0071643192.pdf

PEDIATRICS

COMMON PEDIATRIC PROBLEMS

Colic

Infants with colic have persistent crying without a clear cause. To meet tradi-
tional definitions of colic, the infant must cry at least 3 hours a day, at least
3 days a week, for at least 3 weeks. Roughly 15% of infants have colic at
some time, occurring between the ages of 2 and 16 weeks, with a peak inci-
dence at 6 weeks of age.

SYMPTOMS/EXAM

The physical exam is normal for colicky infants. During episodes of crying,
infants may flex their legs up to their abdomen, arch their backs, and have
abdominal distention. A careful physical examination is required to rule out
other causes of persistent crying (see below).

DIFFERENTIAL

Because crying is nonspecific, the differential diagnosis for colic is extensive
(see Table 5.1). Infants with colic should have a history of appropriate weight
gain and growth.

DIAGNOSIS

Diagnosis is based on careful history and physical examination. A urinalysis
and culture may be useful for ruling out a UTI, with other laboratory studies
sent depending upon the clinical suspicion of possible etiologies.

Colic: Crying at least 3 hours a

day, at least 3 days a week,

for at least 3 weeks.

TABLE 5.1. Differential Diagnosis of Colic

Gastroesophageal reflux

Formula intolerance

Infection (UTI, otitis media, meningitis)

Intussusception

Child abuse (occult fractures, occult subdural hemorrhage)

Corneal abrasion

Congenital abnormality (heart disease, metabolic disorder)

Foreign body in eye (most commonly an eye lash)

Anal fissure

Testicular torsion

Hair tourniquet (hair or thread wrapped tightly around digit or penis)

Recent immunization (most commonly after DTP)

Differential diagno-

sis of colic—

CAN’T FART

Corneal abrasion,

congenital

abnormality

Anal fissure

INtussusception,

iNfection

Tourniquet (around digit

or penis)

Formula intolerance,

Foreign body in eye

Abuse

Recent immunization

Testicular torsion