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Colic

Related Terms :

  • Infantile Colic

Uses

Principal Proposed Natural Treatments

Other Proposed Natural Treatments

The mere thought of a colicky baby is often enough to strike fear in the heart of the parents of a newborn child. A baby with colic may cry for hours despite the parents' attempts at consolation; although the colicky phase will eventually end, it may seem like an eternity while it continues.
Colic is generally defined as excessive (frequently inconsolable) crying that lasts for more than three hours at least three days per week, continuing for at least three weeks; additionally, there must be no medical problem causing the crying.
Other symptoms frequently associated with colic include pulling the knees up towards the stomach, a hard and/or swollen stomach, and excessive gas. Crying occurs most often in the evening. Colic typically ends by the age of 4-5 months.
Colicky babies may be at an increased risk of abuse at the hands of exhausted and frustrated parents. Additionally, the parent may not properly bond with the child because of feelings of inadequacy and anger, leading to developing behavioral problems as the child grows.
No one knows for sure what causes colic, although there are many theories. One view attributes it to painful digestive cramps and/or excessive gas caused by allergic reaction to foods (such as milk). Another theory suggests that some babies may simply have a sensitive temperament, possibly compounded by a parental inability to respond to the infant's needs. Finally, what we call colic may just be an extreme version of normal infant crying, or an increased perception of normal crying by parents with less tolerance for it.
The antispasmodic and sedating drugs dicyclomine and dicycloverine appear to be effective for colic, 1 but they can have dangerous side effects in infants and are not recommended. The gas-relieving drug dimethicone is also sometimes recommended, but evidence suggests that it does not work. 2

Principal Proposed Natural Treatments

A number of natural approaches to colic have preliminary supporting evidence.

Fennel Seed Oil

In a double-blind, placebo-controlled study , 125 infants with colic were given either placebo or fennel seed oil at a dose of 12 mg daily per kg of body weight. 48 The results were promising. About 40% of the infants receiving fennel showed relief of colic symptoms, as compared to only 14% in the placebo group, a significant difference. Another way to look at the results involves hours of inconsolable crying. In the treated group, infants cried about nine hours per week, compared to twelve hours in the placebo group.
While these are encouraging results, confirmation by an independent research group is necessary before the treatment can be accepted as effective. Furthermore, the safety of fennel seed oil for infants has not been conclusively established.
For more information, see the full fennel article .

Dietary Changes

Cow's milk can cause allergic reactions . Most infant formula contains cow’s milk, and can cause reactions in allergic babies. There is also some evidence that breast-fed infants may have allergic responses to cow’s milk proteins in the mother’s diet. 3–7
Numerous small, open and double-blind studies have evaluated the effects of cow's milk or cow’s milk protein in the diet of infants with colic. 8–23,47 Most (but not all) of these found an improvement in crying when cow's milk protein was removed from the diet of formula-fed infants, or from the diet of the mothers in breast-fed infants. 24–31
As an alternative to standard cow’s milk–based formula, researchers primarily used hypoallergenic formula made from hydrolyzed (processed) whey or casein. Formula based on these sources of protein may be superior to those based on soy, because soy itself can cause allergic reactions in sensitive children.
If no improvement is seen through eliminating cow's milk, some experts recommend searching in the breastfeeding mother's diet for other potential food allergens, such as wheat, soy, or eggs. 32–34 However, it is important to keep nutritional needs in mind: the nursing mother who eliminates certain foods needs to maintain an adequate intake of calcium, protein, and other nutrients.
It should be noted that most infants with colic are able to tolerate cow's milk protein as they get older, so neither the mother nor the baby are doomed to life without milk. Researchers propose that this might be the result of an immature digestive system; according to this theory, maturation of the digestive tract is the reason that colic usually disappears on its own in time.
Milk also contains lactose, a form of sugar that many adults can't digest (see the lactose intolerance article for more information). However, reducing the lactose content of infant formula has not been found helpful in treating colic. 42

Behavioral Methods

Many doctors believe that the cause of colic is not physical; rather, that it results from a child's oversensitivity to stimuli in the environment. 36-40 Overanxious parents might contribute to the problem by adding more stimulation in an attempt to calm their child. Other parents might under-react in the belief that paying too much attention to the infant's cries will "spoil" him. Either response could set up a vicious cycle leading to long periods of inconsolable crying.
Based on these theories, some authorities recommend counseling the parents of a colicky infant on appropriate coping strategies, including building a personal support system and occasionally leaving the child with a different caregiver to provide a respite.
Studies evaluating the effects of carrying a colicky child more, or using a motion-simulation device, have not found benefit. 41,42

