|Year : 2013 | Volume
| Issue : 2 | Page : 169-173
Mothers' perception and management of abdominal colic in infants in Enugu, Nigeria
JM Chinawa, AC Ubesie, GN Adimora, HA Obu, CB Eke
Department of Paediatrics, University of Nigeria Enugu Campus; University of Nigeria, Teaching Hospital Ituku-Ozalla, Enugu, Nigeria
|Date of Acceptance||09-Aug-2012|
|Date of Web Publication||6-Apr-2013|
J M Chinawa
Department of Pediatrics, University of Nigeria Enugu Campus; University Of Nigeria, Teaching Hospital Ituku-Ozalla, Enugu
| Abstract|| |
Background: Abdominal colic is common in infants but generally harmless. The exact aetiology is unknown but it has been associated with vicious cycle of crying and swallowing of air by the infant. The excessive crying associated with it can result in a lot of distress for family members creating unnecessary panics. We sought to find the perception and management of abdominal colic by mothers in Enugu.
Objective: Objective of this study is to determine the perception and 'home management' of abdominal colic in infants by mothers in Enugu, south-east Nigeria and the factors associated with them.
Materials and Methods: A cross-sectional survey involving 177 mothers that presented with their infants at the pediatric outpatient clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu between June and November 2011. A pretested questionnaire was used after obtaining their consent.
Results: A total of one hundred and seventy-seven mothers participated in this study. They were aged 20 to 60 years with mean age of 34 ± 7.3 years. Most of them (99.4%) believed that babies can have abdominal colic. While 41.3% attributed no problems to colic, the rest believed that it causes loose/greenish stools (12.4%), fever (16.4%) and vomiting (9.6%) etc. Most of the mothers (87.7%) do apply medications for colic which range from paracetamol (33.1%), Gbomoro (16.2%), teething powder (15.4%), salt water (13.2%), Buscopan (7.7%) and gripe water (4.6%).
Conclusions : Mothers attribute symptoms of childhood illnesses to abdominal colic. This may have led to unnecessary and sometimes harmful management. There is need for health education of mothers and potential mothers.
Keywords: Abdominal colics, enugu, infants
|How to cite this article:|
Chinawa J M, Ubesie A C, Adimora G N, Obu H A, Eke C B. Mothers' perception and management of abdominal colic in infants in Enugu, Nigeria. Niger J Clin Pract 2013;16:169-73
|How to cite this URL:|
Chinawa J M, Ubesie A C, Adimora G N, Obu H A, Eke C B. Mothers' perception and management of abdominal colic in infants in Enugu, Nigeria. Niger J Clin Pract [serial online] 2013 [cited 2014 Dec 22];16:169-73. Available from: http://www.njcponline.com/text.asp?2013/16/2/169/110135
| Introduction|| |
Infantile colic is a syndrome characterised by excessive, unexplained paroxysmal crying in an otherwise healthy baby. Colic is noted to occur in about 25 percent of babies.  It mainly manifests as an acute abdominal discomfort with intense spasmodic cramping, but since colicky babies cannot describe exactly what distresses them, it is hard for parents to know the precise cause of their distress. Infantile colic is most common in the first few weeks to four months of an infant's life.  Although many may experience this for a longer period. , A baby cries excessively if the baby does so for more than three or more hours per day, more than three times per week and more than three month period. ,,, The cry has been typically described as a high-pitched scream, occurring mainly in the late afternoon or evening but may occur at any time.  Cries arising from colic are very intense and hard. It is usually difficult to calm the baby down. The feet are curled; fingers clenched, and the abdominal muscles are tightened, which is what usually happens at the time of recurrence of colic.
Many theories have been suggested to explain this entity ranging from food hypersensitivity or allergy  and immaturity of gut function or gut dysmotility  to behavioural hypotheses including inadequate maternal- infant interaction and maternal anxiety.  Three main theories of single causes are also reviewed by Carey et al.;  they include feeding, psychosocial environment, and problems in the infant. However none of these are widely accepted. The role of gut microflora in the aetiopathogenesis of colic has been reported too.  The linking of colic to organic causes has changed its interventions which include the use of wider range of pharmacological agents such as antispasmodic.  , defoaming agents,  gut hormone antagonists and herbal medicines. Majority of Nigerians are known to use and consult traditional medicine for healthcare because of poverty and poor enlightenment. Based on this, herbal medicines are commonly used in childhood illnesses and even in managing colic.  The use of probiotics in the management of colic has been documented in some series. 
This study sorts to assess the perception and 'home management' of abdominal colic in infants by mothers in Enugu, south-east Nigeria and the factors associated with them.
