Options for Prevention and Treatment of Infantile Colic – A Systematic Review of Studies

Definition and Causes of Infantile Colic

Infant crying after birth varies in duration throughout the day and is longest around 6 weeks of age. In 4–28% of babies, the duration of crying meets the criteria for infantile colic: Infantile colic has been defined as crying lasting at least 3 hours a day, at least 3 days a week, for ≥3 weeks in an otherwise healthy infant. A recent update of the Rome criteria for functional gastrointestinal disorders reduced the duration criterion from 3 weeks to 7 days.

The causes of infantile colic are likely multifactorial and include maternal stress and postpartum depression as well as the infant's temperament, developmental milestones, and sensory processing capacity. Organic causes include food allergies or intolerances.

Systematic Review of Studies

The aim of a recent literature review was to assess evidence of the benefits of various methods for preventing and treating infantile colic. Swedish authors based their work on the MEDLINE, Web of Science, and PsycINFO databases, searching for works published from 2007 to 2017 that focused on excessive crying and colic in infants. Only randomized or quasi-randomized controlled studies, or their meta-analyses, involving children up to 6 months of age with at least 20 children in each group were included. Outcomes for both children and parents could be evaluated.

Results

The inclusion criteria were met by 10 original intervention studies and 2 meta-analyses. According to GRADE criteria, their quality ranged from moderate to high. Interventions included parental education, probiotic administration, maternal diet modification, pain relief preparations, and acupuncture.

Education

An Australian study evaluated an intervention involving parental education through a 27-page booklet and a 23-minute video discussing normal infant sleep cycles, crying, sleep in a separate crib, and self-care for parents. The intervention included access to a phone consultation at 6–8 weeks of the infant's age and a meeting at 12 weeks. This intervention did not reduce the infants' crying duration but did show a lower incidence of depression among mothers.

Pain Relief

Researchers assessed the effects of various analgesics and herbal preparations in infants with colic. No effect was found for simethicone, and ambiguous conclusions were reached for herbal preparations, sucrose, and cimetropium bromide. Shortening of crying duration compared to placebo was observed with dicycloverine, but at the expense of adverse events such as prolonged sleep (in 4%), wide-open eyes (4%), and drowsiness (13%).

Acupuncture

Acupuncture in the treatment of infantile colic was evaluated by 4 randomized Scandinavian studies. The duration of crying was the same in both groups, i.e., the intervention group and the control group.

Probiotics

One theory for the cause of infantile colic is the colonization of the originally sterile gut by bacteria, which occurs between 2 weeks and 3 months of age and might be accompanied by discomfort or pain. Therefore, probiotic administration was evaluated in the treatment of infant colic. Most frequently, shortening of the crying duration was associated with Lactobacillus reuteri DSM 17938. Two Italian studies showed benefits from its preventive administration. A Finnish study did not demonstrate an effect of administering a mix of probiotic bacteria not containing L. reuteri DSM 17938 on the incidence of infant colic and allergies.

A meta-analysis of 6 randomized controlled studies with L. reuteri DSM 17938 in infants with colic conducted in 3 European countries and Australia showed a reduction in crying duration by nearly an hour per day after 21 days, although the largest Australian study did not record any benefits. The strength of evidence according to GRADE terminology was assessed as moderate due to population heterogeneity. An Iranian study showed a significant effect of a mix of fructooligosaccharides with 6 types of probiotics not including L. reuteri DSM 17938 in infants with colic after 7 days of treatment.

Conclusion and Discussion

According to this literature review, L. reuteri DSM 17938 is a promising method for treating infantile colic, but as evidence is only of moderate strength, further studies are needed. The authors also find the knowledge insufficient to enable the creation of systematic support strategies for parents with infants suffering from colic.

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Source: Hjern A., Lindblom K., Reuter A., Silfverdal S. A. A systematic review of prevention and treatment of infantile colic. Acta Paediatr 2020; 109 (9): 1733–1744, doi: 10.1111/apa.15247.