hours solid per day. She sleeps well eventually, and is feeding (breast feeding) on demand every 2-4 hours without problem. Her bowels are fine, and she has plenty of wet nappies. She has not had a temperature or felt warm. Other than the crying she seems well in herself. No possetting, no vomiting, putting on weight well. You have not noticed any redcurrant jelly stools if asked. Due to see health visitor and yourself in one week. Your baby cries mainly in the afternoon, evening, and sometimes draws up her legs to her tummy when doing so.
You are on maternity leave from your job as an accountant. Your parents live 2 hours away, and your husband is in the military, and is currently away on training at the moment. Your mum can only come up every 2 weeks to help. You don't have much friends locally, most of your friends are work friends, as your job was so busy you never really had time to make much friends outside of work.
You have discussed this with your work colleagues who had young children, and they have informed you that constant crying can be a sign of serious underlying problems, so you have brought her in today.
In reality you don't feel like you are coping well (only revealed if asked), you feel isolated, as you are alone most of the day. You can't cope with all the crying and it's making you resent your baby. You are not depressed, your mood is fine for now. You don't feel stressed, just finding the crying difficult to cope with. You don't have any previous psych history. You don't take any regular medication. You have no allergies. No thoughts of harm to self or baby, and no voices heard that others can't hear. You don't have any symptoms of thyroid disease if asked.
Ideas, that Jennie may have a serious underlying problem
Concerns, that you are not coping well, and feeling very isolated, also that this may signify a serious underlying concern
Expectations, that the Dr checks to make sure Jennie is OK. You want some support at home. You would be very grateful if there was some way of getting additional support, or a ways to meet other new mums. Also any way to stop Jennie crying!
If it is explained to you that this should settle by 3-4 months of age, then you will be happy with this, and you wont want Jennie to have any medications.
PC: baby won't stop crying ( you have got your mum up today, and she has Jennie for the day)
Opening line: doctor I need help, I think there is something seriously wrong with my baby, she won't shut up, it's driving me insane!
Further information revealed only if asked:
You gave birth to Jennie around 8 weeks ago, and all was going so well initially, Jennie was quiet, and slept most of the time. But for the last 3 weeks she hasn't stopped crying, nothing settles her. She cries for at least 4 hours solid per day. She sleeps well eventually, and is feeding (breast feeding) on demand every 2-4 hours without problem. Her bowels are fine, and she has plenty of wet nappies. She has not had a temperature or felt warm. Other than the crying she seems well in herself. No possetting, no vomiting, putting on weight well. You have not noticed any redcurrant jelly stools if asked. Due to see health visitor and yourself in one week. Your baby cries mainly in the afternoon, evening, and sometimes draws up her legs to her tummy when doing so.
You are on maternity leave from your job as an accountant. Your parents live 2 hours away, and your husband is in the military, and is currently away on training at the moment. Your mum can only come up every 2 weeks to help. You don't have much friends locally, most of your friends are work friends, as your job was so busy you never really had time to make much friends outside of work.
You have discussed this with your work colleagues who had young children, and they have informed you that constant crying can be a sign of serious underlying problems, so you have brought her in today.
In reality you don't feel like you are coping well (only revealed if asked), you feel isolated, as you are alone most of the day. You can't cope with all the crying and it's making you resent your baby. You are not depressed, your mood is fine for now. You don't feel stressed, just finding the crying difficult to cope with. You don't have any previous psych history. You don't take any regular medication. You have no allergies. No thoughts of harm to self or baby, and no voices heard that others can't hear. You don't have any symptoms of thyroid disease if asked.
Ideas, that Jennie may have a serious underlying problem
Concerns, that you are not coping well, and feeling very isolated, also that this may signify a serious underlying concern
Expectations, that the Dr checks to make sure Jennie is OK. You want some support at home. You would be very grateful if there was some way of getting additional support, or a ways to meet other new mums. Also any way to stop Jennie crying!
If it is explained to you that this should settle by 3-4 months of age, then you will be happy with this, and you wont want Jennie to have any medications.
