watercress words by Dr Aletha

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Infantile colic, another medical mystery, baffles parents and doctors. Unlike renal (kidney) colic due to a stone, we don’t know what causes colic in babies. But whatever the cause, it frustrates and tires parents of affected infants.

Colic is defined as “paroxysms of inconsolable crying”. Since there are many reasons babies cry, ranging from wet diapers to hunger to serious illness, doctors have established specific diagnostic criteria for colic, since there is no diagnostic test for it.

Doctors consider the crying diagnostic of colic if it occurs

3 hours per day
More than 3 days per week
Longer than 3 weeks.

Possible causes for colic include

Changes in gut bacteria
Intolerance to cow’s milk protein or lactose
Gut inflammation
Poor feeding technique
Maternal smoking or other nicotine use

The episodes typically resolve by 3 to 6 months of age.No long term consequences result from colic, but parents and babies both need relief from the distress it causes.

Three strategies seem to be most helpful.

For breast fed infants,

Mother can try a low-allergen diet. This means restricting intake of cow’s milk, eggs, peanuts, tree nuts, wheat, soy and fish.

fried eggs on toast

Another alternative is the probiotic Lactobacillus reuteri (strain DSM 17938). Unfortunately in bottle fed babies, this seems to make colic worse.

So for bottle-fed infants, changing to a hydrolyzed formula, such as Gentlease, Nutramigen, Pregestimil, or Neocate is suggested. .

No smoking sign — Maternal smoking may be a cause of infant colic

Here are some other suggestions from Family Doctor.org .

As always, the best source of advice is your baby’s own physician, so talk first before making any changes.

You may have heard that the American Cancer Society (ACS) has published new guidelines on breast cancer screening. The last guidelines are 12 years old so it is time for an update based on current understanding of the value versus the risk of breast cancer screening.

According to the report published in JAMA, screening mammograms can reduce deaths from breast cancer. Breast exams done routinely do not decrease mortality.

These guidelines apply only to women at average risk of breast cancer, which is most women.

They are not used for high risk women- women with

a history of previous breast cancer
a suspected or confirmed genetic mutation known to increase breast cancer risk
a history of radiation to the chest
a close family history of breast history, usually meaning parent, sibling, grandparent, aunt/uncle, or cousin.

Screening guidelines also do not apply to women with breast symptoms suggestive of cancer.These women need appropriate diagnostic testing which might include mammography, ultrasound, MRI, and/or biopsy.

woman having a mammogram — photo from Medline, National Library of Medicine

In summary, here are the new guidelines from the ACS-

Offer annual screening to women age 40 to 44 years.
Perform a mammogram annually in women 45 to 54 years.
Perform a mammogram annually or every other year starting at age 55 years.
Continue screen mammography as long as a woman’s overall health is good, with a life expectancy of 10 years or longer.
Routine breast exams by either the patient or a physician are not recommended.

These are guidelines for physicians to apply to each individual patient, not hard and fast rules. Some physicians may choose to follow the guidelines of the U.S. Preventive Services Task Force (USPSTF)

For ages 40-49 years, individualize the decision to screen every 2 years
For ages 50-74 years, screen every 2 years
For ages 75 years and older there is no recommendation.

Both organizations recommend that physicians discuss the decision to screen or not to screen with patients and base the decision after considering possible harms versus potential benefit.

And while breast cancer is the second leading cause of cancer death among women in the United States, it is treatable and the chance of long term survival is high.