Other Proposed Natural Treatments

A one week, double-blind, placebo-controlled study of 93 breast-fed colicky infants found benefits with a standardized extract of fennel, lemon balm , and chamomile . 49 Another double-blind, placebo-controlled study found benefits with a combination of chamomile, vervain , licorice , fennel, and lemon balm. However, the safety of these herbal combinations in infants have not been established.
A mixture of hydrolyzed whey protein and prebiotics has shown some promise for reducing colic symptoms. 51
One controlled study found that use of a special type of bottle for bottle feeding (Dr. Brown's Natural Flow Baby Bottle) reduced colic symptoms. 50
Chiropractic spinal manipulation has also been tried for colic. 44 One controlled study compared chiropractic treatments with the drug dimethicone. Fifty infants were randomly assigned one of the treatments for two weeks. By the sixth day of treatment, the spinal manipulation group cried significantly less than those on dimethicone. Whether this was a specific effect of the manipulation or a general response to attention and touch is difficult to determine.
In one small study, light needling at one acupuncture point on both hands was more effective than no needling among 40 infants with colic. 52
In Britain, a preparation called "gripe water" is widely sold for the treatment of colic. 45 Varying formulations exist; however, all include aromatic oils such as dill, spearmint, or caraway , combined with alcohol, sucrose (sugar), and sodium bicarbonate. There is no scientific evidence to show whether or not gripe water works. It should be noted that at the recommended dosage, the infant would receive the equivalent of five shots of whiskey. That would be enough to calm anyone.
Other herbs sometimes recommended for colic include cardamom, angelica, peppermint , lemon balm , rooibos (red tea) and yarrow . However, no scientific evidence as yet supports their use.
The use of an herbal tea may offer some benefits. Sixty-eight infants (aged 2-8 weeks old) with colic were randomized to receive herbal tea (German chamomile, vervain , licorice , fennel , and balm-mint) or placebo (sugar water) up to three times daily during each colic episode. 53 After one week, the infants in the herbal tea group had an improvement in their symptoms compared to those given the placebo.
The use of salt substitutes containing potassium have also been recommended, but they can be dangerous. 46

References

1 Lucassen PL, Assendelft WJ, Gubbels JW, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ . 1998;316:1563–1569.

2 Lucassen PL, Assendelft WJ, Gubbels JW, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ . 1998;316:1563–1569.

3 Axelsson I, Jakobsson I, Lindberg T, et al. Bovine beta-lactoglobulin in the human milk. A longitudinal study during the whole lactation period. Acta Pediatr Scand . 1986;75:702–707.

4 Jakobsson I, Lindberg T, Benediktsson B, et al. Dietary bovine beta-lactoglobulin is transferred to human milk. Acta Pediatr Scand . 1985;74:342–345.

5 Machtinger S, Moss R. Cow's milk allergy in breast-fed infants: the role of allergen and maternal secretory IgA antibody. Allergy Clin Immunol . 1986;77:341–347.

6 Stuart CA, Twiselton R, Nicholas MK, et al. Passage of cows' milk protein in breast milk. Clin Allergy . 1984;14:533–535.

7 Gerrard JW. Allergy in breast fed babies to ingredients in breast milk. Ann Allergy . 1979;42:69–72.

8 Lucassen PL, Assendelft WJ, Gubbels JW, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ . 1998;316:1563–1569.

9 Forsyth BWC. Colic and the effect of changing formulas: a double blind, multiple crossover study. J Pediatr . 1989; 115:521–526.

10 Hill DJ, Hudson IL, Sheffield LJ, et al.. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol . 1995;96:886–892.

11 Evans RW, Allardyce RA, Fergusson DM, et al. Maternal diet and infantile colic in breast-fed infants. Lancet . 1981;1:1340–1342

12 Lothe L, Lindberg T, Jakobsson I. Cow's milk formula as a cause of infantile colic: a double-blind study. Pediatrics . 1982;70:7–10.

13 Lothe L, Lindberg T. Cow's milk whey protein elicits symptoms of infantile colic in colicky formula-fed infants: a double-blind crossover study. Pediatrics . 1989;83:262–266.

14 Sampson HA. Infantile colic and food allergy: fact or fiction? J Pediatr . 1989;115:583–584.

15 Gerrard JW. Allergies in breast-fed babies to foods ingested by the mother. Clin Rev Allergy . 1984;2:143–149.

16 Gerrard JW. Allergy in breast fed babies to ingredients in breast milk. Ann Allergy . 1979;42:69–72.

17 Iacono G, Carroccio A, Montalto G, et al. Severe infantile colic and food intolerance: a long-term prospective study. J Pediatr Gastroenterol Nutr . 1991;12:332–335.

18 Taubman B. Parental counseling compared with elimination of cow's milk or soy milk protein for the treatment of infant colic syndrome: a randomized trial. Pediatrics .1988;81:756–761.

19 Jakobsson I, Lindberg T.. Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics . 1983;71:268–271.

20 Thomas DW, McGilligan K, Eisenberg LD, et al. Infantile colic and type of milk feeding. Am J Dis Child . 1987;141:451–453.

