Home > Evidence-based treatment for the dietary management of colic

Evidence-based treatment for the dietary management of colic

Although infantile colic is considered to be a self-limiting condition with few, if any, long-term medical consequences1, it is often a frustrating and distressing time for new parents. Affecting as many as 20% of newborn babies in their first months of life2, colic is characterised by extended periods of inconsolable crying in otherwise healthy infants. As a result, colic is associated with high levels of parental anxiety, sleep deprivation and stress. Understandably, colic is a frequent contributor to the need for healthcare professional consultations with 1 in 6 families seeking help and advice about the management of the condition1.

 

Introduction

The National Institute for Health and Care Excellence (NICE) recognises the impact that colic has on both families’ lives and healthcare professional resources and include information about the condition on their Clinical Knowledge Summaries (NICE CKS) website. NICE CKS provides a review of the latest evidence on colic and delivers practical advice and guidance about the diagnosis and management of colic for healthcare professionals in primary care.

 

Understanding colic

For the purposes of clinical management, infantile colic is defined as ‘repeated episodes of excessive and inconsolable crying in an infant that otherwise appears to be healthy and thriving’3. Although it is not known what causes colic3, gastrointestinal factors, such as intolerance to milk or lactose are often cited by clinicians3. Parenting behaviour, such as overstimulation or anxiety, may also be a contributing factor4.

Whatever the cause, colic may affect parent-child relationships and influence early breastfeeding cessation or the introduction of solid foods earlier than would normally happen5.

The most useful intervention by a healthcare professional is providing support for parents and reassurance that infantile colic will resolve usually by 3-4 months of age and by 6 months at the latest2.

 

How do I know an infant has colic?

A diagnosis of colic should be preceded by a thorough examination and patient history to limit the risk of missing serious underlying medical problems2.

The history and examination should include the2:

  • General health of the baby.
  • Antenatal and perinatal history.
  • Onset and length of crying.
  • Nature of the stools.
  • Feeding assessment.
  • Mother’s diet if breastfeeding.
  • Family history of allergy.
  • Parent’s response to the baby’s crying.
  • Factors that lessen or worsen the crying.

If inconsolable crying is the sole symptom, other typical behaviours associated with colic are2,4:

  • Clenched fists, drawing up knees, arching back while crying.
  • Crying most often occurring in the late afternoon or evening.

 

Helping parents manage colic

When a baby is suffering from colic it can be traumatic for the parents, who may feel like they are doing something wrong or that they haven’t established a relationship with their baby2. It is important to reassure the parents that there is nothing medically wrong with the baby and it is a phase that will pass over the course of 3-4 months2.

Strategies for soothing their child can be employed including gentle motion (e.g., pushing the pram), a warm bath or creating ‘white noise’ (e.g., vacuum cleaner or running tap)2.

Holding the baby during a period of excessive crying maybe helpful2 and some babies may indicate they want to be held4. However, if the crying is proving intolerable for the parent, taking a break is important. In fact, it is crucial that the parents take time to consider their own health and mental well-being and rest when the baby is asleep. Asking friends and family for support should also be encouraged, along with meeting other parents with babies of the same age2. CRY-SIS, a support group for families (www.cry-sis.org.uk) is available to provide further advice and reassurance.

 

Infant formula for the dietary management of colic in bottle-fed infants

Also referred to as hydrolysed, or partially hydrolysed, these formulae are either casein or whey based and because the proteins are already partially broken down, they may be easier for the infant to digest. There is increasing support for the use of these formulae in alleviating symptoms of colic6. A study conducted in 2008 found that infants fed a hydrolysed formula showed a greater reduction in crying compared to alternative treatment methods such as massage7.

There is increasing evidence to suggest that adding prebiotic oligosaccharides to an infant’s diet can have a positive effect on their digestive system8,9. Prebiotic oligosaccharides are a particular set of carbohydrates that help reduce the presence of unwanted pathogens in the gut and increase the amount of friendly bacteria such as bifidobacteria and lactobacilli10. Prebiotic oligosaccharides are now included in some brands of infant formula milk to help increase the amount of friendly bacteria.

