Rome IV Diagnostic Criteria for Infant Colic
Official Rome IV criteria for the diagnosis of infant colic.
Use in infants < 5 months with symptoms of infant colic such as recurrent and prolonged, unsoothable episodes of crying, fussing, or irritability that occur without obvious cause.
Patients with any of the following alarm features must be evaluated clinically for other anatomic, metabolic, infectious, neurological, or behavioral conditions:
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Extreme or high-pitched cry.
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Symptoms after 4 months of age.
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Failure to thrive.
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Developmental delays.
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Maternal drug use.
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Fever or illness.
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Parental anxiety or maternal depression.
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Abnormal physical examination.
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Bloody stools.
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Vomiting.
If diagnosis not met (negative):
Current symptoms are unlikely to be related to infant colic. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above.
If meets diagnosis (positive):
Likely diagnosis of infant colic. Provide reassurance.
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Parental reassurance and support is the most important intervention as symptoms related to infant colic are very distressing to the family.
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Suggest soothing behaviors such as carrying and rocking the baby, swaddling, placing the baby in a swing, and/or use of “white noise”.
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There is some evidence that elimination of cow milk protein may be beneficial and a short-term trial can be considered (switching to a hydrolyzed formula in a formula-fed baby or maternal dairy restriction in the case of breast-fed babies).
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Probiotics or herbal interventions are commonly used, despite lack of evidence supporting their benefit.
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It is important to discuss coping mechanisms and inquire if parents have additional support at home so they have times to safely step away from the crying baby and “recharge”. In rare cases, admission to the hospital is necessary to provide relief for the parents.
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Treatment for reflux in the form of PPI or H2 receptor antagonists is not effective and should be avoided.
This calculator should only be used in infants who do not have signs or symptoms suggestive of an anatomical, metabolic, infectious, neurologic or behavioral cause of their symptoms based on a detailed clinical history and physical exam.