To the best of our knowledge, there is a dearth of published work on this issue in the area and in Nigeria in general. It is hoped that this study may shed more light on mothers approach to abdominal colic and how best it can be handled.
| Materials and Methods|| |
The study was carried out at the Children's Outpatient (CHOP) of the Paediatrics Department of the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Nigeria. UNTH is a referral centre for various health centers in Enugu state and environs. The Paediatrics Department comprises the children's outpatient clinic (CHOP), the children emergency room (CHER), the general ward, and the new born special care unit (NBSCU).The children's outpatient clinic runs every weekday and averages of 480 patients are seen monthly.
A cross sectional survey of 177 mothers seen at the Pediatric Outpatient Clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu between June and November 2011, was done. All mothers attending the pediatric clinic of the hospital with their infants during the study period; and who met inclusion criteria were consecutively enrolled.
A structured self -administered questionnaire was used to collect information from the mothers attending the pediatric outpatient clinic of the hospital with their infants during the study period. In a few cases where the mothers were illiterate, the questionnaire was administered to them by the investigators.
Mothers whose infants are aged between 0 and 9 months and mothers whose informed consent were obtained are included in the study while mothers with severely ill infants were excluded.
Data was analyzed using SPSS version 19. An initial frequency count of all variables was done and represented in tables. The mean and ranges of all the variables were calculated. Chi-squared test was used to test for significant association of the categorical variable (mothers' age group) and being worried about abdominal colic in the infant. The Level of significance was set at P = 0.05 and 95% confidence interval reported where indicated.
Ethical clearance for the study was sought from the Ethics and Research Committee of the University of Nigeria Teaching Hospital. A written informed consent was sought from mothers or from caregivers.
Objective of this study is to determine the perception and 'home management' of abdominal colic in infants by mothers in Enugu, south-east Nigeria and the factors associated with them.
| Results|| |
One hundred and seventy seven mothers with mean age of 34 ± 7.3 years (range 20-60 years) were enrolled into this study. The age group of the mothers is shown in [Table 1].
One hundred and seven (60.5%) of the respondents had some form of tertiary education that ranges from ordinary national diploma, higher national diploma and first degree. The rest had senior secondary education (26%), post- graduate degree (5.1%), primary education (4.5%) and no formal education (1.1%) while (2.8%) gave no response. The main occupation engaged by these mothers was civil service (30%), trading (21.1%), schooling or unemployed (16.5%), health care providers (10%) and teaching (9.4%). A minority were bankers, hair dressers, architects, lawyers and clergy. The mean number of children per mother was 3 ± 1.7 and the mean age of the last child per mother was 3 ± 2.2 years.
Perception of abdominal colic
Almost all the participants (99.4%) believed that young infants do experience abdominal colic at some point in their lives. Most of them (91.6%) believed that colic occur between 0 and 3 months. Eighty-five respondents (48%) believed that colic occur at nights while 17.5%, 7.3%, 5.6% and 4.5% thought it occurs every time, afternoons, evenings and mornings respectively. The rest did not know the exact timing of colic. One hundred and fourteen (83.2%) of the 137 respondents were worried about abdominal colic in their infants, Younger mothers appear to worry more about abdominal colic in infants than older mothers although this difference was not statistically significant (P = 0. 21) as shown in [Table 2].
|Table 2: Relationship between maternal age and frequency of worrying about colic's |
Click here to view
Seventy-three mothers (41.3%) did not think that abdominal colic's are associated with other medical problems. However, 16.4%, 14.7% and 12.4% thought abdominal colic in infants are associated with fever, diarrhea and greenish stools respectively as shown in [Table 3]. Aetiologically, eighty respondents (45.2%) said they don't know the cause of colic in infants; 20.3% thought it is due to malaria while 11.3% believed it is a normal physiological process.
Management of abdominal colic
One hundred and forty seven (73.1%) respondents had used some form of medications to treat colic at some point while 30 (17%) do not use medications at all. Among those that use medications, the most commonly used substances were Paracetamol 43 (24.3%), "gbomoro" 21 (11.9%), teething powder 20 (11.3%), salt water 16 (9.0%), buscopan 10 (5.6%), gripe water 6 (3.4%) [Table 4].
|Table 4: The various substances used in managing abdominal colic's by mothers |
Click here to view
| Discussion|| |
Infantile colic is a challenging disturbance with a high occurrence reported worldwide.  In this study 99.4 % of the mothers admitted that their infants have colic. This is similar to 82.7% noted by Kazeem et al.  High level of education of the mothers(as shown in our study, where half the mothers attended tertiary institution) may explain why they are able to identify this colic without attributing it to other disease. It is noted, from this study, that majority of the mothers believe that colic occur at night than day time. It is important to note that some of these mothers are working class mothers and self-employed who normally keep their babies with house helps or in day care centers, only to pick them in the evening, and thus could not give appropriate account of what happen to their children.  Colic in babies could occur at any time of the day, though some study noted that it is common at evening time. 
