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Diagnosis and treatment of Infantile Colic

Diagnosis and treatment of Infantile Colic. Aaron E. Carroll, MD, MS. Disclosure. Aaron E. Carroll, MD, MS has documented that he has no relevant financial relationships to disclose or COIs to resolve. Definition.

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Diagnosis and treatment of Infantile Colic

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  1. Diagnosis and treatment of Infantile Colic Aaron E. Carroll, MD, MS

  2. Disclosure • Aaron E. Carroll, MD, MS has documented that he has no relevant financial relationships to disclose or COIs to resolve.

  3. Definition • Infantile colic is unexplained inconsolable crying in otherwise health infants in early weeks of life • Peaks 6-8 weeks, and resolves by 3-4 months • Wessel Criteria: • Crying episodes for more than 3 hours per day • Three or more days per week • Three or more weeks

  4. Epidemiology • Accounts for up to 20% of pediatrician visits in the first four months of life • Proposed causes include: • Alterations in gut hormones or microflora • Gas • Lactoste intolerance or cow milk protein allergy • Behavioral issues, family tension, parental anxiety • Nervous system imbalance

  5. Confusion • Variety of causes have led to a variety of treatments • Very few proven to work • Most confounded by the fact that pretty much all colic resolves • The vast majority of colic needs no workup

  6. This doesn’t make parents feel better • Colic is extremely stressful • Leads to parental exhaustion • Loss of patience • Ready frustration • Difficulties with concentration • Fears of harming child • Early discontinuation of breast feeding • Reduced face-to-face time with infant • Potentially increases risk of maternal depression

  7. Many, many studies • Fortunately, colic is well studied • There have been a number of systematic reviews • Will review many of them and offer results • Will help when talking to parents of infants with colic

  8. Dietary Management • 2012 Systematic review examined studies of dietary interventions for infantile colic • After reviewing 742 articles, 24 met inclusion criteria • 23 of these were randomized controlled trials • All examined infants less than 6 months of age • Babies had to be healthy and developing normally • Moms had to be 18-45 and also healthy

  9. Dietary Management - Findings • Six studies looked at breastfeeding mom’s diets • One found mom changing to hypoallergenic diet reduced colic from 56% to 15% • NNT = 2.5 • A small RCT found that eliminating milk had no effect • Other studies had no effect

  10. Dietary Management - Findings • Thirteen studies examined the use of hydrolyzed formulas • One RCT found an effect, but no non-hydrolyzed formula was used • NNT=5 to resolve symptoms • Other studies found a similar effect, diminishing with time • In fact, most studies found that hydrolyzed formulas reduced the symptoms of colic, even in breastfed infants

  11. Dietary Management - Findings • Three studies examined the effects of soy based formulas • These were not the best quality • Results suggest that soy based formulas might reduce the symptoms of colic, but more evidence is needed to recommend them as strongly as hydrolyzed formulas • One study found that fiber enriched formula didn’t work • Three studies examining fruit juice were similarly negative

  12. Pharmacologic Management - Findings • Simethicone has been studied, based on the idea that gas is causing colic • Studies show no difference between simethicone and placebo • Dicyclomine hydrochloride reduced infant crying time from 4 hours to 1 hour per day • Side effects make this hard to justify • Cimetropium bromide worked as well, but is similarly plagued by side effects • All of these studies have methodological issues

  13. Behavioral Management - Findings • One study found no improvement with increased carrying during episodes • One study found that two weeks of counseling for strategies to manage colic made no difference • One study found an improvement with decreased stimulation, but was significantly flawed

  14. Naturopathic Management - Findings • Lactobacillus findings have been mixed • Some trials positive, but flawed and contested • Future studies are pending • Glucose and sucrose have been studied • “Positive” results, but not in a meaningful way • Not enough evidence to recommend this strongly

  15. Naturopathic Management - Findings • Herbal remedies are popular • But many of the studies are hard to “replicate” • A study of fellel oil found it superior in achieving a response • NNT = 2.5 • Herbal tea containing chamomile, vervain, licorice, fennel, and balm-mint also reduced colic criteria • NNT = 3

  16. Manipulative Management - Findings • Some studies of spinal manipulation have been done • Many have non-significant results • Some studies have actually had results go in the opposite direction • Little evidence for this to work at all • Almost no studies are blinded and therefore subject to significant bias

  17. What to do? • REASSURE • Reassure again • Do not work up • Do not use drugs or manipulative treatments

  18. What to do? • If breastfeeding, consider a hypoallergenic diet • If bottlefeeding, consider a hydrolyzed formula • Consider herbal tea or fennel oil, but be sure of ingredients • Weigh the benefits versus the harms

  19. Questions? • Email: aaecarro@iupui.edu • Twitter: @aaronecarroll • YouTube: Healthcare Triage

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