When does crying occur and how long does it last? Crying that occurs directly after feeding may be caused by gastroesophageal reflux (heartburn) or swallowed air.
Does the crying begin at the same time every day? Does the infant cry at other times of the day?
What seems to trigger an episode of crying? What helps to stop crying?
What do you do when the baby cries? Parents who respond to their crying infant by yelling, shaking, or hitting can prolong crying and potentially harm an infant.
What does the cry sound like? As mentioned above, infants with colic often have a higher pitched, louder, and more intense sounding cry.
How and what do you feed the baby? As mentioned above, overfeeding, underfeeding, and feeding inappropriate foods have been described as a cause of colic.
Is the crying getting better, worse, or is it about the same? Parents may be reassured that for all infants, colic is a temporary problem. It resolves by three months in 60 percent of infants and by nine months in 90 percent of infants.
How do you feel when the baby cries? Parents' experiences of living with a colicky infant vary; some parents feel overwhelmed and incapable of caring for their infant, although others blame the infant for being difficult.
How has colic affected your family? Colic affects all members of a household, and it is important to consider input from everyone.
Why do you think the baby cries? Parents should feel comfortable discussing thoughts and concerns about their infant with a healthcare provider.
COLIC MYTHS AND FACTS — There are a number of myths about the causes and treatments of colic. Myths often develop to explain problems that are not well understood, including colic. Parents can learn to separate myths from facts through education and support from respected sources, including healthcare providers.
Babies do not cry to manipulate their parent(s).
It is not possible to spoil a baby by holding or comforting them.
Rice cereal does not improve colic. Infants should be given only breast milk or formula until they are 4 to 6 months old, unless told otherwise by a healthcare provider.
Studies show that simethicone (Mylicon®) and lactase (the enzyme that helps to digest lactose, the sugar in milk) are of no benefit.
Sedatives, antihistamines (diphenhydramine [Benadryl®]), and motion-sickness medications (dicyclomine [Bentyl®]) are not safe or effective. Dicyclomine can temporarily stop breathing or cause seizures or coma.
MANAGEMENT — Colic affects the whole family, and treatment is individualized based upon an infant's symptoms and the family's response. The goals of colic management are to decrease the infant's crying, help the family cope, and prevent long-term difficulties in the family's relationships.
No single management strategy has proven to be successful for all infants, thus many providers recommend trying several strategies at once (show table 3). One or more strategies are beneficial for up to one-third of infants.
Parental support — Parents of infants with colic often feel frustrated, angry, exhausted, guilty, and helpless because of their child's crying. These feelings are normal, and do not indicate that a parent is incapable or unworthy of caring for their child.
Take a break — It is normal for parents to need a break from a child who cries excessively. A parent who is alone and needs a break may leave the infant in a safe place; the infant should be placed on his or her back in a crib or bassinet with side rails. Loose blankets, pillows, and toys that could potentially suffocate the child should be removed.
Single parents can get support and information from Parents Without Partners (
www.parentswithoutpartners.org).Taking a break allows a parent to call a friend or relative for help, get away from the crying, and can prevent them from potentially harming the child. Shaking, smothering, or slapping will not stop an infant's crying but can seriously injure or even kill him or her. A parent in the United States can call 24 hours a day, 7 days a week and speak with a professional counselor at 1-800-4-A-CHILD (422-4453).
Shaken baby syndrome is the term used to describe the injuries suffered by infants who are violently shaken, often by a parent or adult caretaker who has become overwhelmed by excessive crying. Infants do not have sufficient strength in their neck to limit head movement, and shaking causes the head to move suddenly and uncontrollably. As the head moves backwards and forwards, the brain hits the inside of the skull, causing serious damage and even death.
Dietary and feeding technique changes
Bottle-fed infants — A number of devices (nipples, bottles) have been designed to decrease the amount of air swallowed during feeding. Parents may try positioning the infant in a vertical position while feeding. A curved bottle or collapsible bag, in combination with frequent burping, also may be tried. These techniques can reduce the amount of air swallowed, thus reducing colic in some infants.
Some studies suggest that infants with colic improve when their formula is switched to a soy-based or hypoallergenic formula. However, the results are inconclusive. Parents should consult with their infant's healthcare provider to determine if a formula change is indicated.
Some providers suggest a trial of a different formula for one week (for bottle-fed infants). The original formula is resumed if no change is observed; hypoallergenic and soy-based formulas are more costly than traditional formula, and are not necessary in infants who fail to improve after a one-week trial.
Breast-fed infants — Mothers who breastfeed may try a hypoallergenic diet, which eliminates potentially aggravating food groups, including milk, eggs, nuts, and wheat.