Most of the mothers in our study, believed that colic occur between 0 and 3 months. This is similar to one study where it was noted to occur from first week of life and ends at about the age of four months. , From this present study, younger mothers worry more about colic than older ones. Successful management of colic by these older mothers in their previous infants with colic, have given them the knowledge and mastery on colic, thus reducing fears and worries. 
Some caregivers believe that colic are associated with other symptom such as diarrhea, fever and vomiting. These symptoms are not associated with colic and could be attributed to other diseases like malaria, gastroenteritis and even sepsis. These assertions could make them to mistake these symptoms as normal and delay taking their babies to the hospital. This could lead to increase mortality and morbidity.  On the other hand a good number of parents do not think abdominal colic's are associated with other medical problems. This shows that a significant proportion of these mothers are enlightened on colic, however majority of them are older mothers who had had experience on this event. In the light of this, health education about colic in babies during ante-natal visits and vaccination clinics should be encouraged to help enlighten the care givers about this condition.
Home base management of colic was commonly practiced by mothers. Many of the care givers gave paracetamol to their babies. The reason for this is that it gives the caregivers the feeling of 'Doing something'. They also believe that paracetamol makes the child to rest and sleep and enables the families have peace. 
Buscopan a homatroprine methylbromide (an anticholinergic) was prescribed to 7.7% of infants in this study. The use of anticholinergics for infantile colic has been reported.  Evidence-based medicine has however shown a clear benefit of these drugs in the treatment of excessive crying in infants.  The reported side effects in infants are of great concern  which may limit their use.
The use of herbal concoctions in management of childhood illnesses have been reported both in developed and developing countries.  However the one commonly used by caregivers in this study is 'Gbomoro'. This is an herbal medication which contains mainly chloroquine, lactose and ascorbic acid. , It has been hypothesized that when given to infants with colic, it relieves them of pain. Pharmacological and toxicological studies are necessary so as to determine the safety of this herbal medication in infants.
Gripe water has been in use for treating colic over a century with little or no response.  This may explain the 4.6% of mothers that were involved in its self-medication. It has been stipulated that the alcohol content of gripe water provides a soothing effect,  the bicarbonate provides a neutralizing effect to the gastric acid,  and the carminative in the plant extract causes the soothing of the infant in the presence of excess gas in the lumen that may cause pain.  These treatments are however not entirely harmless,  therefore proper dose has to be scientifically determined. Though majority of mothers did not attribute colic to any disease, yet a good number of them used something to treat abdominal colic. This is not surprising as no caregiver worth his salt will sit put and watch his child in pain and/or discomfort without doing anything.  The use of native concoctions for infants with colic may be viewed as a common practice among mothers of different culture and tribes in Nigeria but the types of herbal medicine used may likely differ. For instance "Ororo Ogiri" was the mostly used herbal medicine in a particular study.  It is derived from putrefied Cucumeropsis mannii (melon) seeds which are used as a local food seasoning amongst the Yoruba tribe in Nigeria. When dissolved in water and taken by adults, it relieves indigestion by causing excessive flatulence.  Its use in the treatment of infantile colic was based on the hypothesis that it removes the excess intraluminal gas in the infant by causing flatulence. Hepatic encephalopathy and death from the use of herbal preparations (Allium sativum L. and Allium asalonicum L) containing naphthalene tablets has been reported by some workers.  There are other documented harmful effects of this herbal preparations.
Kazeem and colleagues  noted that laying the infant on the abdomen, early response to the child while crying, giving the infant a gentle soothing motion and avoidance of over-stimulation are acceptable psychosocial methods of managing infantile colic. They also stipulated that, applying hot water bottle to the abdomen of the infant has been reported to relieve rectal spasm to aid easier passage of flatus.  Although parents must be cautioned about the use of this method as they stand the risk of causing burn to the infants' abdomen.
Although colic is not detrimental to an infant's health, it can place tremendous stress on the family. No effective cure for this disorder is known. Researchers have investigated a wide variety of therapies, including formula changes; pharmacotherapy and infant positioning maneuvers, but study results have been conflicting, controversial and inconclusive.  At present, behavioral management, supportive counseling and parental reassurance are the mainstays of treatment. By formulating an effective individualized management plan, the family physician can help assist parents through the trying period of infantile colic. 
| Conclusion|| |
Mothers attribute symptoms of childhood illnesses to abdominal colic. This may have led to unnecessary and sometimes harmful management. Health education about colic at children outpatient, vaccination clinics and public health campaign are warranted. Efficacy, potency, dosage and toxicity of the traditional herbal medicines need to be established scientifically before they are used in infants.
Infantile colic is not harmful, unnecessary and sometimes harmful management should be avoided. Health education about colic is warranted.
