Piercarlo Salari

HOW TO RECOGNIZE THEM

Gas colic is defined as an acute, benign event that affects about 50% of infants (most often in the first 6 weeks of life). Based on data from the literature, colic occurs on average in at least one in five infants.
Colic usually arises after a feeding, particularly in the evening hours: the infant screams, cries, fusses, alternately flexes his legs over his abdomen, which is tense and sore to the touch, and arches his back.
Gas emission may occur during crying, which is sometimes associated with resolution of the episode. They tend to occur mainly in the evening hours and can vary in duration. Although it is a common disorder in infancy, colic often causes serious concern for parents and can even foster depression in mothers, who feel disoriented and helpless.

All of the following criteria must be met for diagnosis:

• Age less than 5 months;
• onset with recurrent and prolonged episodes of irritability, agitation, or crying reported by parents in the absence of obvious causes that cannot be prevented or resolved;
• Absence of growth arrest, fever, or pathological signs.

In any case, this is a diagnosis of exclusion that is made only after other possible hypotheses or causes have been ruled out. On the other hand, in less than 5% of infants with acute crying, an underlying organic disease is really present.

ASPECTS TO BE EVALUATED AND REPORTED

• Timetable and possible periodicity of colic.
• Association with particular stimuli and/or environmental or food elements.
• Possible presence of family tensions or concerns.
• Infant’s reaction to any remedies taken (e.g., massage).
• Presence of other digestive complaints (e.g., vomiting, diarrhea) and/or abdominal pain/reactivity outside of episodes.

CAUSES AND MECHANISMS

Among the possible factors suggested were:

• Gastrointestinal immaturity.
• A change in mother-child bonding and gastrointestinal failure with fermentation in the intestines and flatulence, but rightly no specific cause has been identified. Some hypotheses suggest analteration in intestinal bacterial flora, others a possible food intolerance (which, moreover, in atopic children could also manifest in this way) or digestive difficulty, and still others propose a socio-psychological hypothesis, with the mother-child relationship being the focal point).

It is therefore likely that infant colic is the consequence of a synergistic interaction between biological and behavioral factors. Colic generally does not result in long-term complications but induces frustration in parents, amplifies postpartum depression, and is a cause of doctor visits and stress for the family

CARE AND PREVENTION

If the crying lasts too long or occurs with excessive frequency and especially if fever, decreased liveliness, and/or enlargement of the abdomen occur, the pediatrician should be consulted. Quite different, however, is the situation with crying and fussing after meals, which calms down at least temporarily in two or three minutes by picking up the baby. Colic, in fact, is benign and, depending on the case, as evidenced by numerous traditional remedies, benefits from manipulation (massage on the abdomen clockwise around the navel, rocking) and the use of probiotics. Preventive use of preparations that can promote gas expulsion (e.g., simethicone-based) or homeopathic or herbal medicines is common.

Foreword:

In pediatric age, gastrointestinal disorders are almost the order of the day.

There are at least three reasons for not only their high frequency but also their ease of occurrence:

• First, because thedigestive system, similarly to the respiratory system, is a “direct mediator” of the relationship with the environment: consequently, it is always in close contact with the outside world and is constantly a potential target of microbial aggression.
• Secondly, because, especially in the early years of age, there is an instinctive reaction to “take everything to the mouth,” using it as an organ to explore any object: hence an additional likelihood of exposure to pathogens, as well as of their mutual exchange through objects, accessories and games.
• Finally, to limit ourselves to only the most relevant factors, it should be remembered that the immune system matures during the first 10 years of life, so it is sometimes unable to cope immediately and effectively with the entry of microorganisms of various kinds. If, however, that of barrier organ is, so to speak, an ancillary and obligatory role, the main function of the digestive system is absorptive. That is why infectious diseases are joined by those related to specific issues, such as enzyme deficiencies, malabsorption syndromes, and nutrition. There are two categories of gastrointestinal disorders: acute forms, such as gastroenteritis, and functional disorders.