Effectiveness of treatments for infantile colic: systematic review

Abstract

Objective: To evaluate the effectiveness of diets, drug treatment, and behavioural interventions on infantile colic in trials with crying or the presence of colic as the primary outcome measure. Data sources: Controlled clinical trials identified by a highly sensitive search strategy in Medline (1966-96), Embase (1986-95), and the Cochrane Controlled Trials Register, in combination with reference checking for further relevant publications. Keywords were crying and colic. Study selection: Two independent assessors selected controlled trials with interventions lasting at least 3 days that included infants younger than 6 months who cried excessively. Data synthesis: Methodological quality was assessed by two assessors independently with a quality assessment scale (range 0-5). Effect sizes were calculated as percentage success. Effect sizes of trials using identical interventions were pooled using a random effects model. Results: 27 controlled trials were identified. Elimination of cows' milk protein was effective when substituted by hypoallergenic formula milks (effect size 0.22 (95% confidence interval 0.09 to 0.34)). The effectiveness of substitution by soy formula milks was unclear when only trials of good methodological quality were considered. The benefit of eliminating cows' milk protein was not restricted to highly selected populations. Dicyclomine was effective (effect size 0.46 ( 0.33 to 0.60)), but serious side effects have been reported. The advice to reduce stimulation was beneficial (effect size 0.48 (0.23 to 0.74)), whereas the advice to increase carrying and holding seemed not to reduce crying. No benefit was shown for simethicone. Uncertainty remained about the effectiveness of low lactose formula milks. Conclusions: Infantile colic should preferably be treated by advising carers to reduce stimulation and with a one week trial of a hypoallergenic formula milk.

Reduction of crying episodes owing to infantile colic: a randomized controlled study on the efficacy of a new infant formula

“…Our findings show that infants fed with a partially hydrolysed formula, added with a mixture comprising 90% GOS and 10% FOS, had a significant decrease in colic episodes after 1 week of treatment compared to infants from the control group, confirming data of a previous observational study (Savino et al, 2003) and according to most of the diet studies on infantile colic (Lucassen et al, 1998(Lucassen et al, , 2000Garrison and Christakis, 2000). The difference in crying time was even more significant after 2 weeks of treatment.…”

“…Randomized controlled study for infantile colic F Savino et al symptoms (Miller-Loncar et al, 2004): Lucassen, in a recent review, reported that infantile colic should be treated preferably with a 1-week trial of a hypoallergenic formula (Lucassen et al, 1998). On the other hand, as Garrison suggested the need of further studies on existing and alternative dietary therapies (Garrison and Christakis, 2000), our study could represent a first step approaching colic from changing the feeding formula.…”

“…Simethicone was used in the CT because it is as effective as placebo in the treatment of infantile colic (Lucassen et al, 1998;Garrison and Christakis, 2000). The composition of the formulas used in the study is given in Table 1a; molecular weight percentage distribution of partially hydrolysed proteins in the new formula is reported in Table 1b.…”

“…Hypoallergenic formulas and mainly extensively hydrolysed formulas are effective in the treatment of infantile colic, indicating that dietary factors can play an important role (Lindberg, 1999;Jakobsson et al, 2000;Lucassen et al, 2000). However, considering the favourable clinical course of infantile colic, the wide range of manifestations, the day to day variability of crying time and the fact that many but not all the affected infants have symptoms related to cow's milk allergy, the majority of the studies on dietary interventions, particularly in formula-fed infants, concluded that further research is necessary (Lucassen et al, 1998;Garrison and Christakis, 2000).…”

Infant Massage Compared With Crib Vibrator in the Treatment of Colicky Infants

“…The benefit of cow's milk elimination has been shown in several studies, 12,13 and a 1-week trial with a hypoallergenic formula has been suggested for colicky infants. 14 However, no consensus about the role of cow's milk allergy or intolerance in colic has so far been reached. Parental counseling is beneficial 15,16 and is considered important in the current management of colic.…”