ACUTE INFANTILE COLIC AND ITS HOMOEOPATHIC APPROACH

Abstract: Infantile colic is a common cause of maternal distress and family           disturbance, the cause remains unclear and the prevalent treatment is not assurable. This article is an attempt to explore its aetiology, symptoms, diagnosis, management and homoeopathic approach in cases of colic in infants.
Introduction:
From the beginning of the life on the earth and with the changing civilization human beings are very much prone to the environmental changes and infectious diseases. Among them the infants are the most vulnerable victims. As the immunity of the infants are not properly developed in their early life, they are very much susceptible to the unhygienic conditions, environmental changes and infectious diseases. Among many acute clinical conditions, colic in infants is one of the common reasons parents seek medical advice for their baby in his first 3–4 months of life and attend our clinics.  A baby is unable to explain its problem which makes the diagnosis of this disease a difficult task.
The term colic derives from the Greek word kolikos or kolon, for intestine (sharing the same root as the word “colon”).
Definition:
Infantile colic is a behavioral syndrome characterized by paroxysms of excessive crying in an otherwise healthy baby lasting more than 3 hours per day, occurring > 3 days in any week for 3 weeks, aged 2 weeks to 4 months. By contrast, infants normally cry an average of just over two hours a day, with the duration peaking at six weeks. It is quite characteristic, a baby who has colic often cries about the same time every day, usually in the late afternoon or evening.
Epidemiology:
Internationally Colic affects 10-30% of infants worldwide. This condition is encountered in male and female neonates and infants with equal frequency. The colic syndrome is commonly observed in neonates and infants aged 2 weeks to 4 months. The incidence of colic in breastfed and bottle-fed infants is similar with no difference.
Aetiology: The cause of infantile colic remains unclear. Though the cause of colic in infants can be classified as:

• Internal cause:

1. Fundamental cause:

According to homoeopathic philosophy the real cause of the disease condition is miasmatic in origin. Hahnemann’s wisdom and foresight in recognizing the fact that the disease lied not in the pathology alone; it is not a first cause in any case. There is something deeper down in each case. Pathology may be a death process, but it was first a perverted life process, first a perverted physiology, a perverted function and function change preceded, and do precede, all pathology. So pathology is secondary and primary factor is fundamental cause.
View of stalwart regarding miasm of infantile colic:
According to Phyllis Speight: Children born of sycotic parents often suffer from colic almost from the moment of birth; not the ordinary flatulent colic but one of the severe and specific nature continuing often from one to three months after birth.
An individual suffers from disease according to the trend of the dominating miasm. So, the characters of actual constitution, the history of past illness and influences of the environment gives the miasmatic diagnosis to a particular patient, who is suffering from a disease. individualization is very essential procedure for curative treatment in infantile colic. This individualization is nothing but peculiar individual reaction of the infant under dominating miasmatic influence in diseased condition.

1. Predisposing factors or Accessory Circumstances:

Predisposing factors are considered for development of a disease in a susceptible constitution provided that fundamental cause is present before hand in that constitution.
Organic causes account for less than 5 percent of infants presenting with excessive crying. Gastrointestinal, psychosocial, and neurodevelopmental disorders have been suggested as the cause of colic.
Organic causes:

• These includes CNS causes like infantile migraine and subdural haematoma,
• GIT causes include Constipation , Cow’s milk protein intolerance, Gastro esophageal reflux , Lactose intolerance, Intussusception, Rectal fissure, Strangulated inguinal hernia.
• Infections like Meningitis, Otitis media, Urinary tract infection and viral illness can also mimic colic.
• Trauma has to be excluded in a colicky baby namely child abuse or shaken baby syndrome. Corneal abrasions, Foreign body in the eye, Fractured bone and Hair tourniquet syndrome are the other causes of trauma which should be excluded.

