Q: My daughter is 2 months old and we are concerned about her slow weight gain. Her birth weight is 3.25 kg and current weight is 4.2 kg; height is 1.10 feet. We have observed that she cries very loudly while passing stools. She passes only a few drops at a time. Her rectal area also becomes red, so we are applying siloderm cream. Our doctor suggested to use cyclopam and digestive enzymes. We used these and she was fine for a week. Later, I realised that cyclopam contains a drug dicyclomine hydrochloride, which must not be used for babies below 6 months of age. So I discontinued it. Since then the irritable bowel problem has increased, in this week she has lost 200 grams of weight. Due to the pain she is crying the whole night, while she is crying she refuses to drink milk. she is exclusively breast-fed. Please suggest a solution so that she can feed properly and we can control her irritable bowel. Her paediatrician has suggested colic aid drops, is it safe to use? Can I give her gripe water/binnisal, which one is better? What can be done to increase her appetite?

A:Colic commonly affects infants and is characterised by episodes of unprovoked crying, causing great distress to the family. There is no definite reason for colic. Whether colic is related to the mothers diet, milk allergy, etc is not proven, and in general there is no clear evidence in the literature citing milk intolerance or mothers diet as a cause for colic. Hence, change in mothers diet or change of milk for the baby is not recommended. As a first step, before making the diagnosis of colic, the following have to be ruled out: 1. Irritable baby due to uncomfortable bed, tight diapers, rashes, too high or too low room temperature, noises, lighting etc. 2. Irritability due to excessive stimulation by caretakers or not enough attention and swaddling of the baby 3. Hunger/Overfeeding 4. Mild upper respiratory or viral infection or ear infection, diagnosis often missed; in such cases, history of noisy breathing, congestion, low-grade fever, etc have to be carefully elicited. This is often misinterpreted as colic. The infant refuses to feed due to nasal block, and feeds well if saline drops are instilled into the nose before feed. Paracetamol helps in such situations for pain or low-grade fever. Colic is related more to baby's temperament and mother's anxiety than anything else. The following tips may help to manage colic, which will usually last for weeks or months. Gripe water should be completely avoided. Medicines such as simethicone while relatively safe are still better avoided. Tips for colic: 1. Mother must calm herself down that crying is a form of communication, and does not necessarily mean a disease or pain. 2. The room must be reasonably cool, with dim lights, minimal noise 3. Baby should get used to some kind of music played repeatedly. Sometimes even repetitive noises of vacuum cleaners, dishwashers, etc quiets a crying baby! 4. When the baby cries, swaddling movements as in a cloth hammock, walking with the baby carried in a sling or back pack, ride in a car etc. help. 5. Gentle massage of tummy and full body in the evenings and bath with warm water help. 6. Don't get too carried away by weekly weights of the baby. The general pattern of growth over a few months is what matters. 7. Stool pattern in babies may vary from few drops of watery stools several times a day, to stools once in 5 days: both of these are normal. Similarly, crying before passing stools or flatus is normal. Knowledge of this will help in avoiding unnecessary medicines. 8. Lactation counselling by an expert to learn proper techniques of latching-on, etc. will avoid irritability due to hunger or poor feeding technique.