Talk:Infant colic/Draft

Nancy Sculerati MD has nominated this version of this article for approval. Other editors may also sign to support approval. The Health Sciences Workgroup is overseeing this approval. Unless this notice is removed, the article will be approved on April 22, 2007.

Article Checklist for "Infant colic/Draft"

Workgroup category or categories	Health Sciences Workgroup [Categories OK]
Article status	Developed article: complete or nearly so
Underlinked article?	No
Basic cleanup done?	Yes
Checklist last edited by	Christo Muller (Talk) 10:31, 11 April 2007 (CDT)

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First posting

An original Citizendium by myself with references. Now to add pictures. Comments, changes, deletions, and additions as always welcome. Links need to be added. Christo Muller (Talk) 09:59, 9 April 2007 (CDT)

Wow, very impressive! Would have been nice to have about eight months ago, although our baby didn't really have colic. What might be nice (I mean, for purely selfish personal reasons) is an article about how babies start to walk, and one on how they start to talk. --Larry Sanger 10:50, 9 April 2007 (CDT)

Another editor asks

Christo, I am working my way through. I think this is just the kind of thing that CZ can offer the world as a real benefit. I do not intend on "authoring" in the sense of adding any new ideas or information. I would like to edit this-which I have begun doing, simply for such things as language and links. Hopefully, we can get this approved. I have a first specific complaint that requires your input. I quote below: "During the attack the babies face is contorted in apparent pain (though the eyes may remain open, and the child appear alert, in contrast to, for instance, needle stick and post-operative pain)." Now that is useful for pediatricians, Recovery room nurses, house staff etc- but what about parents? They are hopefully neither sticking needles or operating on their children with enough regularity to use these examples pragmatically (that is a joke, coming from a mother- a loving mother I am told- who is also a surgeon, so please -anyone reading this-don't get too upset) - so can you re-state it? Perhaps distinguishing it from cries that parents should worry about- like meningitis or even acute otitis media, rather than dismiss as "just colic", or cries like hunger- dirty diaper that they may be familiar with?. Nancy Sculerati 11:06, 9 April 2007 (CDT)

Well done

Good job Christo. A very thorough, informative, neutral narrative. What more could we ask for. My only 2 cents were from an editing point of view noting that there was some repetition with signs and symptoms that were repeated among at least two of the sections, but it might have been necessary to keep it clear in the readers mind. Other than that, you kept me focused and answered all my questions along the way. --Matt Innis (Talk) 12:26, 9 April 2007 (CDT)

Just a bit more editing

1) the graph would benefit from a bit more of a caption. Additionally, could you actually describe some of the data it is based on? I know you have references, I'm asking you to describe the content of those references in the text, in a paragraph that refers explicitly to the excellent graph you created. 2)"It is equally wise to remember that when the health worker has not identified a definite cause for the crying, this does not exclude more serious problems with anything like 100% certainty, and conversely, where a separate disease has been diagnosed, its treatment will not necessarily solve co-incidental colic."

This sentence (quoted above) is very clear to me, but the article would benefit from its expansion, in my view. Perhaps, bearing in mind that this article is likely to be read by exasperated parents (at midnight) with a certain high pitched cry very audible in the background (as they stare at their computer screens), you could actually give a couple of theoretical cases. Interesting, easy to follow. You know- make it clear that you are making up examples, but a narrative that illustrates those important concepts of sensitivity and specificity. Just like you would probably use in talking to parents you are counseling. That's a hard one (specificity/sensitivity) for even medical students and residents to apply to real cases. Anyway, thanks, the article is really looking good. Nancy Sculerati 14:23, 12 April 2007 (CDT)

Conventional medicine: "Since both these medications cause sedation and sleepiness, it is possible that the beneficial effect is on the central nervous system. This raises the question of whether it would be wise to use such treatments indiscriminately." If you agree, I think that pointing out that in infants who at the age during which colic strikes, actual brain meyelination and synaptic connections are being made, and that drugs crossing the blood -brain barrier may have not only immediate, but, at least in theory, lasting effects. Aternative medicine:" Once the reason for their efficacy is determined, these herbals would become part of the armamentarium of scientific medicine." Perhaps a word also that a profile of side effects and safety (therapeutic index) would also be available - and is not now available for these medications. Nancy Sculerati 21:08, 12 April 2007 (CDT)

all babies in distress

Christo. I am going through again, from the beginning. I changed word order and punctuation in some places, and inserted a sentence that explains more about entry criteria in a study (without using that term.) I want to confine my role here strictly to editing, and not authoring, and I believe that I have done so, but please change any of my changes without need for explanation if you would prefer the previous language. I come to the phrase: "all babies in distress". Since it is so important to a mother or father when faced with a colicky infant to know whether the doctors think the baby actually is in distress, and the point of this section seems, to me, partly to reassure parents that the loudness and pitch of the cry of the baby is the same when they get into a crying jag; whether they are pain, hungry, or irritated by diaper rash, or suffering from catostrophic problem, as when they are not any of those things, but - as far as can be told-are actually just fine (but crying anyway.) So, this "all babies in distress", needs clarification. Do you mean "in distress", or do you mean in an episode of crying? If you mean in distress, could you be more specific. I had 2 babies and I assure you if I thought they were "in distress", neither man nor beast could have stopped me from doing something about it, let alone some doctor's written assurance that it doesn't matter. Are you implying that it's OK for my baby to be in distress? Or are you implying that's it allright for a baby to cry a lot? I'm resorting to the dictionary - give me a moment ;) Nancy Sculerati 09:16, 14 April 2007 (CDT)