 

• External cause:

1. Exciting cause: According to homoeopathy exciting cause is the cause which excites the latent miasm, to produce disease state. In infantile colic exciting cause are the triggering factors (Child abuse, Cow’s milk protein intolerance etc) which make the susceptible host to suffer from colic.
2. Maintaining cause: If manifest exciting cause is unremoved that is continuous exposure of trigger factors is act as maintaining cause of colic in infants.

Symptoms:

• Crying most commonly happen in the evening and for no obvious reason.
• Associated symptoms may include legs pulled up to the stomach, a flushed face, clenched hands, and a wrinkled brow.
• The cry is often high pitched (piercing).

There are some clinical conditions which needs special attention.
 Causes for concern include:

• An elevated temperature,
• A history of breathing problems or
• A child who is not appropriately gaining weight.

“Red flag” indicating that further investigations may be needed include:

• Vomiting (vomit that is green or yellow, bloody or occurring more than 5/day)
• Change in stool (constipation or diarrhea, especially with blood or mucous)
• Abnormal temperature (a rectal temperature less than 97.0 °F (36.1 °C) or over 100.4 °F (38.0 °C)
• Irritability (crying all day with few calm periods in between)
• Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over 6 hours)
• Poor weight gain (gaining less than 15 grams a day)

Diagnosis: Babies who cry may simply be hungry, uncomfortable, or ill. Colic is diagnosed after other potential causes of crying are excluded. This can typically be done via a history and physical exam, and in most cases tests such as X-rays or blood tests are not needed.
Management:
Rhythmic calming techniques are effective in calming colicky babies which forms the core of the 5 Ss approach. When the “5 S’s” are done correctly and in combination, they offer significant potential to promptly reducing infant crying and promote sleep.

1. Swaddling, safe swaddling carefully avoiding overheating, covering the head, using bulky or loose blankets, and allowing the hips to be flexed.
2. Side or stomach (holding a baby on the back is the only safe position for sleep, but it is the worst position for calming a fussy baby).
3. Shhh sound (making a strong shush sound near the baby’s ear.
4. Swinging the baby with tiny jiggly movements (no more than 1″ back and forth) always supporting the head and neck.
5. Sucking (Letting the baby suckle on the breast, your clean finger or a pacifier).

There is no specific evidence for restricting certain foods or changing over to certain foods. However, some infants benefit from modifications in the diet:

• Change from one cow’s milk formula to another
• Change from a cow’s milk formula to a soy formula
• Change from a regular formula to a “pre-digested,” hypoallergenic formula
• If you’re breastfeeding, avoid eating certain foods such as caffeine, excessive use of milk products, certain vegetables like cabbage, broccoli, cauliflower; nuts, too much animal protein and taking herbal supplements
• If breastfeeding, nurse whenever your baby seems hungry, usually every 2 – 3 hours. Elevate your infant’s head during and after feedings
• If bottle-feeding, ask your baby’s paediatrician to recommend a formula that is not based on cow’s milk and that is not iron-fortified
• Keep the baby in a sitting position when feeding, and massage her back to get rid of gas bubbles. Burp after every ounce or two of milk
• Try the “colic carry” — Place your baby, chest down, on your extended forearm, with his head supported by your hand and his legs on either side of your elbow. Use your other hand to provide additional support and walk around with the baby
• If bottle feeding, try to limit milk intake, and if that doesn’t work, avoid limiting milk intake
• If your baby is spitting up, keep him upright after he feeds

 Homoeopathic approach:
Homoeopathy is the only mode of treatment in which each and every case should be individualized and treated accordingly. The application of our remedies will not only aid to treat pain but also correction of the soil i.e. maism and individual susceptibility to that particular disease.
 Paediatric Case taking:
In the case of diseases belong to infancy, we mostly depend upon objective symptoms. As infants are incapable of explaining their sensations in speech, without the objective symptoms we are unable to prescribe with any degree of accuracy. Objective symptom can provide various indications if interpreted correctly to prescribe similimum.
The following hints during history taking may help him to build a totality in order to make a suitable prescription:

• Baby’s posture during pain e.g. Doubling up, lying on painful or painless side, stretching out, etc.
• Factors which bring about relief e.g. Carrying, rocking, applying pressure, rubbing, massaging
• When is the colic worst, like morning, night, before eating, after eating, before sleep, during sleep, before stool, during or after stool
• Other aggravating factors like motion, jar, movement
• Emotional factors that help to either pacify or aggravate the baby like: carrying, rocking, holding, touching, company, etc.
• Stool – colour, consistency, odour, constipation, diarrhoea
• Abdomen – distension, firm, hard, soft, noises from abdomen like gurgling
• Appetite
• Kind of cry – whining, moaning, high pitched, low pitched, screaming, howling etc.
• Mother’s emotional status – angry, disturbed, anxious, fearful, depressed etc.

Repertorial approach in case of colic in infants:
On the basis of observation made during case taking there are many rubrics which covers the symptoms  and related to the conditions or suffering during the colic in infants. Nearly every repertory represents the rubric of different abdominal complain but there are a very few repertory which contents the rubric i.e; colic in infant. Those  are as follows:
In Robin murphy’s repertory:
COLIC, infants,(see intestines cramping)- aeth; bell; calc-p; carb-ac; carb-v; CHAM; chin; cina; coloc; dios; ign; kali-br; lyc; mag-c; MAG-P; NUX-V; staph.
anger, mother or nurse, from- calc-p; cham; staph.
constipation, with, caused by stimulating food taken by mother or nurse, much flatus- nux-v.
flatulent, with drawing up of legs- MAG-P.
grief, after taking breast of mother who suffers from- ign.
griping, with constipation in- nux-v; OP.
    indisposition, of nurse, from- cham; staph.
legs, drawing up- cham; coloc.
periodic, 5 p.m.- kali-br.
In Knerr repertory:
Infants, colic: I Carbol.ac; II Cham; I Coloc; with constipation caused by stimulating food taken by mother or nurse, much flatus, I Nux-v.; flatulent, with drawing up of legs, II Magn.p.; after taking breast of mother who suffers from grief, I Ign,; griping, with constipation in, I Nux v; II Op.; from indisposition of nurse, I Staph.; drawing up legs, I Cham; I Coloc.; periodic, 5 P.M; I Kali br.
In Boericke’s repertory: In the chapter abdomen
Babies’ colic– Aeth.; Asaf.; Bell.; Calc.p.; Cataria.; Cepa.; Cham.; Cina.; Col.; Illic.; Jal.; Lali br.; lyc.; Mag.p.; Mentha pip.; Nepeta.; Rheum.; Senna.; Staph.
In BBCR:  In  the chapter sensations and complaints in general under the rubric
Infants, affections of, abdominal:
        gastric:
According to homoeopathic principle a medicine have been prescribed on the basis of the individual/peculiar/uncommon/characteristic symptoms ( § 153- 5^th edn of Organon of medicine) and not on the nosological name of the disease. Now a days few physician named certain diseases with certain miasm which is nothing but a gross mistake. It is the symptoms which reflect the predominanting miasm. Hence each and every cases should be individualized and then particular symptoms are considered. Few medicines which can be considered in colic in infants as a constitutional medicines are following. 
BELLADONNA:
There is a sudden onset of intense, spasmodic pains. The pains come and go suddenly. Any jar, motion, movement, light, touch may bring on the pain. There is flushing of face with colic. Bending forward, lying on abdomen and pressure relieve the pains.
BRYONIA ALBA:
Pains are worse from the least movement, motion and jar. Pains are better from rest and by pressure. The infant may want to lie on the painful side and may feel better by pressing the abdomen, by lying still with legs drawn up. The baby is very irritable and prefers to lie alone in a cool, quiet and dark room without being disturbed.
CATARIA NEPETA:
In this remedy there is severe colic compelling the baby to flex its thighs. There is twisting of the body during colic. The child cries and whines.
CHAMOMILL:
A Chamomilla baby is irritable to the highest degree, appears angry and distressed, screams, howls and whines. Violent with pains, he may kick the mother. These babies are extremely oversensitive to light, noise, touch. He is better by being held and being rocked about slowly and by warm application. 
 
