Medscape Pediatrics

Jordi Cuñé, PhD, Jonathan Santas, PhDDisclosures

March 19, 2014

 

 

EDITORS' RECOMMENDATIONS

Prophylactic Probiotics Reduce Infantile Colic and Reflux

Probiotics Likely Do Little to Soothe Colicky Babies

What Treatments Have Been Tried for Infant Colic?

 

Infant colic, also referred to as excessive crying syndrome, is one of the most common causes of visits to a healthcare provider during the first year of an infant's life. It has a significant effect on the quality of life of infants and their family. Despite the prevalence and costs in both dollars and stress of this condition, its etiology is still elusive. No clearly effective and safe treatment or management option is currently available.

 

Traditionally, different drug therapies have been used for reduction of crying and fussing, especially in "colicky infants." Simethicone has been commonly proposed as a potential treatment option, but it has been shown to be no more effective than placebo.[1] Other drug-based treatments, including dicyclomine hydrochloride and cimetropium bromide, have been considered more efficacious. However, their use is limited, especially in infants younger than 6 months of age, due to undesirable side effects such as gassiness, abdominal distention, drowsiness, and -- in some extreme cases -- life-threatening events that may include respiratory distress and apnea.[2-4]

 

Other more "natural" treatments have been proposed for crying relief. These include herbal remedies including plant extracts (ie, Matricaria chamomilla [chamomile], Foeniculum vulgare [fennel], Melissa officinalis [lemon balm], and Mentha piperita [peppermint oil]). These, too, have been shown to be of limited efficacy and are also associated with several secondary effects, including sleepiness, constipation, and loss of appetite.[5-7] Similarly, although it has been reported that sucrose solutions may ameliorate crying syndrome,[8] there are important concerns regarding the poor quality of the scientific evidence and sucrose's nutritional effects.

 

Based on the theory that infantile colic can result from food allergies or digestion problems, several nutritional interventions have been proposed. Infant formulas designed to overcome food allergies (eg, partially hydrolyzed whey proteins) have been reported to reduce crying episodes.[9] However, these formulas may benefit only those infants whose excessive crying is ascribed to known food allergies. Lactase therapy adds a galactosidase (lactase) to an infant's formula to reduce the level of lactose in the milk. While some improvement in symptoms has been noted, results are conflicting.[2,10] High-fiber or fiber-enriched formulas have also been proposed as a possible treatment, but no significant differences in symptoms have been found when compared with standard formula.[11]

 

Complementary therapies such as massage or chiropractic treatment have also been advocated as treatment options for relieving crying symptoms. Evaluation of these options is challenging due to the absence of good quality clinical trials.[5]

 

References

 

Metcalf TJ, Irons TG, Sher LD, Young PC. Simethicone in the treatment of infant colic: a randomized, placebo-controlled, multicenter trial. Pediatrics. 1994;94:29-34. Abstract

 

Hall B, Chesters J, Robinson A. Infantile colic: a systematic review of medical and conventional therapies. J Paediatr Child Health. 2012;48:128-137. Abstract

 

Savino F, Tarasco V. New treatments for infant colic. Curr Opin Pediatr. 2010;22:791-797. Abstract

 

Savino F, Brondello C, Cresi F, Oggero R, Silvestro L. Cimetropium bromide in the treatment of crisis in infantile colic. J Pediatr Gastroenterol Nutr. 2002;34:417-419. Abstract

 

Drug and Therapeutics Bulletin. Management of infantile colic. BMJ. 2013;347:f4102.

 

Savino F, Cresi F, Castagno E, Silvestro L, Oggero R. A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants. Phytother Res. 2005;19:335-340. Abstract

 

Alves JG, de Brito Rde C, Cavalcanti TS. Effectiveness of Mentha piperita in the treatment of infantile colic: a crossover study. Evid Based Complement Alternat Med. 2012;2012:981352.

 

Akçam M, Yilmaz A. Oral hypertonic glucose solution in the treatment of infantile colic. Pediatr Int. 2006;48:125-127. Abstract

 

Savino F, Palumeri E, Castagno E, et al. Reduction of crying episodes owing to infantile colic: a randomized controlled study on the efficacy of a new infant formula. Eur J Clin Nutr. 2006;60:1304-1310. Abstract

 

Kanabar D, Randhawa M, Clayton P. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Diet. 2001;14:359-363. Abstract

 

Iacovou M, Ralston RA, Muir J, Walker KZ, Truby H. Dietary management of infantile colic: a systematic review. Matern Child Health J. 2012;16:1319-1331. Abstract

 

de Weerth C, Fuentes S, Puylaert P, de Vos WM. Intestinal microbiota of infants with colic: development and specific signatures. Pediatrics. 2013;131:e550-558. Abstract

 

Anabrees J. Probiotics for the management of infantile colic in breastfed infants. J Clin Neonatol. 2013;2:9-11.

 

Sung V, Collett S, de Gooyer T, Hiscock H, Tang M, Wake M. Probiotics to prevent or treat excessive infant crying: systematic review and meta-analysis. JAMA Pediatr. 2013;167:1150-1157.

 

Lucassen PL, Assendelft WJ, van Eijk JT, Gubbels JW, Douwes AC, van Geldrop WJ. Systematic review of the occurrence of infantile colic in the community. Arch Dis Child. 2001;84:398-403. Abstract

 

Wessel MA, Cobb JC, Jackson EB, Harris GS Jr, Detwiler AC. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics. 1954;14:421-435. Abstract

 

Kvitvaer BG, Miller J, Newell D. Improving our understanding of the colicky infant: a prospective observational study. J Clin Nurs. 2012;21:63-69. Abstract

 

van der Wal MF, van den Boom DC, Pauw-Plomp H, de Jonge GA. Mothers' reports of infant crying and soothing in a multicultural population. Arch Dis Child. 1998;79:312-317. Abstract

 

Reijneveld SA, Brugman E, Hirasing RA. Excessive infant crying: definitions determine risk groups. Arch Dis Child. 2002;87:43-44. Abstract