Paediatrics

Intestinal Colic in Infants (with GER and Gastrocolic Reflux)

بچوں کے پیٹ کا درد

Excessive crying in an infant. Rule out encephalitis first: fever, refusal to feed and a bulging fontanelle point to encephalitis; no fever, taking orally and a depressed fontanelle point to colic.

ICD-10: —
Source: OPD handbook pp.196–198
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Excessive cry

Red flags Refer urgently if any are present

Fever → may be encephalitis
Not taking orally → may be encephalitis
Bulging fontanelle → encephalitis

Diagnosis

Differential diagnosis: encephalitis
Fever: yes → may be encephalitis; no → colic
Taking orally: no → may be encephalitis; yes → colic
Fontanelle: bulging → encephalitis; depressed → colic

Treatment

Step 1 of 5

1. Reassurance (Urdu note)

There is no worrying matter; the child's intestines and stomach are weak, so there is pain in the abdomen; after milk the child may burp, or pass stool or flatus
GER = milk coming back (vomiting/burping); gastrocolic reflux = passing stool after milk; intestinal colic: same management

Step 2 of 5

2. Counselling (Urdu notes)

Feed milk every 3 hours; keep the bottle and utensils clean
Feed well for 15–20 minutes each time
After feeding, hold the baby on the shoulder and pat the back until the baby burps
Keep the child's head raised while feeding
Half an hour after feeding, do a gentle massage: move the legs and rub the abdomen with the hands for 10–15 minutes

Step 3 of 5

3. Specific medication: intestinal colic

Antispasmodic: Digas colic drops, 4+4+4+4 drops, 10 minutes before milk
Alternate: Spasler-P drops (hyoscine), 4+4+4+4 drops as needed

Prescription

Digas colic drops (generic not written in the book)Antispasmodic / antiflatulent drops (infant colic)

Dose4+4+4+4 drops, 10 minutes before feeding

Brand Digas colic drops

Hyoscine dropsAntispasmodic (infant colic)

Dose4+4+4+4 drops as needed

Brand Spasler-P drops

Step 4 of 5

4. Gastro-oesophageal reflux (GER)

Give a burp after milk (take milk out)

Prescription

DomperidoneProkinetic / antiemetic

Dose½ teaspoon as needed (SOS)

Brand Syp Motilium 1 mg/mL

Also sold as Stomacol, Motilium, Peridone

Step 5 of 5

5. Gastrocolic reflux

Can add zinc: Syp Zincat-OD 20 mg/5 mL, 1 teaspoon once daily for 14 days (as read)

Prescription

Zinc sulfateMicronutrient

Dose1 tsf

Brand Syp Zincat-OD 20 mg/5 mL 14 days

Zinc dispersible tablets are part of the national diarrhoea management protocol.