Aetiology
The aetiology is not completely understood, but is likely to be multifactorial.
Food allergy
There is some evidence that cow's milk proteins play a role in the pathogenesis of infantile colic.[11][12]
Maternal ingestion of eggs, chocolate, citrus fruits, and certain seafood while breastfeeding may also result in infantile colic.[13]
Parental factors
Exposure to cigarette smoke (both during and after pregnancy) is associated with an increased risk of infantile colic.[14] The prevalence of colic is approximately doubled among infants of mothers who smoke.[14][15][16]
Breastfed infants are less likely to have infantile colic.[17][18]
There is an association between the incidence of infantile colic and psychological factors in the parents, such as stressful pregnancies, postpartum depression, parental anxiety, dissatisfaction with the sexual relationship, and negative experiences during childbirth, as well as poor parental skills.[5][19][20]
There is a correlation between infantile colic and increased parental age and higher level of parental education.[4] This may be due to an increased frequency of reporting or a lower level of tolerance of the symptoms of colic among such parents.[21]
Flatulence
Pathophysiology
Intestinal permeability to macromolecules is increased in some infants with colic; this reflects an immature function of the gastrointestinal tract and accounts for acquired food allergy.[23]
Infantile colic is associated with elevated motilin levels.[14][23] Motilin stimulates gastric and intestinal motility; high motilin levels may lead to intestinal spasm. Exposure to cigarette smoke is associated with increased plasma and intestinal motilin levels.[14]
There is evidence for decreased contractility of the gallbladder in colicky infants.[24] This hypocontractility may be due to a disturbance in cholecystokinin secretion.
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