Colic Syndrome

Colic is paroxysmal abdominal pain that generally occurs in infants under 3 months of age and is
marked by loud, intense crying (Shergill-Bonner, 2010). Infants pull their legs up against their
abdomen, their faces become red and flushed, their fists clench, and their abdomens become
tense. If offered a bottle, an infant with colic will suck vigorously for a few minutes as if starved
and then stop as another wave of intestinal pain occurs.

The cause of colic is unclear and probably results for several reasons. It may occur in susceptible
infants from overfeeding or from swallowing too much air while feeding. Formula-fed babies
tend to have more symptoms than breastfed babies, possibly because they swallow more air
while drinking or because formula is harder to digest. Although infants continue to thrive despite
colic, the condition should not be dismissed as unimportant. It is a distressing and frightening
problem for parents because their infant is not only in acute pain but also the distress persists
for hours, usually into the middle of the night, allowing no one in the family to get adequate
rest. This creates a difficult beginning to a parent–child relationship, which needs to be strong
and binding for parents to enjoy parenting and for an infant to thrive in their care. Take a
thorough history of an infant with signs of colic because an intestinal obstruction or infection can
mimic an attack of colic and be misinterpreted by the casual interviewer. With colic, symptoms
of abdominal pain typically last up to 3 hours a day and occur at least 3 days every week; bowel
movements are normal. Constipation; narrow, ribbonlike stools; and the presence of blood or
mucus suggest other problems. If the infant is bottle fed, ask about the type of formula used,
how it is prepared, and if parents hold the baby upright and burp the infant adequately after
feeding. For a breastfed baby, ask about the mother’s diet (Is she avoiding “gassy” food such as
cabbage?).

A number of interventions can be helpful to recommend to relieve colic symptoms. For example,
both breastfed and formula-fed infants may feel more comfortable with small, frequent feedings
to prevent distention and discomfort. Offering a pacifier can be comforting. Reducing stimuli,
taking infants for car rides, or playing a music box that simulates the sound of a heartbeat are
often reported as being helpful (Gahagan, 2011). Dietary changes have little effect, although
there is some evidence using hydrolyzed protein, probiotics or prebiotics, or a soy-based formula
for bottle-fed babies may be helpful (Iacovou, Ralston, Muir, et al., 2011; Thomas & Greer,
2010). Some parents try placing a hot water bottle on their infant’s stomach for comfort, but this
should be discouraged. A basic rule for any abdominal discomfort is to avoid heat in case
appendicitis is developing. This is highly unlikely in so young an infant, but parents will
remember they once used heat and may use it again when the child is older. Hot water bottles
and heating pads also might burn the delicate skin of infants. Caution parents to check with their
primary care provider before using herbs or home remedies such as star anise to be certain what
they have heard to be effective is 1759 safe for infants (Madden, Schmitz, & Fullerton, 2012).
They should use the same precaution for chiropractic or acupressure therapy. As a final
measure, it is important to think of colic as a family problem or else a vicious circle may
gradually begin. An infant cry and the parents may become tense and unsure of themselves. An
infant then senses the tension and develops more colic. Some parents benefit from planning
relief time from infant care to relieve their stress level and prevent this cycle.

In about 85% of infants, colic disappears almost magically at 3 months of age, probably because
it becomes easier to digest food and an infant maintains a more upright position by this time,
which allows less gas to form.

Colic = consists of recurrent paroxysmal bouts of abdominal pain and is fairly common in young
infants. Although many theories have been proposed, none has been accepted as the causative
factor.

Clinical Manifestations and Diagnosis

✓ Attacks occur suddenly, usually late in the day or evening.

✓ The infant cries loudly and continuously.

✓ The infant appears to be in considerable pain but otherwise seems healthy, breast-feeds or
takes formula well, and gains weight as expected.

✓ The baby may be momentarily soothed only by rocking or holding but eventually falls asleep,
exhausted from crying.

✓ The infant with colic is often considered a “difficult” baby.

✓ Differential diagnosis should be made to rule out an allergic reaction to milk or certain foods.

✓ Changing to a nonallergenic formula helps determine if there is an allergic factor or if the

infant has lactose intolerance.

✓ If the baby is breast-fed, the mother’s diet should be studied to determine if anything she is
eating might be affecting the baby.

✓ Intestinal obstruction or infection also must be ruled out.

Treatment and Nursing Care

✓ No single treatment is consistently successful.

✓ A number of measures may be employed, one or more of which might work.

✓ Medications such as sedatives, antispasmodics, and antiflatulents are sometimes prescribed,

but their effectiveness is inconsistent.

✓ The family must remember that the condition will pass, even though at the time it seems it
will last forever.

