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How do you determine if a baby has colic or is showing signs of gastrointestinal (GI) issues?

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Colic is something that occurs in infants under two months of age. It is comprised of fussiness and frequent crying all day long with difficulty in being consoled. The etiology is unclear; some people think that it is due to feeding problems since some babies have increased gas and stomach discomfort. Methods that help include walking with the baby, rocking the baby while walking, putting the baby in a swing, putting the car seat on the dryer while the dryer is going or taking the baby for a ride. It is a frustrating thing for parents since the baby will be fed, dry, not sleepy and still fuss. The good news is that it always resolves.

Many babies have mild gastroesophageal reflux. These are the babies, who after every meal will spit up a little bit. This is a normal baby phenomenon and occurs in over half of all babies. It is due to the valve between the esophagus and the stomach not being fully "mature" and tending to flop open especially when the stomach is full. Most babies grow out of this by 6 to 9 months. Sometimes it is so severe that they need to be put on medication temporarily. Many pediatricians will recommend thickening the feeds by putting lots of cereal in the bottle, and use positioning of the baby to help control the reflux (head elevated, lying on the stomach). But, if this does not work, they will try the medications. If they do not work, then a referral to a gastroenterologist would be indicated. If signs of reflux start after about 4 months, then it may not be the typical kind, and might need further workup. Most individuals with CdLS (over 90%) will have issues related to gastroesophageal reflux and/or reflux disease.

TK 7-13-10

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Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.

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