While not highlighted in the NICE CKS review, many studies have shown that these friendly bacteria, also known as probiotic bacteria, may help reduce the episodes of crying in infants suffering from colic3,9,11. One study found that probiotics were actually more effective at relieving symptoms of colic than simeticone drops, which are often used as a first line treatment response11.

 

Clinical research

Nutritionally complete milk products suitable from birth for the dietary management of colic and constipation in bottle-fed infants are available. In several studies, partially hydrolysed milk formula containing a patented mix of prebiotic oligosaccharides (GOS/FOS 9:1) was shown to increase the presence of beneficial gut bacteria10,12,13. Other benefits include reduction in the likelihood of flatulence and intestinal discomfort12 while the presence of partially hydrolysed protein may aid digestion. In a study of 604 infants, switching to partially hydrolysed milk formula was found to reduce the frequency of crying episodes in 79% of those infants suffering from colic14.

 

Summary

Infantile colic is a condition that can be very distressing for parents. The reassurance that symptoms are unlikely to last longer than 4 months is the recommended first step, along with offering support options such as friends, family and helplines. While medical treatments are generally only recommended if parents feel unable to cope, experts recognise the role that specialist infant formulas may have in the dietary management of this common and distressing issue in formula-fed infants15.

  1. Drug and Therapeutics Bulletin. Management of Infantile Colic [Online]. 2013. Available At: http://dtb.bmj.com/content/51/1/6.full.pdf+html [Accessed September, 2014].
  2. NHS Clinical Knowledge Summary. Colic – Infantile – Management [Online]. 2012. Available At: http://cks.nice.org.uk/colic-infantile [Accessed November 2016].
  3. Savino, F. et al. Reduction of Crying Episodes Owing to Infantile Colic: A Randomized Controlled Study on the Efficacy of A New Infant Formula. European Journal of Clinical Nutrition 2006;60: 1304-1310.
  4. Reust, CE. Diagnostic Workup Before Diagnosing Colic. Archives of Family Medicine 2000;9(3): 282-3.
  5. Journal of Family Health Care. Management of Infantile Colic [Online]. 2014. Available At: http://www.jfhc.co.uk/management-of-infantile-colic/ [Accessed September, 2014].
  6. Lucassen, P. Colic in Infants. Clinical Evidence 2010; 2010: 0309.
  7. Arikan D. Effectiveness of Massage, Sucrose Solution, Herbal Tea or Hydrolysed Formula in the Treatment of Infantile Colic. Journal of Clinical Nursing 2008;17(13): 1754-61.
  8. Savino, F. et al. Advances in the Management of Digestive Problems During the First Months of Life. Acta Paediatrica 2005;94(S449): 120-124.
  9. Parracho, H., McCartney, Al. & Gibson, Gr. Probiotics and Prebiotics in Infant Nutrition. Proceedings of the Nutrition Society 2007;66: 405-411.
  10. Knol, J. et al. Colon Microflora in Fants Fed Formula with Galacto- and Fructo-Oligosaccharides: More Like Breast-Fed Infants. J Pediatr Gastroenterol Nutr 2005;40: 36-42.
  11. Savino, F. et al. Lactobacilus Reuteri (American Type Culture Collection Strain 55730) Versus Simethicone in The Treatment of Infantile Colic: A Prospective Randomized Sudy. Pediatrics 2007;119: 124-130.
  12. Moro, G. et al. Dosage-Related Bifidogenic Effects of Galact- and Fructooligosaccharides in Formula-Fed Term Infants. J Pediatr Gastroenterol Nutr 2002;34(3):291-5.
  13. Costalos, C. et al. The Effect of A Prebiotic Supplemented Formula on Growth and Stool Microbiology of Term Infants. Early Hum Dev 2008;84:45-9.
  14. Savino, F. et al. “Minor” Feeding Problems During the First Months of Life: Effect of A Partially Hydrolysed Milk Formula Containing Fructo- and Galacto-Oligosaccharides. Acta Paediatrica 2003;92(S441): 86-90.
  15. Vandenplas et al. Algorithms for Managing Infant Constipation, Colic, Regurgitation and Cow’s Milk Allergy in Formula-Fed Infants. Acta Paediatr. 2015 May;104(5):449-57