COLOCYNTH:
Colocynth babies are very irritable and restless. They feel better by applying firm pressure to the abdomen, by laying them over the knee or shoulder. The pain is also better by passing flatus. The baby feels better by doubling up, i.e. folding the legs up to the chest. Pains may occur after a fit of anger in the nursing mother.
JALAPA:
The baby is good the entire day, but screams and tosses about all night. The infant is very restless and troublesome. Lots of flatulence and the abdomen is distended. Colic may be accompanied by thin, muddy stools. There may be coldness of face during colic.
LYCOPODIUM:
Lycopodium babies suffer from flatulent colic. There’s excessive accumulation of gas and the baby is seen to be either burping or passing flatus. There is much rumbling in the abdomen. The colic may take place between 4 p.m. – 8 p.m. Lycopodium babies are irritable and cross. Their abdomen may be distended and firm to touch, due to accumulation of gases. They cannot bear pressure on the abdomen and so they want their diaper to be tied loosely. Baby may be better by lying on their right side. 
MAGNESIA PHOSPHORICA:
The spasmodic pains are relieved by gentle pressure like rubbing the tummy gently or by bending double. The pain is also better by warmth applied to the abdomen. 
NUX VOMICA:
There is flatulent distension, with spasmodic colic in infants. Colic from uncovering. Colic, with drawing up legs. Ineffectual urging to stool.
 RHEUM :
Rheum is frequently used in children during difficult dentition . Whole  child smells sour. Every discharges are sour. Colic with much screaming. The child is weepy and very restless. Excessive salivation accompanies the colic. Colic is better by doubling up and the child is seen to be drawing the legs up. The pain is worse from uncovering any part of the body, motion, feeding, before and during stools. The colic is better by warmth and wrapping up the child.
SENNA:
It is very useful for flatulent colic when the baby is full of wind. The baby is constipated which leads to colic and much flatulence.
Conclusion:
Infantile colic is a common cause of maternal distress and family disturbance, the cause remains unclear, the cornerstone of management remains reassurance of parents regarding the benign and self-limiting nature of the illness as most of the babies grow out of it by the age of 3–4 months. Investigations are rarely required. It has been a very brief narration and presentation of few of the  remedies. Attempt  has been made to make the discussion precise and limiting it only to the use of individual medicine in clinic. There are many other remedies which should be used on the  basis of their characteristic symptoms. Though treatment of colic in infants is not a big challenge for homoeopathy too, but with the help of above described medicines, this can be treated successfully. Testimony in the clinic is the evidence.
Bibliography:

• Boericke W. Boericke’s New Manual of Homoeopathic Materia Medica with Repertory. Third revised and augmented edition based on ninth edition. B. Jain Publishers. New Delhi.
• C.M. Boenninghausen’s characteristics and repertory. B. Jain publishers. New Delhi. 1936.
• Foubister DM. Homoeopathic paediatric case taking in acute disease. The british homoeopathic journal. Vol.LI.No.3. July 1962.
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• http://www.ijponline.net/content/38/1/34 retrieved on 30/07/2015.
• http://www.ijponline.net/content/40/1/9 retrieved on 30/07/2015.
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• Knerr Calvin B. Repertory of hering’s guiding symptoms of our material medica. Jain publishing co. New Delhi. 1980.
• Murphy Robin. Homoeopathic medical repertory. 3^rd Indian edn. B. Jain publishers (Pvt) Ltd. New Delhi. 2006.
• Speight Phyllis, A comparison of the chronic miasms, B. Jain publishers(Pvt).Ltd, New Delhi.

Authors: 

Dr Swapan Paul
Dr Saima Shamim