For a noun, the Oxford English Dictionary uses this meaning for distress, as applies to the use of the word in the prase "in distress" (e.g. damsel in distress)" 2. a. The sore pressure or strain of adversity, trouble, sickness, pain, or sorrow; anguish or affliction affecting the body, spirit, or community. " Affliction sounds like disease to me. Nancy Sculerati 09:26, 14 April 2007 (CDT)

Thanks Nancy. The closest I have come to defining distress in the medical or physiological sense is that the organism is experiencing stress with which it is not able to cope. In this interpretation, stress is both necessary and valuable, distress has doubtful value and may be harmful. Stress is commonly associated with increased efficiency, distress with a failure of compensatory mechanisms. The issue is important in the US, since your congress has written a law which requires that researchers working with animals have to make sure that the animal does not suffer unnecessary "pain or distress". Since it is law, the responsible government agencies have to be able to apply it, and check that "distress" is not being caused, but no-one has a generally accepted definition of distress, nor has anyone a clue as to how to measure it. (I will have to look up the applicable USC, but I know that there have been whole conferences held just on this issue!) Be that as it may, your point is well made. In the article the word is used in a rather loose way, and I shall review the relevant section to see what I can come up with, to decrease the potential for confusion. Christo Muller (Talk) 16:15, 16 April 2007 (CDT)

some references

Crotteau CA. Wright ST. Eglash A. Clinical inquiries. What is the best treatment for infants with colic?. [Review] [9 refs] [Journal Article. Review] Journal of Family Practice. 55(7):634-6, 2006 Jul. UI: 16822454

EVIDENCE-BASED ANSWER Infantile colic, defined as excessive crying in an otherwise healthy baby, is a distressing phenomenon, but there is little evidence to support the many treatments offered. Several small studies report some benefit from use of a hypoallergenic (protein hydrolysate) formula, maternal diet adjustment (focusing on a low-allergen diet), and reduced stimulation of the infant. While dicyclomine has been shown to be effective for colic, there are significant concerns about its safety, and the manufacturer has contraindicated its use in this population. An herbal tea containing chamomile, vervain, licorice, fennel, and balm-mint was also effective in a small RCT, but the volume necessary for treatment limits its usefulness (strength of recommendation: B, inconsistent or limited-quality patientoriented evidence). The one proven treatment is time, as this behavior tends to dissipate by 6 months of age.

There are myriad strategies-ranging from craniosacral osteopathic manipulation to car ride simulation-offered for dealing with infantile colic. Although none of these treatments has been validated in rigorous studies, the available evidence offers tentative support for 3 strategies: (1) a trial of a hypoallergenic (protein hydrolysate) formula (for formula fed infants), (2) a low-allergen maternal diet (for breastfeeding mothers), and (3) reduced stimulation of the infant.

"Several medications have been tested in RCTs; only dicyclomine has shown an effect in a few small RCTs.3,4 However, there have been reports of apnea and other serious, although infrequent, adverse effects. For that reason, the manufacturer has contraindicated the use of this medication in infants aged < 6 months." (Shall we mention apnea? Nancy Sculerati 06:26, 20 April 2007 (CDT))

The American Gastroenterological Association recommends a hypoallergenic, protein hydrolysate formula for formula fed infants or a maternal low-allergen diet as an initial strategy for infant struggling with colic symptoms if the clinician is considering a diagnosis of (cow's milk) allergy.7

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scholarly & readable

What a FINE JOB. I have , as is my wont, been going through a full text search on colic through medline, and all I do is come upon the papers you have so nicely digested and worked into this article. Best of all, I think, the article is not just accurate but is written well and has a doctorly care of the infant with colic incorporated into every line.(see start of sentence) Nancy Sculerati 06:34, 20 April 2007 (CDT)

opening sentences

I think the opening sentences could use a little fine-tuning for a general audience. Below is my suggestion:

Infant colic is a medical term for persistent and inconsolable crying by healthy infants, who are usually between the ages of two and sixteen weeks. It is a syndrome – a defined set of symptoms and signs – and not a specific disease. A common definition is: continuous crying that lasts for a period of more than three hours, occurring more than three days per week, and continuing for longer than three weeks. "Infant colic" (or "colic") applies only to young infants, and does not include older babies and toddlers who may cry excessively.Thomas H. White 09:17, 20 April 2007 (CDT)