Question

A 2-month-old male infant is brought by his mother for his 2 month well baby assessment. He had a completely normal birth history and has been growing well. The mother nursed him for about 3 weeks and then switched to a cow milk based formula after she developed nipple soreness. He took the formula well but a week later became very fussy, crying nonstop for more than 3 hours a day, usually in the evening. He does this just about every day according to mom. The crying does not seem to be related to feedings, and there is no vomiting or diarrhea. He has not been sick or congested and has had normal stools and wet diapers. He does seem gassier during these crying episodes, and he is inconsolable despite holding and rocking. The mother also has 2 toddlers at home and is becoming very frustrated and anxious. His vitals on exam are normal, as is the rest of his physical examination.

What is most appropriate management for this infant?

1. Simethicone
2. Supportive measures
3. Hydrolyzed formula
4. Dicyclomine
5 Prone sleeping position

Answer 1

The most appropriate management for the infant with symptoms consistent with colic is supportive measures, including soothing strategies and caregiver support, rather than medication or changing the formula.

Step-by-step explanation:

The most appropriate management for this 2-month-old infant presenting with symptoms of excessive crying, inconsolability, and gassiness, without apparent illness, vomiting, or diarrhea, is likely option 2, supportive measures. This is because the infant's symptoms are consistent with colic, which is a common condition in infants characterized by periods of intense, unexplained fussiness and crying. Colic typically begins around two weeks of age and usually resolves by three to four months. Supportive measures can include methods such as changing holding positions, providing a soothing environment, gently rocking the baby, and ensuring the baby is adequately burped after feedings. Simethicone (option 1) is sometimes used for gassiness but has not been proven to be effective for colic. Hydrolyzed formula (option 3) is often used for infants with a suspected allergy to cow's milk protein; however, there is no indication of such an allergy based on the provided history. Dicyclomine (option 4) is contraindicated in infants under six months due to the risk of serious side effects. Prone sleeping (option 5) is not recommended as it increases the risk of sudden infant death syndrome (SIDS). It is important to provide reassurance to the caregiver and suggest strategies to help with stress, such as taking breaks and seeking support from family or friends.