✓ The nurse can support the family and promote coping skills by providing Tips for Colic.
An Imperforate Anus
An imperforate anus (Fig. 27.14) is a stricture or the absence of the anus (Gourlay, 2013). In
week 7 of intrauterine life, the upper bowel elongates to pouch and combine with a pouch
invaginating from the perineum. These two sections of bowel meet, the membranes between
them are absorbed, and the bowel is then patent to the outside. If this motion toward each
other does not occur or if the membrane between the two surfaces does not dissolve, an
imperforate anus occurs. The disorder can be relatively minor, requiring just surgical incision of
the persistent membrane, or much more severe, involving sections of the bowel that are many
inches apart with no anus. There may be an accompanying fistula to the bladder in boys and to
the vagina in girls (retrovaginal fistula), further complicating a surgical repair. The problem
occurs in approximately 1 in 5,000 live births, more commonly in boys than in girls. It may occur
as an additional complication of spinal cord disorders because both the external anal canal and
the spinal cord arise from the same germ tissue layer. The lower bowel ends in a blind pouch.

Assessment

The condition may be detected by a prenatal sonogram. It is discovered at birth when inspection
of a newborn’s anal region reveals no anus, a membrane filled with black meconium protrudes
from the anus, or if it is impossible to insert a rubber catheter into the rectum. A “wink” reflex
(touching the skin near the rectum should make the anus contract) cannot be elicited if sensory
nerve endings in the rectum are not intact. Even with all these methods, some instances of the
stricture will not be detected at birth because the anus appears as usual, and the stricture exists
so far inside that it can’t be seen. By 24 hours, no stool will be passed, and abdominal distention
will become evident. An X-ray or sonogram will reveal the disorder if the infant is held in a
slightly head-down position to allow swallowed air to rise to the end of the blind pouch of the
bowel. This method is also helpful to estimate the distance the intestine is separated from the
perineum or the extent of the correction that will be necessary. Because newborns are
discharged at 2 or 3 days or even a few hours after birth, it’s important that follow-up care by
parents includes an assessment of whether the infant is defecating. If not, they may be asked to
collect a urine specimen so it can be examined for the presence of meconium to help determine
whether the infant has a rectal–bladder fistula. Placing a urine collector bag over the vagina in
girls may reveal a meconiumstained discharge or that a rectovaginal fistula is present.

Therapeutic Management

The degree of difficulty in repairing an imperforate anus depends on the extent of the problem.
If the rectum ends close to the perineum (at or below the level of the levator ani muscle) and
the anal sphincter is formed, repair involves simple laparoscopy with anastomosis of the
separated bowel segments (Nam, Kim, & Kim, 2016). A repair becomes complicated if the end of
the rectum is at a distance from the perineum (above the levator ani muscle), the anal sphincter
exists only in an underdeveloped form, or a fistula to the bladder or vagina is present. If the
repair is estimated to be extensive, the child may be given a temporary colostomy, and the final
repair performed when the infant is somewhat older (6 to 12 months).
VII – IMPERFORATE ANUS

Early in intrauterine life, the membrane between the rectum and the anus should be absorbed,
and a clear passage from the rectum to the anus should exist. If the membrane remains and
blocks the union between the rectum and the anus, an imperforate anus result. In a newborn
with imperforate anus, the rectal pouch ends blindly at a distance above the anus; there is no
anal orifice. A fistula may exist between the rectum and the vagina in females or between the
rectum and the urinary tract in males.

Clinical Presentation

 In some newborns, only a dimple indicates the site of the anus.

 When the initial rectal temperature is attempted, it is apparent that there is no anal
opening.
 However, a shallow opening may occur in the anus, with the rectum ending in a blind
pouch some distance higher. Thus, being able to pass a thermometer into the rectum
does not guarantee that the recto anal canal is normal.
 More reliable presumptive evidence is obtained by watching carefully for the first
meconium stool. If the newborn does not pass a stool within the first 24 hours, the
physician should be notified.
 Abdominal distention also occurs.
 Definitive diagnosis is made by radiographic studies.

Treatment

 If the rectal pouch is separated from the anus by only a thin membrane, the surgeon
may repair the defect from below.
 For a high defect, abdominoperineal resection is indicated. In these newborns, a
colostomy is performed, and extensive abdominoperineal resection is delayed until 3 to
5 months of age or later.

Nursing Care

 When the newborn goes home with a colostomy, the family must learn how to give
colostomy care.
 Teach caregivers to keep the area around the colostomy clean with soap and water and
to diaper the baby in the usual way.
 A protective ointment is useful to protect the skin around the colostomy