This is a hospital based study and so may not show all the details on this topic, a community based study will improve this work.
| Acknowledgments|| |
We are grateful to all the doctors and nurses that work at the children outpatient clinic for their co-operation. Our gratitude also extends to the care givers and patients who were very cooperative.
Finally we thank the almighty God whose assistance and ideas through the course of this work is priceless
| References|| |
|1.||Balon AJ. Management of infantile colic. Am Fam Physician 1997;55 : 235-42. |
|2.||Lucassen PL, Assendelft WJ, Gubbels JW, van Eijk JT, van Geldrop WJ, Neven AK. Effectiveness of treatments for infantile colic: Systematic review. BMJ 1998;316 : 1563-9. |
|3.||Savino F. Focus on infantile colic. Acta Paediatr 2007;96 : 1259-64. |
|4.||Barr RG. Colic and crying syndromes in infants. Pediatrics 1991;84:450-55. |
|5.||Leung AK, Lemay JF. Infantile colic: A review. J R Soc Promot Health 2004;124 : 162-6. |
|6.||Asnes RS, Mones RL. Infantile colia: A Review. J Dev Behav Pediatr 1983;4:57- 62. |
|7.||Carey WB. Colic-primary excessive crying as an infant-environment interaction. Pediatr Clin North Am 1984;31:993-1005. |
|8.||Lehtonen L, Korvenranta H, Eerola. Intestinal microflora in colicky infants: Bacterial cultures and gas-liquid chromatography. J Pediatr Gastroenterol Nutr 1994;19:310-4. |
|9.||Savino F, Brondello C, Cresi F, Oggero R, Silvestro L. Cimetropium bromide in the treatment of crisis in infant colic. J Pediatr Gastroenterol Nutr 2002;34:417-19. |
|10.||Oshikoya KA, Njokanma OF, Bello JA, Ayorinde EO. The use of prescribed and non-prescribed drugs in infants in Lagos, Nigeria . J Med Sci 2008;8:111-7. |
|11.||Garrison MM, Christakis DA. Early childhood: Colic, child development, and poisoning prevention. A systematic review of treatments for infant colic. Paediatrics 2000;106:184-90. |
|12.||Kazeem AO , Idowu OS, Njokanma. Self Medication for infants with colic in lagos, Nigeria. BMC Pediatr 2009;9:9. |
|13.||Poudel KC, Nakahara S, Okumura J, Wakai S. Day care Supplementary feeding effects on child nutrition in urban slump areas of Nepal. J Trop Pediatr 2004;50:116-9. |
|14.||Becker N, Lombardi P, Sidoti E, Katkin LS. Mylicon drops in the treatment of infant colic. Clin Ther 1998;10 : 401-5. |
|15.||Campbell HD, Sow SO, Levine MM, Kotloff KL.The causes of hospital admission and death among children in Bamako, Mali. J Trop Pediatr 2004;50:158-63. |
|16.||Obu HA, Chinawa JM, Ubesie AC, Eke CB, Ndu IK. Paracetamol use (and/or misuse) in children in Enugu, South-East, Nigeria. BMC Pediatr 2012;12:103. |
|17.||Colon AR, Dipalma JS. Colic . Am Fam Physician 1989;40 : 122-4. |
|18.||Roberts DM, Ostapchuk M, O'brien JG. Infantile colic. Am Fam Physician 2004;70:735-40. |
|19.||The content of gbomoro. Available from: http://www.springerimages.com/image/medic. [Last Accesses on 2012 March 21]. |
|20.||Weizman Z, Alkrinawi S, Goldfarb D, Bitran C. Efficacy of herbal tea preparation in infant colic. J Pediatr 1993;122:650-52. |
|21.||Oshikoya KA, Njokanma OF, Chukwura HA, Ojo OI. Adverse drug reactions in Nigerian children . Paed Perinat Drug Ther 2007;8 : 81-8. |
|22.||Physicians' Desk Reference 50 th ed. Montvale, NJ: Medical Economics Company; 1996. p. 1501-2. |
|23.||Blumenthal I. The gripe water story. J R Soc Med 2000;93 : 172-4. |
|24.||Illingworth RS. Infantile colic revisited . Arch Dis Child 1985;60 : 981-5. |
|25.||Alexandrovich I, Rakovitskaya O, Kolmo E, Sidorova T, Shushunov S. The effect of fennel (Foeniculum vulgare) seed oil emulsion in infant colic: A randomised, placebo controlled study. Altern Ther Health Med 2003;9 : 58- 61. |
|26.||The 7.30 Report. Australian Broadcasting Cooperation.TV Program transcript. Available from: http://www.abc.net.au/7.30/content/2002/5719324.htm. [Last accessed on 2012 Jun 20]. |
|27.||Gurry D. Infantile colic. Aust Fam Physician 1994;23:337-40. |
[Table 1], [Table 2], [Table 3], [Table 4]