Dr Khurram Sadiq Lone

12/02/2026

06/02/2026

31/01/2026

Infantile Colic :

Infantile colic is excessive, inconsolable crying in an otherwise healthy infant, typically starting in the first weeks of life.

Wessel’s Rule of 3 (Diagnostic Criteria)

Colic is usually defined as:
• Crying > 3 hours per day,
• > 3 days per week,
• For > 3 weeks,
• In an infant < 3 months old,
• With no identifiable medical cause.

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Epidemiology
• Affects 10–30% of infants.
• Peak age: 6–8 weeks.
• Usually resolves spontaneously by 3–4 months.

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Clinical Features
• Crying is:
• Paroxysmal (sudden onset),
• Often in late afternoon or evening,
• High-pitched and intense.
• Associated behaviors:
• Clenched fists
• Drawn-up legs
• Facial flushing
• Abdominal distension
• Important: Baby feeds well, gains weight, and is otherwise normal between episodes.

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Proposed Causes (multifactorial)

No single proven cause; likely contributors include:
• Gut immaturity / dysmotility
• Gas and altered microbiome
• Sensitivity to stimuli
• Caregiver–infant interaction factors
• Possible cow’s milk protein sensitivity in a subset

Not caused by poor parenting or “spoiling” the baby.

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Red Flags — NOT colic (require evaluation)

If any of these are present, think organic disease, not colic:
• Fever
• Vomiting (especially bilious)
• Poor feeding
• Blood in stool
• Failure to thrive
• Lethargy
• Persistent abdominal distension
• Respiratory distress

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Management (mainstay = reassurance + support)

1) Reassure parents

Explain that:
• Colic is benign and self-limiting
• It will pass by 3–4 months
• Their baby is healthy

2) Soothing strategies

Try (no single method works for all babies):
• Swaddling
• Gentle rocking
• White noise
• Pacifier
• Burping well after feeds
• Smaller, more frequent feeds

3) Dietary measures (selected cases)
• If breastfed: consider maternal elimination of dairy for 2 weeks (only if strong suspicion).
• If formula-fed: trial of extensively hydrolyzed formula may help some infants.

4) Medications

Generally not recommended routinely:
• Simethicone — limited evidence
• Dicyclover — contraindicated in infants (serious side effects)
• Probiotics (e.g., Lactobacillus reuteri) — may help some breastfed infants, evidence mixed.

Key Takeaway :

Infantile colic = normal developmental phase, not a disease.
Reassurance and caregiver support are more important than drugs.

11/12/2025

ATYPICAL PNEUMONIA (Walking Pneumonia) :

A type of pneumonia caused by organisms that do not show typical lobar consolidation, and symptoms are usually milder, more systemic, and have dry cough.

Common Causes

Bacteria

• Mycoplasma pneumoniae — most common in school-aged children & young adults

• Chlamydophila pneumoniae

• Legionella pneumophila — severe; associated with contaminated water systems

Viruses

• Influenza virus

• RSV

• Adenovirus

• SARS-CoV-2

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Clinical Features

• Low-grade fever

• Dry, persistent cough

• Headache, sore throat

• Fatigue, malaise

• Mild respiratory distress

• Non-specific findings: myalgia, ear pain (bullous myringitis in Mycoplasma)

• GI symptoms (Legionella): diarrhea, vomiting

• Usually no large consolidation on exam

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Physical Exam

• Chest often mildly abnormal despite patient’s significant symptoms

• Diffuse crackles, wheeze

• No focal dullness like typical pneumonia

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Investigations

Chest X-Ray

• Patchy, diffuse interstitial infiltrates

• “Reticulonodular pattern”

• Not matching the physical exam severity

Labs

• CBC: may be normal or mildly raised WBC

• Mycoplasma: cold agglutinins ↑

• Legionella: hyponatremia, ↑ LFTs

• PCR/serology helpful

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Complications

• Mycoplasma:

• Hemolytic anemia, erythema multiforme, neurological symptoms

• Legionella:

• Respiratory failure, multi-organ involvement

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Treatment

First-line

• Macrolides (Azithromycin, Clarithromycin)

Alternatives

• Doxycycline (children >8 yrs)

• Respiratory fluoroquinolones (adults)

Supportive

• Antipyretics

• Adequate hydration

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Prognosis

• Usually excellent

• Symptoms may last weeks even after treatment

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Picture-style Diagram

ATYPICAL PNEUMONIA

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| Causes: Mycoplasma, Chlamydia, |

| Legionella, Viruses |

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| Symptoms: |

| - Dry cough |

| - Low-grade fever |

| - Headache, fatigue |

| - Mild chest signs |

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| X-ray: Patchy interstitial |

| infiltrates |

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| Treatment: Macrolides |

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