Examination Findings
Not applicable in this scenario
Mark scheme
Data Gathering
|
POSITIVE INDICATORS
Organised and systematic in gathering information from history taking, examination Identifies abnormal findings or results and/or recognises their implications Data gathering does appears to be guided by the probabilities of disease Enquires about health of Jennie and mother Excludes other serious causes (such as intussusception) |
NEGATIVE INDICATORS
Makes immediate assumptions about the problem Is disorganised/unsystematic in gathering information Data gathering does not appear to be guided by the probabilities of disease. Fails to identify abnormal data or correctly interpret them Fails to enquire about how mum is coping, and mums mood. Fails to enquire about social support for mum. |
Clinical Management Skills
|
POSITIVE INDICATORS
Explains colic coherently, and able to discuss other conditions, and why they are unlikely to be the cause Develops a management plan that is appropriate and in line with current best practice Makes plans that reflect the natural history of common problems Management approaches reflect an appropriate assessment of risk Manages risk effectively, safety netting appropriately - Doesn't jump to immediately prescribe medication |
NEGATIVE INDICATORS
Fails to consider common conditions in the differential diagnosis Does not suggest how the problem might develop or resolve Fails to make the patient aware of relative risks of different approaches Offers medication immediately Follow-up arrangements are absent or disjointed |
Inter Personal Skills
|
POSITIVE INDICATORS
Identify patient’s agenda, health beliefs & preferences / does makes use of verbal & non-verbal cues. Works with the patient to develop a shared management plan Uses explanations that are relevant and understandable to the patient Shows sensitivity for the patient’s feelings in all aspects of the consultation including physical examination Shows empathy for difficult situation parents must be in. |
NEGATIVE INDICATORS
Doesn't enquire about patients ICE Takes a doctor centered approach towards management Uses an explanation that is filled with jargon, or forgets to explain at all Doesn't show any sympathy / empathy towards the patient's situation Fails to empower patient |
Management
Explanation: Colic is a common condition where there are repeated bouts of excessive crying in a baby who is otherwise healthy. The definition used by doctors is: a baby crying for more than three hours a day, for more than three days a week, for at least three weeks. Colic is common, affecting up to 3 out of every 10 babies. We do not know exactly why some children get colic, but we know that it’s nothing to do with your parenting, and it does not mean your baby is rejecting you. It usually goes away by the age of 3-4 months, at latest by 6 months of age.
Infantile Colic
Defined as a baby crying for more than three hours a day, for more than three days a week, for at least 3 weeks. Colic is very common, occurring in up to 3 out of 10 children. Luckily it does go away by itself by around 3-4 months of age. The exact cause of infantile colic is unknown.
Other conditions that may present similarly, that would be worth excluding include:
Infantile Colic
Defined as a baby crying for more than three hours a day, for more than three days a week, for at least 3 weeks. Colic is very common, occurring in up to 3 out of 10 children. Luckily it does go away by itself by around 3-4 months of age. The exact cause of infantile colic is unknown.
Other conditions that may present similarly, that would be worth excluding include:
If symptoms are sudden in onset:
Intussusception, volvulus, strangulated hernia, Torsion of the testis.
Other causes to consider.
Non-accidental injury.
Hunger or thirst
Nappy rash
Wind
Constipation
Gastro-oesophageal reflux disease
Cow’s milk intolerance
Lactose Intolerance
Management:
Reassure the parents that their baby is well, that they are not doing something wrong, the baby is not rejecting them, and that colic is common and is a phase that will pass within a few months (normally gone by 6 months of age)
To comfort the baby, try holding the baby. If the baby is often inconsolable, it may advisable to put baby down in a safe place, and take some time out (a few minutes). Other things that may comfort a crying baby include, gentle motion, bathing, background noise (especially white noises - vacuum cleaner, hairdryer). Encourage mother to continue breastfeeding wherever possible.
Encourage parents to look after their own well-being:
Ask family and friends for support, rest when the baby is asleep.
It may be helpful to meet with other parents with children of similar age.
Support groups include: CRY-SIS, Their helpline is available every day from 9 a.m. to 10 p.m. Tel: 08451 228 669. (www.cry-sis.org.uk). Health visitors are also a useful source of advice and support for parents of excessively crying babies.
Alternative Strategies:
Previously, NICE CKS used to recommend trialling medication or alternative strategies if none of the above helped. This advice has however been recently superseded. NICE CKS no longer support the trial of the following strategies, as there is insufficient good-quality evidence for its use:
References:
NICE CKS on Colic
NHS Choices Patient Leaflet on Colic
Reassure the parents that their baby is well, that they are not doing something wrong, the baby is not rejecting them, and that colic is common and is a phase that will pass within a few months (normally gone by 6 months of age)
To comfort the baby, try holding the baby. If the baby is often inconsolable, it may advisable to put baby down in a safe place, and take some time out (a few minutes). Other things that may comfort a crying baby include, gentle motion, bathing, background noise (especially white noises - vacuum cleaner, hairdryer). Encourage mother to continue breastfeeding wherever possible.
Encourage parents to look after their own well-being:
Ask family and friends for support, rest when the baby is asleep.
It may be helpful to meet with other parents with children of similar age.
Support groups include: CRY-SIS, Their helpline is available every day from 9 a.m. to 10 p.m. Tel: 08451 228 669. (www.cry-sis.org.uk). Health visitors are also a useful source of advice and support for parents of excessively crying babies.
Alternative Strategies:
Previously, NICE CKS used to recommend trialling medication or alternative strategies if none of the above helped. This advice has however been recently superseded. NICE CKS no longer support the trial of the following strategies, as there is insufficient good-quality evidence for its use:
- Simeticone (Infacol)
- Lactase (Colief)
- Dietry modification in Mum if breast-feeding.
- Probiotic supplements
- Herbal supplements
- Manipulative strategies (osteopathy)
References:
NICE CKS on Colic
NHS Choices Patient Leaflet on Colic