Approach
Infantile colic is a clinical diagnosis, and assessment should be directed at excluding alternate causes of distress. Fewer than 5% of distressed infants have identifiable medical conditions for their crying.[27] Investigations are not usually necessary.
History and risk factors
The history should document the age at the onset of symptoms, the patterns of crying, the parents' response to the infant's crying, the intensity of crying, and any alleviating or aggravating factors that are associated with the episodes.[21]
The way in which the child is fed should be elicited. The infant's position during feeding, the time taken to feed, and whether the infant is always burped after feeding should be determined. If the infant is bottle-fed, review the type of milk and nipple used. Information about the mother's diet is important if the infant is breastfed.
To rule out other diagnoses such as urinary tract infection or other infection, the infant's defecation, urination, and sleeping patterns should be evaluated for abnormalities; any history of recurrent fever, vomiting, or trauma should be noted.
Physical exam
Physical exam is important to exclude other possible causes of screaming and crying, such as otitis media, intussusception, fracture, corneal abrasion, incarcerated hernia, or anal fissure.[21]
Weight, height, and head circumference should be plotted on standard growth charts, because poor growth suggests the possibility of an underlying chronic systemic disorder.
Vital signs should be noted. Fever indicates an underlying infection. Urinary tract infection may be suspected when the infant has fever or malodorous urine and is not feeding well or not gaining weight.
Investigations
Investigations are not required for the diagnosis of colic, but if clinical findings suggest another cause, appropriate investigations may be indicated.[28]
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