To try a hypoallergenic diet, a single food group is eliminated during a one-week trial period while the infant's crying patterns are monitored. The food may be reintroduced if no improvement is observed. Hypoallergenic maternal diets appear to be more effective for infants whose mothers have eczema, asthma, or allergic rhinitis, or if the infant has symptoms of cow's milk allergy (including eczema, wheezing, diarrhea, or vomiting). There is some evidence that having an infant empty one breast completely before switching sides may reduce colic.
There is no evidence that stopping breastfeeding and starting formula is of any benefit in babies who have colic. There are a number of benefits to breastfeeding and breast milk that are not available with formula. (See "Benefits of breastfeeding").
Carrying — Some parents find that carrying their infant in their arms, a sling, or a front carrier can decrease the infant's and parents' anxiety. Although studies have not proven carrying to be effective for all infants, it may be beneficial for infants who have not responded to other treatments. In addition, many parents find that using a sling or front carrier frees their hands and arms and allows them to move around while closely monitoring their infant.
Change in environmental stimuli — Parents may try a number of techniques to increase environmental stimuli: a pacifier, ride in the car, change of scenery, infant swing, and warm baths have been suggested and may help to soothe an infant with colic. However, none of these suggestions have been supported in clinical trials.
Infants also may benefit from decreased stimuli; swaddling (show figure 1), or placing the infant near a white noise machine or clothes drier may soothe an infant who is hypersensitive to noise.
Herbal remedies — Herbs such as chamomile, fennel seed, and balm-mint are thought to have anti-spasmodic properties and have been used in infants with colic. Although a few studies have shown improvement in infants given a tea made with a specific mix of herbs, parents should be cautious about trying this treatment.
Gripe water is a mixture of herbs, primarily dill, and water that has been promoted for its ability to cure colic. However, various types of gripe water have been found to contain dangerous ingredients, including glass particles and alcohol. A homeopathic remedy, colocynthis (found in cocyntal and Hyland colic tablets), is unlikely to cause harm, but has not been proven to be effective for treatment of colic.
A healthcare provider should be consulted BEFORE any herbal remedy is used; herbal remedies may not be appropriate and could be dangerous in some cases.
Infant massage — Infant massage has been recommended to parents of infants with colic, although no studies have proven it to be of clear benefit. A full description of infant massage can be found at the La Leche League Web site,
www.lalecheleague.org (search for "massage for colic").
WHEN TO SEEK HELP — Parents should call their child's healthcare provider during the day or night if any of the following occur:
The baby has cried for more than two hours
The parent is afraid he or she may hurt the baby, or if the parent has shaken the baby
If crying could be the result of an injury or fall
The baby has a fever greater than 100.4؛F (38؛C). Parents should call their infant's healthcare provider or go to an emergency department immediately.
The infant refuses to eat or drink anything for more than a few hours, vomits excessively, has bloody stools, or has a change in behavior, including lethargy or decreased responsiveness
A parent should call their child's healthcare provider's office during normal office hours if any of the following occur:
Parents cannot soothe their baby's crying or has questions or concerns about how to manage their crying baby
Excessive crying continues after the infant is older than 4 months
The infant fails to gain weight
LONG-TERM OUTCOMES — Colic can take a toll on families. Some researchers have suggested that colic interferes with child-parent interactions and can have a long-term effect on the family and child.
Long-term studies have examined the possible relationships between colic and features of later childhood, including temperament, sleep patterns, family functioning, asthma, and cognitive development. However, no significant relationship between colic and these features of later childhood have been proven.
SUMMARY
There is no standard definition of colic, though the term is used to describe infants who cry excessively for no apparent reason during the first three months of life. Most healthcare providers define colic as crying that lasts more than three hours per day on more than three days per week. All infants cry more during the first three months of life than during any other time.
Colic is a temporary problem. It resolves by three months in 60 percent of infants and by nine months in 90 percent of infants.
Most infants with colic do not have an underlying medical condition. Colic probably results from a number of different factors, including gastrointestinal, biologic, and psychosocial factors. However, other causes of prolonged crying must be considered in any infant who is suspected to have colic (show table 2).
Parents can monitor the characteristics of their infant's crying; it may be helpful to keep a written record. This information can be shared with a healthcare provider and may help to determine the cause of an infant's crying as well as the best ways to manage it.
Colic affects the whole family, and treatment is individualized based upon an infant's symptoms and the family's response. No single management strategy has proven to be successful for all infants, thus many providers recommend trying several strategies at once (show table 3).
Long-term studies have examined the possible relationships between colic and features of later childhood, including temperament, sleep patterns, family functioning, asthma, and cognitive development. However, no significant relationship has been proven.
WHERE
موضوع: crying con 
الثلاثاء أكتوبر 23, 2007 7:26 pm
