What are the treatment options for a baby with colic?

Management of Infantile Colic

For infantile colic, Lactobacillus reuteri (strain DSM 17938) probiotic supplementation is recommended as first-line treatment for breastfed infants, while extensively hydrolyzed protein formula should be considered for formula-fed infants. 1

Definition and Prevalence

Infantile colic is defined as:

• Paroxysms of inconsolable crying for more than 3 hours per day
• Occurring more than 3 days per week
• Lasting longer than 3 weeks
• In an otherwise healthy infant 1, 2

This condition affects approximately 10-40% of infants worldwide, with equal incidence between sexes and no correlation to feeding type, gestational age, or socioeconomic status. Symptoms typically peak around 6 weeks of age and resolve by 3-6 months. 2

Evidence-Based Treatment Options

For Breastfed Infants:

1. Probiotic supplementation:

   • Lactobacillus reuteri (strain DSM 17938) has the strongest evidence, reducing crying time by approximately 65 minutes per day 1
   • This is specifically recommended by the American Academy of Pediatrics 1

2. Maternal dietary modifications:

   • Trial of maternal exclusion diet restricting milk and egg for 2-4 weeks 1
   • This approach is recommended by the American Family Physician 1

For Formula-Fed Infants:

• Switch to extensively hydrolyzed protein formula 1, 2
• Evidence for this intervention is not as strong as for probiotics in breastfed infants

General Management Strategies:

• Parental reassurance and education about the benign, self-limiting nature of colic 1
• Behavioral techniques:
  • Gentle rocking
  • White noise
  • Swaddling
  • Responding quickly and appropriately to infant cues 3

Ineffective Treatments to Avoid

• Simethicone (anti-gas medication) - ineffective 2
• Proton pump inhibitors - ineffective 2
• Dicyclomine - contraindicated due to safety concerns 2

Supporting Parents

Parents of colicky infants experience significant distress. Key interventions include:

• Validating parental distress and frustration
• Encouraging caregiver self-care and respite
• Providing reassurance about the benign nature and self-limiting course (typically resolves by 3-6 months of age) 1, 4

Behavioral Modification

Research shows that modifying parent-infant interactions can significantly reduce crying time. In one study, individualized counseling and education for parents reduced crying from 3.79 hours per day to 1.12 hours per day 3. Teaching parents to respond quickly and appropriately to infant cues can be an effective non-pharmacological approach.

Important Caveats

• Colic is a diagnosis of exclusion - a thorough history and physical examination must rule out other causes of excessive crying 2
• While colic is benign and self-limiting, it causes significant parental stress and anxiety, which should not be dismissed 4
• Evidence for most colic treatments is generally of low quality, with the strongest evidence supporting L. reuteri for breastfed infants 1