We’re all familiar with the following scenario. Mrs. Archer, a first-time mother, brings her 5-week-old son for a consultation regarding his constant crying. She’s 40 years old and this child was conceived after many years of trying. She’s practically in tears as she relates the symptoms of “constant crying,” usually worse in the evening. Her baby seems inconsolable and often gets red-faced and draws his legs up. She’s tried everything and nothing seems to calm her baby. You examine the infant and find a perfectly healthy 5-week-old on the 90 centile for height and weight. Mrs. Archer’s description matches that of infantile colic, well described in Wessel’s criteria in 1954.1 In that paper, he quotes the nurse’s notes: The baby is increasingly unmanageable and more puzzling. Babies never annoy me, but this one does. I have never seen a baby act like this before. It seems that nothing satisfies him but holding him… Dr. Cobb saw the baby, held him, burped him, tried putting him in different positions in bed… but the baby cried as vigorously as ever. I’m sure every practitioner has encountered this problem.
Infantile colic is common with estimates of prevalence from 5-19% of infants and its etiology is unknown.2 Usually colic begins when the infant is 1-2 weeks old, peaks around 6-8 weeks and disappears around 10-12 weeks. It can be very trying and exhausting for new parents. There are various theories regarding its etiology, ranging from allergy to tensions between parent and infant that are sensed by the baby. Some feel it’s a normal developmental stage that’s more pronounced in some infants, those we label as colicky. The truth is that we do not yet know what causes colic and therefore, there’s no certain remedy for it.
A review of the literature
Whenever modern, evidence-based medicine does not have a “cure,” our parents turn to the internet or social networks such as Facebook or Twitter to seek help. There they may find many alternative treatments for colic. Do any really work as advertised? Rachel Perry and her colleagues have published the first systematic review of complementary medicines used in the treatment of colic in the April issue of Pediatrics and it’s worth reading. Using rigorous inclusion criteria, these authors identified 15 RCTs out of a total of 1,764 that were methodologically sound. These 15 trials had a total of 944 infants enrolled. The infants ranged in age from 0-16 weeks with sample sizes from 9-175 infants. Of the 15 studies, 8 were considered methodologically well-designed and 7 of poorer quality. Interventions examined were 30% glucose solutions, soy formulas with added polysaccharide, probiotics (Lactobacillus reuteri, L. rhamnosus, P. freudenreichii), herbal tea (chamomile, vervain, licorice, mint), fennel seed emulsion, infant massage, reflexology, chiropractic manipulation and cranial osteopathy.
The results? Three of four studies examining manipulation showed a reduction in mean hours crying but there were methodological shortcomings that prevent firm conclusions. One study of chiropractic manipulation showed no difference between intervention and control groups. Trials analyzing the response to various herbal teas showed some tendency towards improvement but again, methodological considerations prevent us from drawing any firm conclusions. Similar problems are reported for those examining glucose or sucrose solutions, probiotics, massage and reflexology. Fennel extract and herbal teas showed some promise but require further studies to confirm efficacy.
An elusive cause
What’s the bottom line for busy practitioners? Since we don’t know the cause of colic, we still don’t have a remedy. As the authors of this study state, “The notion that any form of CAM is effective for infantile colic is currently not supported from the evidence from the included RCTs.”3 In my practice, I usually stress four things: first, we don’t know the cause of colic but it’s self-limiting and has no long-term consequences that we know of; second, try to arrange for the new mother to have some relief as it can be exhausting for a first-time mom who may also be trying to breastfeed; third, if the caregiver is feeling that he/she is “losing it,” have her put the baby down in the crib and go for a walk. This latter piece of advice is necessary because the “shaken baby syndrome” is a risk in these situations. Finally, I don’t object if the parent wishes to try a harmless remedy such as simethicone drops (Ovol), or gripe water, which is water with a variety of different ingredients including one ore more of the following: sodium bicarbonate, alcohol (not recommended), chamomile, fennel, caraway, ginger, peppermint, aloe, lemon balm, sucrose, fructose, clove and others. Gripe water is manufactured under many different brand names and the ingredients are considered harmless. Some parents claim that Ovol or gripe water help relieve the colic (placebo effect) but again, we just don’t yet have any evidence-based recommendations for the treatment of infantile colic.