嬰兒腸絞痛的症狀緩解
楊惟婷整理
半夜的兒科急診常遇到滿臉無奈的家長，抱著剛出生數週大的嬰兒來看診，主訴是寶寶在家中連續哭鬧不休好幾小時，試過各種方法皆無法安撫，尖銳的哭聲吵到全家沒辦法睡覺，甚至被鄰居敲門抗議，最後實在沒辦法才帶寶寶來小兒急診室。
不過比較尷尬的是，當寶寶抱到診所準備看診時，往往如天使般睡得香甜，完全不像曾經在家中大吵大鬧的小惡魔。
一、「嬰兒腸絞痛」的症狀
先看看以下一段醫師與家長的對話：
醫師：「寶寶是什麼時候開始哭鬧的？」
家長：「大概下午四、五點左右就開始了，入夜後情形更嚴重….」
醫師：「是連續不停地哭鬧，還是間歇性中間有停止的哭鬧？」
家長：「連續哭鬧好幾個小時，只有抱起來時會好一點，一但放回床上又開始大哭，我們只能一直輪流抱，手都快斷掉了！」
醫師：「今天整天包括哭鬧時，餵食的情形正常嗎？ 奶量有沒有減少很多？ 餵食後有沒有噴射狀的嘔吐？」
家長：「餵食很正常，奶量跟平常差不多，只有輕微溢奶，並沒有嘔吐的情形。」
醫師：「有發燒、活力變差、或是咳嗽、流鼻水、腹瀉等生病的症狀嗎？」
家長：「沒有。」
醫師：「剛剛什麼時候停止哭鬧的？ 是不是抱上車引擎發動後沒多久，才到第一個紅燈路口停下來，就發現小朋友已經睡著了？」
家長：「醫師您怎麼知道？ 寶寶在開車後沒多久就睡著了，一路睡到現在，剛剛車子停在急診門口時我們還在猶豫到底要不要下車看診…….」
由以上醫師與家長的對話，幾乎可以斷定寶寶的症狀就是「嬰兒腸絞痛」。
總結「嬰兒腸絞痛」的症狀特色是：
沒有哭鬧時寶寶幾乎是完全正常的，即使在大哭大鬧的時候，到了該餵奶的時間，寶寶的食量依然和平常差不多。
症狀通常在太陽下山後開始，當太陽升起時症狀就會緩解，但有些寶寶白天也會發作，只是症狀比夜間輕微。要和其他疾病，像是感染、腸套疊、腸阻塞等做鑑別診斷，事實上只要寶寶食慾、活力沒有變化，沒有發燒、嘔吐、腹瀉等其他症狀，糞便型態正常，發生上述疾病的機率是極低的。
腸套疊的哭鬧模式是間歇性的，跟嬰兒腸絞痛持續哭鬧不同，也不會因抱起來安撫而有所改善，腸套疊通常會合併嘔吐或活力變差、有時會有果凍狀血便出現。
疝氣也是要注意的疾病，要檢查腹股溝是不是有腫脹的情形出現。
一旦注意到這些危險信號，可能就不是單純嬰兒腸絞痛，要帶寶寶給小兒科醫師看診。
二、「嬰兒腸絞痛」的定義
嬰兒腸絞痛的定義，可以用「333 法則」 來說明：
每天哭鬧超過 3 小時、每周超過 3 天、症狀持續超過 3 週，出現在餵食正常、沒有其他器官疾病的嬰兒。發生原因不明，但會自行痊癒。通常從 2至 3 週大開始，持續到四、五個月，有些甚至到六個月大後才會緩解。發生率約 5% ~ 25%。有研究指出母奶寶寶發生率會降低，但也有研究表示改變飲食對發生率其實沒有影響。
三、「嬰兒腸絞痛」的症狀緩解
嬰兒腸絞痛治療方式有很多種，但沒有保證可以緩解症狀的方法，事實上，「時間」是唯一的解藥。嬰兒通常4個月大時會自行痊癒，有時症狀會持續到6個月，不會造成其他後遺症。
不過還是有些方法可以讓寶寶稍微緩解症狀：
1、汽車引擎聲、吸塵器馬達聲、吹風機馬達聲…等，有時候可以有效安撫嬰兒，原因是這些聲音跟寶寶在媽媽子宮內聽到血管中血液流動的聲音類似。
2、幫助寶寶排氣或是排大便，有時候可以讓激烈哭鬧的寶寶安靜下來。
方法有﹕順時針按摩腹部術、細棉花棒沾凡士林刺激肛門、用甘油球灌大便（建議由醫護人員執行，因為需要控制劑量）。
3、找診所醫師看診，有時候一些藥物可以幫助稍微緩解症狀，但有時候是完全沒有效果。
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