What are the treatment options for infantile colic?

Treatment Options for Infantile Colic

For infants with colic, first-line management should include parental reassurance and support, followed by dietary modifications such as maternal elimination diet for breastfed infants or hydrolyzed protein formulas for formula-fed infants, while probiotics (particularly Lactobacillus reuteri) may be beneficial for breastfed infants. 1, 2

Understanding Infantile Colic

• Infantile colic affects approximately 10-40% of infants worldwide, typically peaks at around 6 weeks of age, and resolves by 3-6 months 2
• It is characterized by paroxysms of inconsolable crying for more than 3 hours per day, more than 3 days per week, for longer than 3 weeks 2
• The condition is benign but causes significant distress to families 3

First-Line Management Approaches

Parental Support and Reassurance

• Providing reassurance about the benign and self-limiting nature of colic is a key component of management 2, 4
• Explaining that symptoms typically resolve by 3-6 months of age can help reduce parental anxiety 2

Dietary Interventions

For Breastfed Infants:

• A 2-4 week maternal elimination diet restricting at least milk and egg may help alleviate symptoms 1
• Low-allergen maternal diets have shown favorable results in some studies 5
• The probiotic Lactobacillus reuteri (strain DSM 17938) has shown effectiveness for breastfed infants with colic 2

For Formula-Fed Infants:

• Switching to extensively hydrolyzed protein or amino acid-based formula can be considered 1, 2
• Hydrolyzed casein formulas have shown some scientific evidence of effectiveness 5
• Empiric formula switching for colic is not generally recommended without evidence of milk protein allergy 6

Feeding Techniques

• Reducing feeding volume while increasing feeding frequency may help minimize gastric distension 1
• Proper burping techniques after feedings can help reduce symptoms 1
• Keeping the infant in a completely upright position when awake may help reduce symptoms 1
• Avoiding seated positions after feeding can be beneficial 1

Pharmacological Options

Ineffective Treatments

• Simethicone has shown conflicting results in studies and is generally not recommended 2, 5
• Proton pump inhibitors are ineffective for the treatment of colic 2
• Dicyclomine hydrochloride has been shown to be effective but is contraindicated in infants due to significant safety concerns 2, 7

Complementary and Alternative Approaches

Limited Evidence Treatments

• There is limited evidence supporting the use of complementary and alternative treatments such as herbal supplements, manipulative approaches, and acupuncture 3
• Evidence does not support chiropractic or osteopathic manipulation, infant massage, swaddling, or acupuncture 2

Behavioral Interventions

• Studies on decreased stimulation have shown favorable results, though with poor methodological rigor 5
• Increased stimulation has shown unfavorable results 5

Monitoring and Follow-up

• Close monitoring of weight gain is critical to ensure the infant is thriving despite colic symptoms 1
• If no improvement is seen after 2 weeks of feeding changes, consider evaluating for other causes 1
• Warning signs requiring immediate evaluation include bilious vomiting, gastrointestinal bleeding, consistently forceful vomiting, fever, or abdominal tenderness/distension 1

Common Pitfalls to Avoid

• Overdiagnosis and overtreatment with medications before trying conservative measures 1
• Using soy-based formulas or lactase therapy, which have no proven role in the management of infantile colic 4
• Failing to provide sufficient parental support, which is essential in all cases of infantile colic 4