What are the treatment options for colic in infants?

Treatment Options for Infantile Colic

Probiotics containing Lactobacillus reuteri are the most effective first-line treatment for colic in breastfed infants, while formula-fed infants may benefit from switching to a hydrolyzed protein formula. 1, 2

Definition and Epidemiology

• Infantile colic is defined as paroxysms of inconsolable crying for more than 3 hours per day, more than 3 days per week, for longer than 3 weeks in an otherwise healthy infant
• Affects approximately 10-40% of infants worldwide
• Peaks at around 6 weeks of age and typically resolves by 3-6 months
• Equal incidence between sexes with no correlation to feeding type, gestational age, or socioeconomic status 2

Treatment Algorithm

First-Line Interventions:

1. For breastfed infants:

   • Lactobacillus reuteri (strain DSM 17938) probiotic supplementation
   • Meta-analysis shows L. reuteri markedly reduced crying time by approximately 65 minutes per day in breastfed infants with colic 1
   • Consider maternal dietary modifications:
     • Trial of maternal exclusion diet restricting milk and egg for 2-4 weeks 1
     • Elimination of potential allergens from maternal diet 3

2. For formula-fed infants:

   • Switch to extensively hydrolyzed protein formula 2, 3
   • If symptoms persist, consider switching to amino acid-based formula 3

3. For all infants:

   • Parental reassurance and education about the benign, self-limiting nature of colic
   • Behavioral techniques: gentle rocking, white noise, swaddling 3

Second-Line Interventions:

1. Feeding techniques:

   • Ensure proper feeding position
   • Frequent burping during and after feeds
   • Smaller, more frequent feedings

2. Environmental modifications:

   • Reduced stimulation
   • Consistent daily routine
   • Use of pacifier
   • Application of warm compress to abdomen 3

Ineffective or Not Recommended Treatments:

1. Medications to avoid:

   • Simethicone (no benefit over placebo) 4
   • Proton pump inhibitors (ineffective) 2
   • Dicyclomine (contraindicated due to significant adverse effects including drowsiness and respiratory symptoms) 4, 5

2. Other interventions with insufficient evidence:

   • Chiropractic or osteopathic manipulation
   • Infant massage
   • Acupuncture
   • Herbal supplements (except specific formulations in limited studies) 2

Evidence Quality and Considerations

The evidence for colic treatments is generally of low quality with small sample sizes and methodological limitations 4. Most studies show inconsistent benefits, with the exception of:

1. Probiotics: The strongest evidence supports L. reuteri for breastfed infants, showing consistent reduction in crying time 1, 2

2. Hydrolyzed formula: Moderate evidence supports switching to hydrolyzed casein formula for formula-fed infants 3, 5

3. Time: The most reliable "treatment" is time, as colic typically resolves spontaneously by 4-6 months of age 5

Parental Support

A crucial aspect of colic management is supporting parents through this challenging period:

• Provide reassurance about the benign nature and self-limiting course
• Validate parental distress and frustration
• Encourage caregiver self-care and respite
• Schedule regular follow-up to monitor progress and provide ongoing support

Pitfalls to Avoid

1. Failing to rule out other causes of excessive crying (infection, intussusception, trauma)
2. Overmedication with ineffective or potentially harmful agents
3. Dismissing parental concerns without providing adequate support
4. Excessive diagnostic testing in an otherwise healthy, thriving infant
5. Recommending frequent formula changes without adequate trial periods

Remember that while colic is distressing, it is a self-limiting condition with no long-term health consequences when appropriately managed.