21 Warner JO. Food allergy in fully breast-fed infants. Clin Allergy . 1980;10:133–136.

22 Clyne PS, Kulczycki A Jr.. Human breast milk contains bovine IgG. Relationship to infant colic? Pediatrics . 1991;87:439–444.

23 Taubman B, Lothe L, Lindberg T. Colic or milk allergy [letters]. Pediatrics . 1989;84:938–939.

24 Jakobsson I, Lindberg T.. Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics . 1983;71:268–271.

25 Iacono G, Carroccio A, Montalto G, et al. Severe infantile colic and food intolerance: a long-term prospective study. J Pediatr Gastroenterol Nutr . 1991;12:332–335.

26 Gerrard JW. Allergies in breast-fed babies to foods ingested by the mother. Clin Rev Allergy . 1984;2:143–149.

27 Sampson HA. Infantile colic and food allergy: fact or fiction? J Pediatr . 1989;115:583–584.

28 Lothe L, Lindberg T. Cow's milk whey protein elicits symptoms of infantile colic in colicky formula-fed infants: a double-blind crossover study. Pediatrics . 1989;83:262–266.

29 Lothe L, Lindberg T, Jakobsson I. Cow's milk formula as a cause of infantile colic: a double-blind study. Pediatrics . 1982;70:7–10.

30 Hill DJ, Hudson IL, Sheffield LJ, et al.. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol . 1995;96:886–892.

31 Forsyth BWC. Colic and the effect of changing formulas: a double blind, multiple crossover study. J Pediatr . 1989; 115:521–526.

32 Warner JO. Food allergy in fully breast-fed infants. Clin Allergy . 1980;10:133–136.

33 Gerrard JW. Allergies in breast-fed babies to foods ingested by the mother. Clin Rev Allergy . 1984;2:143–149.

34 Hill DJ, Hudson IL, Sheffield LJ, et al.. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol . 1995;96:886–892.

35 Lucassen PL, Assendelft WJ, Gubbels JW, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ . 1998;316:1563–1569.

36 Lucassen PL, Assendelft WJ, Gubbels JW, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ . 1998;316:1563–1569.

37 Parkin PC, Schwartz CJ, Manuel BA. Randomized controlled trial of three interventions in the management of persistent crying of infancy. Pediatrics . 1993;92:197–201.

38 Barr RG, McMullan SJ, Spiess H, et al. Carrying as colic "therapy": a randomized controlled trial. Pediatrics . 1991;87:623–630.

39 Taubman B. Clinical trial of the treatment of colic by modification of parent-infant interaction. Pediatrics . 1984;74:998–1003.

40 Taubman B. Parental counseling compared with elimination of cow's milk or soy milk protein for the treatment of infant colic syndrome: a randomized trial. Pediatrics .1988;81:756–761.

41 Barr RG, McMullan SJ, Spiess H, et al. Carrying as colic "therapy": a randomized controlled trial. Pediatrics . 1991;87:623–630.

42 Parkin PC, Schwartz CJ, Manuel BA. Randomized controlled trial of three interventions in the management of persistent crying of infancy. Pediatrics . 1993;92:197–201.

43 Weizman Z, Alkrinawi S, Goldfarb D, et al. Efficacy of herbal tea preparation in infantile colic. J Pediatr 1993;122:650–652.

44 Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther . 1999;22:517–522.

45 Illingworth C, Timmins J. Gripe water: what is it? Why is it given? Health Visit . 1990;63:378.

46 Oseas RS, Phelps DL, Kaplan SA. Near fatal hyperkalemia from a dangerous treatment for colic [letter]. Pediatrics . 1982;69:117–118.

47 Swadling C, Griffiths P. Is modified cow's milk formula effective in reducing symptoms of infant colic? Br J Community Nurs . 2003;8:24–27.

48 Alexandrovich I, Rakovitskaya O, Kolmo E, et al. The effect of fennel (Foeniculum Vulgare) seed oil emulsion in infantile colic: a randomized, placebo-controlled study. Altern Ther Health Med . 2003;9:58-61.

49 Savino F, Cresi F, Castagno E, et al. A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil®) in the treatment of breast-fed colicky infants. Phytother Res . 2005;19:335-40.

50 Cirgin Ellett ML, Perkins SM. Examination of the Effect of Dr. Brown's Natural Flow Baby Bottles on Infant Colic. Gastroenterol Nurs. 2006;29:226-31

51 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;60:1304-10.

52 Reinthal M, Andersson S, Gustafsson M, et al. Effects of minimal acupuncture in children with infantile colic—a prospective, quasi-randomised single blind controlled trial. Acupunct Med. 2008;26:171-182.

53 Weizman Z, Alkrinawi S, Goldfarb D, Bitran C. Efficacy of herbal tea preparation in infantile colic. J Pediatr. 1993;122(4):650-652.

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