What are the recommended treatments for infantile colic?

Management of Infantile Colic

For infantile colic, the strongest evidence supports the use of Lactobacillus reuteri DSM 17938 probiotic supplementation for breastfed infants, while parental reassurance and education about the benign, self-limiting nature of colic is crucial for all cases. 1, 2

Definition and Clinical Presentation

• 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
• Equal incidence between sexes with no correlation to feeding type, gestational age, or socioeconomic status

Evidence-Based Treatment Approach

First-Line Interventions:

1. For Breastfed Infants:

   • Lactobacillus reuteri DSM 17938 probiotic supplementation at a daily dose of 10^8 CFU
   • Reduces crying time by approximately 65 minutes per day 1, 3
   • Number needed to treat: 5 (95% CI: 4-8) 3

2. For Formula-Fed Infants:

   • Consider switching to extensively hydrolyzed protein formula 4
   • Evidence is less robust than for probiotics in breastfed infants

3. Maternal Dietary Modifications:

   • Trial of maternal exclusion diet restricting milk and egg for 2-4 weeks for breastfeeding mothers 1

Behavioral Interventions:

• Gentle rocking
• White noise
• Swaddling
• Decreased stimulation 4

Medications and Interventions to Avoid

1. Cough suppressants and over-the-counter medicines:

   • Should not be used as they may cause significant morbidity and mortality, especially in young children 5

2. Simethicone:

   • Conflicting results with limited evidence of effectiveness 4, 6

3. Dicyclomine hydrochloride:

   • Not recommended in children younger than six months due to potential side effects 6

4. Acid suppressive therapy:

   • Should not be used solely for symptoms without evidence of GERD 5

5. Acupuncture:

   • Not effective for infantile colic based on four RCTs showing no or minimal effect on crying duration 2

Supporting Parents

• Provide clear reassurance about the benign and self-limiting nature of colic
• Validate parental distress and frustration
• Determine parental expectations and address specific concerns 5
• Encourage caregiver self-care and respite
• Explain the typical time course: symptoms usually peak at 6 weeks of age and resolve by 3-4 months

Important Considerations

• All studies with follow-up until or beyond three months of age show a steep decline over time in crying duration in both treatment and control groups 2
• Infantile colic is a diagnosis of exclusion - ensure other pathologies are ruled out
• Avoid exposure to tobacco smoke and other environmental irritants 5

When to Consider Referral

• If symptoms persist beyond 4 months of age
• If there are red flags suggesting other diagnoses (vomiting, poor weight gain, fever, lethargy)
• If parents are experiencing significant distress or inability to cope

Infantile colic remains challenging to treat, but with appropriate support and evidence-based interventions, most families can successfully manage this temporary condition until its natural resolution.