Colic is often diagnosed by using Wessel’s Rule of Threes: crying for more than 3 hours per day, at least 3 days per week for more than 3 weeks.

Colic is a diagnosis of exclusion; it is critical to evaluate for other conditions with a thorough history and physical exam.

Management of colic includes parental education regarding natural, self-limited course of condition, parental coping mechanisms, and safe maneuvers to soothe baby such as the “5 Ss.”

Nonaccidental trauma can be a serious consequence of colic.

Temper tantrums are commonplace in early childhood and are characterized by episodes of extreme frustration and anger, manifesting as a wide range of behaviors that appear disproportionate to the situation.

• •
  

  Evaluation should include a thorough history and physical examination to rule out for other etiologies such as development delay and hearing or visual deficits.

  
  
• •
  

  Atypical tantrums, particularly those that are destructive or injurious, may be indicative of a more serious underlying condition; consider sleep disturbances, attention-deficit/hyperactivity disorder (ADHD), mood disorders, or significant family stressors in these situations.

Anticipatory guidance for parents should include tips for acute management of temper tantrums (e.g., staying calm, using distraction, cool-down techniques, not giving into the child’s demands, and ignoring inappropriate behavior) as well as for prevention of future tantrums (e.g., setting clear limits, consistently enforcing limits, teaching communication skills, offering choices, role-modeling, and using positive and negative reinforcement).

ADHD is multifactorial in origin with genetic, neural, and environmental contributions. It is characterized by symptoms of inattention, hyperactivity, and/or impulsivity that persist over a period of more than 6 months, are present prior to age 12, and lead to impairment in more than one setting.

Diagnosis is by history including reports of the patient , parents, and teachers; diagnosis requires use of validated rating scales.

Other diagnoses and co-morbidities should be considered, including learning disabilities, mood disorders, anxiety, and autism spectrum disorder.

Behavior modification is the standard of care for management of ADHD in preschool-aged children.

Management of ADHD for older children and adolescents should include behavioral management as well as parent training and classroom interventions.

• •
  

  Stimulant medications have been shown to be effective for the overall management of ADHD in these age groups. Side effects should be monitored carefully and doses titrated for optimal treatment response and diminished side effects.