Colic and Probiotics – A Cure for the Crying?

Colic is a syndrome that appears in up to 20% of infants. It is generally defined by a set of criteria in which a baby between the ages of 2 weeks and 16 weeks cries inconsolably for at least 3 hours a day for at least 3 days a week, lasting at least 3 weeks. Colic has no defined etiology, and no effective treatments. But, any parent who has suffered through a baby with colic would be willing to try almost any remedy to soothe a crying baby.

While colic poses no direct threat to an infant, it can have significant consequences to the child and the family. To the baby himself, colic may lead to poor growth and development if normal sleep and feeding is interrupted. For the family as well, colic causes severe emotional distress, and babies with colic are at increased risk for abuse and shaken baby syndrome owing to parents’ frustrations. Over the years, everything from diet modifications for the infant (or mother, if baby is breast-fed) to gas-relieving medications to motion and sound machines to reducing stimuli altogether have been recommended in an effort to quell the cries of the infant, but nothing has proved effective. Until now, that is.

A new study published in the Journal of Pediatrics is among the first to report the effectiveness of a treatment for colic after a randomized, placebo-controlled, double-blind study. The authors report that the probiotic Lactobacillus reuteri significantly reduced crying time among infants with colic, compared to placebo. The subjects included 50 exclusively breast-fed infants, and were administered either L. reuteri or placebo daily for 21 days. At baseline, average crying times were 370 minutes/day for the L. reuteri group and 300 minutes/day for the placebo group. At the end of the 3 week study, crying times were significantly reduced to 35 minutes/day in the intervention group and 90 minutes/day in the placebo group. Even by day 7, the number of babies whose crying time had reduced by 50% from baseline was significantly higher among infants receiving L. reuteri than those receiving placebo. No adverse effects were reported among the infants, nor were any differences in weight gain, stool frequency, or incidence of constipation or regurgitation.

This is not the first study to show that probiotics might be helpful in reducing colic symptoms, but previous studies were not blinded or placebo-controlled. The mechanism behind the effectiveness of L. reuteri in reducing colic symptoms is unknown. Likely, it involves restoring normal gut flora and motility and reducing pain perception. Replication of the results among larger populations of infants will help define the mechanism. Several clinical trials involving L. reuteri and other strains of probiotics are underway worldwide, and the results are much anticipated among parents and pediatricians.

First and foremost, a diagnosis of colic should come after other medical or feeding problems have been ruled out. Continued reassurance of the parents until the colic resolves is often the only valuable management for colic. It is hard to imagine through the days and nights of incessant crying that there is nothing truly wrong with a baby, or that the parents are not doing something wrong, but colic will resolve without long-term effects on the baby or family. (Other than painful memories of sleepless days and nights.)

For families with a colicky infant, a reduction in crying times like seen in the study could prove to be a life-saver. But, colic is self-resolving, and it is difficult to say for certain that the infants did not outgrow the syndrome during the study period, or that some other intervention made a difference in symptoms. Still, desperate parents will try anything that is safe to treat their baby’s colic. Probiotics are safe, do not pose a risk of drugs interactions or adverse effects, and should be further explored as a treatment for infant colic.

References

Rogovik AL, & Goldman RD (2005). Treating infants’ colic. Canadian family physician Medecin de famille canadien, 51, 1209-11 PMID: 16190173

Savino F, Cordisco L, Tarasco V, Palumeri E, Calabrese R, Oggero R, Roos S, & Matteuzzi D (2010). Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics, 126 (3) PMID: 20713478

Savino F, Pelle E, Palumeri E, Oggero R, & Miniero R (2007). Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics, 119 (1) PMID: 17200238

Savino F, & Tarasco V (2010). New treatments for infant colic. Current opinion in pediatrics PMID: 20859207

Shergill-Bonner R (2010). Infantile colic: practicalities of management, including dietary aspects. The journal of family health care, 20 (6), 206-9 PMID: 21319674