Posts Tagged ‘infants’

Colic and Probiotics

Posted: June 10, 2014 in medicine
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For anyone who hasn’t had a child, one of the things that be very stressful is colic, aka “Cry fuss behavior”. Colic is a poorly understood constellation of symptoms which there is no effective treatment, yet it puts the caretakers under great stress and is a common reason for ER and primary care visits.

To start off, there are different definitions of colic depending on what criteria you use but they all rely on a certain amount of time (usually over 3 hours a day on a frequent basis) and an infant who is healthy (meaning ruling out other causes) for a colic diagnosis. Examples of this include the “Rome III criteria” and the “Wessel Criteria”.

There is no one accepted theory that explains colic, and it is most likely a combination of social and physical causes, but most theories focus on the GI system (specifically around milk digestion), biological factors (like smoke exposure), and psychosocial (the babies tempermant).

The history and physical focus on ruling out diseases that CAN be treated, such as metabolic disease and GI disease, and the workup would be dependent on if you think one of the other disorders exist (this includes labs, radiology studies).

The usual recommended treatment of colic focuses on supportive therapy (soothing the baby) and with adjusting feeding techniques. Other treatments include removing lactose from the diet (for suspected lactose intolerance) to herbal remedies.

One of the secondary treatments that has been gaining some interest is treating with probiotics. A review of RCT(randomized control studies) in 2013 found inconclusive results regarding probiotics. Multiple other reviews occured in 2013, which showed confilicting results (some positive, some showing no effect)

A new paper, by Indrio, et al. “Prophylactic Use of a Probiotic in the Prevention of Colic, Regurgitation, and Functional Constipation: A Randomized Clinical Trial”, published 2014 in JAMA pediatrics adds to this existing knowledge.

This is a somewhat small study (n=238 in the treatment group) for a short peiod (90 days), but it is structued as a “double blind” study. The secondary outcomes used include the number of medical visits, ER visits, and the number of parent work days lost, were much less in the treatment group. This makes both a difference to the parents along with reduced healthcare costs. The authors mention that longer studies are needed, as are ones comparing the different probiotic formulations – which would be interesting if they were designed in a similar way.

This provides an interesting alternative if the methods of feeding adjustment and soothing do not work and you are left with a very frustrated parent.

SOURCES

Uptodate – uptodate.com

Indrio F, Di Mauro A, Riezzo G, et al. Prophylactic Use of a Probiotic in the Prevention of Colic, Regurgitation, and Functional Constipation: A Randomized Clinical Trial, JAMA Pediatrics. 2014;168:228-233