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Infantile Colic: A Symptom or Diagnosis?




Infantile Colic is defined by the rule of 3s: at least 3 hours of crying per day, at least 3 days per week, for 3 weeks or more. This is likely what your pediatrician will use to make the diagnosis but it usually leaves more unanswered questions and frustrated parents. But what is the reason your child is crying? It is their only form of communication, so they are likely trying to tell you they need something, but what is that? Normal crying is considered 2 hours per day or less with most or all of it consolable.


Let’s start with the actual term colic- of or relating to the colon; an attack of acute abdominal pain, localized in a hollow organ or part (as the small intestine, ureter or bile duct) and often caused by spasm, obstruction or twisting (Merriam-Webster). To me, those two definitions don’t line up. The rule of 3s says nothing about the digestive system, so where do the two come together? Well, maybe they are two separate and distinct diagnoses.


Joyce Miller, DC, PhD proposes that all babies that fit the rule of 3s be considered inconsolable, irritable infants and providers should differentially diagnose what the true cause of that is. Miller states there are 5 categories a baby could fit into. Pathology is the first that should be ruled out. The most common pathology to affect this group would be a urinary tract infection. Along with the crying there will likely be an elevated temperature, increased heart and respiratory rate among other common infection symptoms.


Or maybe there is something else underlying such as a cow’s-milk protein intolerance. As someone who suffers from food allergies, I can tell you that eating something that my body cannot tolerate makes me very uncomfortable. I have the ability to use words to express discomfort but your baby only knows how to cry. Imagine having a constant stomach ache and continuing to put the irritating food into your stomach- you would be quite uncomfortable too!


Next is Irritable Infant Syndrome of Musculoskeletal Origin (IISMO). This is likely caused by a traumatic birth (think about intervention of some sort: forceps, vacuum, Cesarean) or intrauterine constraint. These babies may have restless sleep, discomfort in a car seat or be sensitive to touch. There are muscular or skeletal restrictions that are not allowing your baby to rest comfortably. They are usually consolable if held or positioned in the “correct” way.


Number four is Inefficient Feeding Crying Infant with Disordered Sleep (IFCIDS) and likely the hardest to treat. Sleep and feedings are both affected, intense crying episodes both day and night. IFCIDS could continue as the child grows to school aged, therefore not fitting the “aging out” of infantile colic.


The last is infant colic, which Miller believes should be renamed to Inconsolable Nocturnal Crying Syndrome (INCS) due to the evening peak of inconsolability it is known for. This most commonly starts between 2-10 days old but no later than 2 weeks old. The arms and legs are often flailing and the stomach is tense. They are often passing gas because their intrathecal pressure is increasing from the crying.


For a long time, there have been chiropractors claiming to treat infantile colic and at the same time there are other chiropractors saying infantile colic is a visceral problem, outside of our scope of practice and there is no evidence to support the claim. Well, what if the research supports both claims to some extent? There is research to support that parents and babies presenting to a chiropractor’s office with infant colic and as well as the subgroup IISMO both have reported a decreased amount of crying and an unintended improvement in sleep. The research also supports that the IISMO subgroup responded better than the infant colic group.


I have told patients for a long time that in my opinion infant colic is a symptom of something larger and have recently learned that it is only partially true. Pinnacle Hill Chiropractic providers are continuously reading and engaging in continuing education for these exact reasons, to give our patients the most up to date research so we can treat you more effectively. As always, if you have questions please do not hesitate to ask us!




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