Baby Colic - Treatment

Treatment

Currently, the first approach most commonly recommended in healthy babies (without any "red flag" symptoms) is to use non-medicinal, noninvasive treatments like burping, stomach massage and gas release techniques as well as symptomatic and emotional support.

Some reports have associated colic to changes in the bacterial balance in a baby's intestine. They suggest treating the crying with daily doses of probiotics, or "good bacteria" (such as Lactobacillus acidophilus or Lactobacillus reuteri). In one study, 83 colicky babies given Lactobacillus reuteri had reduced crying time. After one week, treated babies had close to 20% less crying time (159 min/day vs. 197 min/day). By 4 weeks, treated babies had 74% less crying (51 min/day vs. 197 min/day). Overall, there was a 95% positive response to the Lactobacillus reuteri probiotic drops in colicky infants. However this study was not blinded so further studies are needed.

It has been an age-old practice to drug crying infants. During the second century BC, the Greek physician, Galen, prescribed opium to calm fussy babies, and during the Middle Ages in Europe, mothers and wet nurses smeared their nipples with opium lotions before each feeding. Alcohol was also commonly given to infants.

In past decades, doctors recommended treating colicky babies with sedative medications (e.g. phenobarbital, Valium, ethanol), analgesics (e.g. opium) or anti-spasm drugs (e.g. scopolamine, Donnatal, dicyclomine), but all of these have been stopped because of potential serious side-effects, including death.

Another age-old practice recommended by doctors is the "cry-it-out" approach (also known as "controlled crying.") The "cry-it-out" approach refers to the practice of leaving crying babies in their cribs and letting them cry themselves to sleep. First recommended in the U.S. by Luther Emmett Holt, it was later also recommended by Benjamin Spock in his best-selling book, Baby and Child Care. More recently, Richard Ferber has recommended a modified version of this approach.

Several pediatricians and psychologists have claimed that the "cry-it-out" approach is harmful to infants because it can interfere with the development of trust and secure attachment. Researchers have found that infants become more securely attached when their parents respond promptly to their cries.

There is evidence that leaving babies to cry alone can increase their emotional stress level. Researchers measured saliva cortisol levels in 25 infants during a sleep training program in which the infants were left to cry themselves to sleep over a three-day period. The infants’ cortisol levels were elevated when they were left to cry alone, indicating a state of high emotional stress. However, the cortisol levels remained high even on the third day, after the infants had stopped crying. This implies that, even though the sleep training program appeared to "work" and the infants fell asleep without crying, their stress levels were still high. Another study found that even brief separations between mothers and their 9-month-old infants can result in elevated infant cortisol levels, indicating emotional stress.

There is a broad body of evidence showing that colic symptoms can be eased through soothing measures, such as pacifiers, strong white noise and jiggly rocking are effective in calming babies during crying bouts. These techniques form the core of the "5 S's" approach:

1. Swaddling (safe swaddling carefully avoiding overheating, covering the head, using bulky or loose blankets, and allowing the hips to be flexed);
2. Side or stomach (holding a baby on the back is the only safe position for sleep, but it is the worst position for calming a fussy baby;)
3. Shhh sound (making a strong shush sound near the baby's ear or using a CD of womb sound/white noise);
4. Swinging the baby with tiny jiggly movements (no more than 1" back and forth) always supporting the head and neck;
5. Sucking (Letting the baby suckle on the breast, a clean finger or a pacifier)

Although soothing techniques (such as movement, sucking, or shushing sounds) can lead to a short-term cessation of crying, it has been suggested that these techniques may serve only to postpone the crying. The absence of crying does not necessarily imply emotional well-being. It can also indicate dissociation, a state of psychological numbing seen in stressed or traumatized infants, during which stress hormone levels (such as epinephrine and cortisol) remain high, but the infants appear to be calm. Researchers have found that infants can have elevated cortisol levels in the absence of crying, while sucking on a pacifier.

Another approach to colic is the "crying-in-arms" approach, in which the parent lovingly holds the crying infant while letting the crying run its course (after all immediate needs have been met). This approach differs from the "cry-it-out" approach because the infant is never left to cry alone. It also differs from the soothing approaches because the goal is not to cut the crying short, but rather to accept the crying and support the infant through it. The "crying-in-arms" approach is based on the assumption that persistent crying during infancy can be the result of accumulated stress or unhealed trauma (such as a traumatic birth), and that allowing the infant to cry in arms will provide long-term psychological and physiological benefits. There appears to be some evidence for the effectiveness of the "crying-in-arms" approach, including an improvement in infant sleep.

In a breastfed baby, the doctor may suggest eliminating all stimulant foods (e.g. coffee, tea, cola, chocolate, decongestants, diet supplements, etc.) from a mother's diet for a few days to evaluate for improvements in the baby's condition. If food allergy is suspected, the doctor may suggest a hypoallergenic formula for a formula fed infant or, if the mother is breastfeeding, a period of elimination of allergenic foods (e.g. dairy, nuts, soy, citrus, etc.) from her diet in order to observe changes in the baby's condition. If the crying is related to a cow's milk allergy benefits are usually seen within 2–7 days. Mothers can then choose to add back small amounts of the suspected offending food a little bit at a time as long as persistent crying does not reappear. If crying reappears, the offending foods may need to be avoided for many months.

Persistently fussy babies with poor weight gain, vomiting more than 5 times a day, or other significant feeding problems should be evaluated by a healthcare professional for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).

Several studies demonstrated benefits of herbal remedies containing fennel. In one study S. Savino et al. used extracts of three plants, including fennel. In another study Sergei Shushunov et al. successfully used fennel oil emulsion.