Infant colic

A study in JAMA (2013;309:1607-12) found that children and adolescents seen in emergency departments and diagnosed with migraine were more than six times more likely to have had a history of colic than children seen in the ED for other reasons. The association with colic did not appear for other forms of headache, but was consistent for the patients diagnosed with migraine both with and without aura.

The authors of the study, which was done in three tertiary care hospitals in France and Italy, wonder if nerve endings in the gut and brain may be sensitized in a similar fashion. I have always suspected that there might be an association between migraine and colicky infants, and I find the investigators’ explanations interesting and plausible. But I think that there may be a simpler explanation that doesn’t involve as-yet-undiscovered neurochemical similarities between the infant gut and the brain of older children.

First, in my construct of infancy "Colic" with a capital "C" isn’t really a diagnosis, and attempts to treat it as a diagnosis only lead to confusion, misdiagnosis, and overtreatment. It is more helpful to describe young infants with episodic fussiness as being "colicky" or "having colicky pain."

In some cases the pain is obviously linked to a gastrointestinal cause. For example, the breast-fed infant with blood-streaked loose green stools has colicky pain. The infant who swallows more air than he can handle and is relieved by flatus or an improved burping technique has colicky pain. But, so may the child with an aberrant coronary artery or a urinary tract obstruction. Little babies can’t tell us where it hurts. They may grab their ears when their belly hurts or grab their belly when their ears hurt. In my experience, many colicky infants don’t have an abdominal cause for their pain. But, with centuries of old wives’ tales and anecdotal pseudoscience behind us, parents and physicians assume that babies with episodic spells of fussiness are having a gut problem.

Instead of postulating some undiscovered neurochemical relationships, doesn’t it make more sense to suspect that some colicky infants are actually having migraine headaches? We already know that sleep deprivation is a major trigger for childhood migraine. (Or, at least I do!) And we know that many infants don’t readily fall into a pattern that provides them with enough sleep.

In my experience, colicky infants who don’t have an obvious gastrointestinal cause for their episodes of discomfort are usually suffering because they find themselves in a poorly managed sleep environment. If I am successful in helping parents create more sleep-friendly schedules, the colicky pain often resolves.

For older children, migraine headaches usually resolve when the child falls asleep in a dark room. They wake up cured until the next episode of sleep deprivation starts the cycle over again. However, getting parents to put their obviously uncomfortable infant in a dark room and allowing sleep to take over isn’t always easy.

This study from the pages of JAMA should be a launching pad for some new thoughts about "Colic," but I fear that they will fall into the same old orbit that equates colicky pain with infant gastrointestinal tract problems.

This column, "Letters From Maine," regularly appears in Pediatric News, a publication of IMNG Medical Media. Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

A study in JAMA (2013;309:1607-12) found that children and adolescents seen in emergency departments and diagnosed with migraine were more than six times more likely to have had a history of colic than children seen in the ED for other reasons. The association with colic did not appear for other forms of headache, but was consistent for the patients diagnosed with migraine both with and without aura.

The authors of the study, which was done in three tertiary care hospitals in France and Italy, wonder if nerve endings in the gut and brain may be sensitized in a similar fashion. I have always suspected that there might be an association between migraine and colicky infants, and I find the investigators’ explanations interesting and plausible. But I think that there may be a simpler explanation that doesn’t involve as-yet-undiscovered neurochemical similarities between the infant gut and the brain of older children.

First, in my construct of infancy "Colic" with a capital "C" isn’t really a diagnosis, and attempts to treat it as a diagnosis only lead to confusion, misdiagnosis, and overtreatment. It is more helpful to describe young infants with episodic fussiness as being "colicky" or "having colicky pain."

In some cases the pain is obviously linked to a gastrointestinal cause. For example, the breast-fed infant with blood-streaked loose green stools has colicky pain. The infant who swallows more air than he can handle and is relieved by flatus or an improved burping technique has colicky pain. But, so may the child with an aberrant coronary artery or a urinary tract obstruction. Little babies can’t tell us where it hurts. They may grab their ears when their belly hurts or grab their belly when their ears hurt. In my experience, many colicky infants don’t have an abdominal cause for their pain. But, with centuries of old wives’ tales and anecdotal pseudoscience behind us, parents and physicians assume that babies with episodic spells of fussiness are having a gut problem.

