What are the treatment options for a baby with colic?

Treatment Options for Infantile Colic

For infants with colic, the most effective treatment approach includes parental reassurance about its benign nature, probiotics for breastfed infants, and consideration of formula changes for formula-fed infants, as colic is a self-limiting condition that resolves by 3-6 months of age. 1, 2

Understanding Infantile Colic

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. It affects approximately 10-40% of infants worldwide, typically peaks around 6 weeks of age, and resolves by 3-6 months of age. The incidence is equal between sexes with no correlation to feeding type, gestational age, or socioeconomic status. 1, 2

Evidence-Based Treatment Options

For Breastfed Infants:

• Probiotics: Lactobacillus reuteri (strain DSM 17938) supplementation is recommended by the American Academy of Pediatrics, as it has been shown to reduce crying time by approximately 65 minutes per day 1
• Maternal Diet Modifications:
  • Consider a trial of maternal exclusion diet restricting milk and egg for 2-4 weeks 1
  • Studies show that cow's milk proteins consumed by mothers can cause colic in breastfed infants 3

For Formula-Fed Infants:

• Formula Changes:
  • Consider switching to extensively hydrolyzed protein formula 1
  • Research shows that hydrolyzed formulas may provide improvement in up to 95.4% of cases, which is significantly better than pharmacological treatments (p<0.01) 4
• Soy Formula: May be beneficial for some infants, though empiric switch is not recommended for colic or irritability according to guidelines 5

General Management Approaches:

• Parental Support and Education: Explaining the benign, self-limiting nature of colic is crucial 1, 2
• Behavioral Techniques:
  • Gentle rocking
  • White noise
  • Swaddling
  • Holding (reported effective by 87% of parents)
  • Walking (67% effective)
  • Rocking (63% effective) 6

Treatments to Avoid

• Simethicone and proton pump inhibitors: Ineffective for treating colic 2
• Dicyclomine: Contraindicated in infants 2
• Empiric Formula Changes: Guidelines specifically note that empiric switching to soy, extensively hydrolyzed casein, or elemental formulas is not recommended for colic or irritability 5
• Alternative Therapies: Evidence does not support chiropractic or osteopathic manipulation, infant massage, acupuncture, or herbal supplements 2

Impact on Breastfeeding

• Mothers who use breastfeeding as a comforting technique tend to have longer overall breastfeeding duration 6
• However, mothers of infants diagnosed with colic are at risk for shortened duration of full breastfeeding 6

Supporting Parents

• Validate parental distress and frustration
• Encourage caregiver self-care and respite
• Educate about normal infant crying patterns and effective comforting methods
• Emphasize that colic is not caused by poor parenting and will resolve with time

Key Considerations for Clinical Practice

• Colic is a diagnosis of exclusion after ruling out concerning causes through history and physical examination
• The strongest evidence supports L. reuteri probiotics for breastfed infants
• Parental reassurance about the benign, self-limiting nature of colic is a cornerstone of management
• Breastfeeding as a comforting technique should be encouraged when appropriate

By implementing these evidence-based approaches, clinicians can help families navigate this challenging but temporary period in their infant's development.