What is the first line of management for infantile colic?

From the Guidelines

The first line of management for infantile colic should be L. reuteri DSM 17938, especially in breastfed babies, as recommended by the ESPGHAN working group 1. This approach is based on the most recent guidelines and position papers in pediatric nutrition, which suggest that L. reuteri DSM 17938 can be effective in treating infantile colic. Some key points to consider when managing infantile colic include:

• Reassurance and supportive care for parents, emphasizing that colic is a benign, self-limiting condition
• Strategies such as holding the baby, using gentle rocking motions, providing white noise, and ensuring proper feeding techniques to minimize air swallowing
• For breastfed babies, L. reuteri DSM 17938 can be a useful adjunct to these supportive measures, as recommended by the ESPGHAN working group 1
• It is essential to note that the evidence for other probiotics is less supportive, and safety aspects should be considered, particularly in premature neonates, immunocompromised patients, and critically ill patients 1
• Maintaining a consistent daily routine and addressing potential contributing factors such as overstimulation and gastrointestinal discomfort can also be beneficial.

From the Research

Definition and Management of Infantile Colic

• Infantile colic is a condition characterized by paroxysmal episodes of unexplained full force crying for at least three days a week and continuing for one week or more in a thriving well-nourished infant 2.
• The management of infants with colics is difficult due to several factors involved in the etiopathogenesis, including food intolerance or allergy to cow's milk protein, intolerance to lactose, intestinal hyperperistalsis, neuro-hormonal immaturity, maternal anxiety, and familial stress 2.

First Line of Management

• The first line of management for infantile colic includes non-pharmacological interventions such as pacifier, rocking, dull continuous background noise, hot water bottle on the abdomen, herbal tea, and simethicone 2.
• Dietary modifications, such as a diet with no milk or products containing its proteins, or fish, or eggs for breast-fed infants, and soy milk or hydrolyzed casein milk formula for non-breast-fed infants, may also be considered 2.

Probiotics as a Treatment Option

• Probiotic supplementation, particularly with Lactobacillus reuteri, has been shown to be effective in reducing crying time and treating infantile colic in breastfed infants 3, 4.
• However, the evidence supporting probiotic use for the treatment of infant colic in formula-fed infants remains unresolved 3, 4.

Other Treatment Options

• Pharmacological treatment, including antispastic drugs such as cimetropium bromide, may be considered for severe infantile colic 2, 5.
• Complementary and alternative treatments, such as herbal supplements, manipulative approach, and acupuncture, have limited evidence supporting their use 5, 6.