Parenting an infant can be totally overwhelming. One of the earliest challenge many face is learning to deal with periods of intractable crying. I often speak with sleep deprived parents when they’re looking for something — anything — to stop their baby from crying. They’ve typically been told by friends of family that their baby must have “colic” and they’ve come to the pharmacy, looking for a treatment. Colic is common, affecting up to 40% of babies in the few months of life.
While distressing, colic is a diagnosis of exclusion — that it, it is given only after other causes have been ruled out (hunger, pain, fatigue, etc.). The most common definition for colic is fussing or crying for more than 3 hours per day, more than 3 days per week, for more than 3 weeks. These criteria, first proposed by Morris Wessel in 1954, continue to be used today. However, scientific evidence to explain the cause is lacking. Ideas proposed include:
changes in gastrointestinal bacteria/flora
excess gas in stomach
cramping or indigestion
intolerance to substances in the breast milk
behavioural issues secondary to parenting factors
Despite its intensity, colic resolves on its own with no interventions. By three months of age, colic has resolved in 60% of infants. By four months, it’s 90%. It sounds harmless and short-lived, but colic’s ability to induce stress in parents cannot be overstated. Parents may be angry, frustrated, depressed, exhausted, or just feel guilty, ascribing their baby’s cries to some parenting fault.
Given our lack of understanding of the true cause of colic, there’s no shortage of cures that have been proposed. From drugs, to supplements, to manual therapies, everyone has their preferred intervention. As a pharmacist, I’m usually asked about drug and non-drug treatments. In particular, I’m often asked about gripe water — a cocktail of different ingredients, involving some combination of herbs, sodium bicarbonate, sugar, and alcohol. Invented by pharmacist William Woodward in the 1800’s, gripe water was originally develop to treat the fevers of malaria. Over time, it was felt to be helpful for babies with colic — though no rigorous evaluation has ever been conducted [PDF].
So what does work for colic? My usual advice to parents starts with reassurance. It’s not bad parenting, and it will pass, given enough time. But the lack of a clear cause and simple solution is not satisfying to many that I speak with. A discussion of stress management, dietary changes, or feeding changes (all usually recommended as first-line approaches) leaves few satisfied. Some are determined to leave the pharmacy with something. “What about this?” they’ll say, gesturing to a product on the shelf. “Will this help?” And that’s when it’s time to distill the evidence. Nicely, we have two new complementary (I don’t mean that in the CAM sense) systematic reviews published in 2011 that, together, cover most of the common treatments. The first review, Infantile colic: A systematic review of medical and conventional therapies by Belinda Hall and associates in Victoria, Australia, looked at “conventional” treatments — drugs, behavioural therapy, and dietary changes. The second, Nutritional Supplements and Other complementary medicines for infantile colic: A systematic review, is from Rachel Perry, Katherine Hunt, and Edzard Ernst. It looked at CAM therapies — supplements, nutritional products, and manual therapies. The two reviews overlapped with respect to nutritional products. Both papers are behind paywalls — I’ll summarize the highlights of both reviews.
The Hall paper was published the Journal of Pediatrics and Child Health earlier this year. A systematic review, it sought to examine all randomized interventions, cohort studies, and quasi-experimental studies for colic. Despite the ubiquity of colic, there have been few proper evaluations done. In a 30-year search of the literature, only 19 published trials were identified: five on drug treatments, ten on nutritional interventions, and four on behavioural interventions. All studies of drug products had significant quality limitations, including a lack of blinding and randomization information, unclear statisitical analyses, and in one case, no comparison of baseline demographics.