Instead of postulating some undiscovered neurochemical relationships, doesn’t it make more sense to suspect that some colicky infants are actually having migraine headaches? We already know that sleep deprivation is a major trigger for childhood migraine. (Or, at least I do!) And we know that many infants don’t readily fall into a pattern that provides them with enough sleep.

In my experience, colicky infants who don’t have an obvious gastrointestinal cause for their episodes of discomfort are usually suffering because they find themselves in a poorly managed sleep environment. If I am successful in helping parents create more sleep-friendly schedules, the colicky pain often resolves.

For older children, migraine headaches usually resolve when the child falls asleep in a dark room. They wake up cured until the next episode of sleep deprivation starts the cycle over again. However, getting parents to put their obviously uncomfortable infant in a dark room and allowing sleep to take over isn’t always easy.

This study from the pages of JAMA should be a launching pad for some new thoughts about "Colic," but I fear that they will fall into the same old orbit that equates colicky pain with infant gastrointestinal tract problems.

This column, "Letters From Maine," regularly appears in Pediatric News, a publication of IMNG Medical Media. Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

A study in JAMA (2013;309:1607-12) found that children and adolescents seen in emergency departments and diagnosed with migraine were more than six times more likely to have had a history of colic than children seen in the ED for other reasons. The association with colic did not appear for other forms of headache, but was consistent for the patients diagnosed with migraine both with and without aura.

The authors of the study, which was done in three tertiary care hospitals in France and Italy, wonder if nerve endings in the gut and brain may be sensitized in a similar fashion. I have always suspected that there might be an association between migraine and colicky infants, and I find the investigators’ explanations interesting and plausible. But I think that there may be a simpler explanation that doesn’t involve as-yet-undiscovered neurochemical similarities between the infant gut and the brain of older children.

First, in my construct of infancy "Colic" with a capital "C" isn’t really a diagnosis, and attempts to treat it as a diagnosis only lead to confusion, misdiagnosis, and overtreatment. It is more helpful to describe young infants with episodic fussiness as being "colicky" or "having colicky pain."

In some cases the pain is obviously linked to a gastrointestinal cause. For example, the breast-fed infant with blood-streaked loose green stools has colicky pain. The infant who swallows more air than he can handle and is relieved by flatus or an improved burping technique has colicky pain. But, so may the child with an aberrant coronary artery or a urinary tract obstruction. Little babies can’t tell us where it hurts. They may grab their ears when their belly hurts or grab their belly when their ears hurt. In my experience, many colicky infants don’t have an abdominal cause for their pain. But, with centuries of old wives’ tales and anecdotal pseudoscience behind us, parents and physicians assume that babies with episodic spells of fussiness are having a gut problem.

Instead of postulating some undiscovered neurochemical relationships, doesn’t it make more sense to suspect that some colicky infants are actually having migraine headaches? We already know that sleep deprivation is a major trigger for childhood migraine. (Or, at least I do!) And we know that many infants don’t readily fall into a pattern that provides them with enough sleep.

In my experience, colicky infants who don’t have an obvious gastrointestinal cause for their episodes of discomfort are usually suffering because they find themselves in a poorly managed sleep environment. If I am successful in helping parents create more sleep-friendly schedules, the colicky pain often resolves.

For older children, migraine headaches usually resolve when the child falls asleep in a dark room. They wake up cured until the next episode of sleep deprivation starts the cycle over again. However, getting parents to put their obviously uncomfortable infant in a dark room and allowing sleep to take over isn’t always easy.

This study from the pages of JAMA should be a launching pad for some new thoughts about "Colic," but I fear that they will fall into the same old orbit that equates colicky pain with infant gastrointestinal tract problems.

This column, "Letters From Maine," regularly appears in Pediatric News, a publication of IMNG Medical Media. Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].