The exact cause of colic remains uncertain, with various theories proposed, including issues related to attachment, infant temperament, food intolerances, gastrointestinal nervous system hyperstimulation, intestinal gas, and physiological immaturity in infants. Researchers are increasingly exploring the possibility of an altered gut microbiome as a contributing factor to colic symptoms.
A systematic review by Simonson et al, demonstrates that probiotics are effective in treating infantile colic. Oral probiotic administration to breastfed infants led to a significant reduction in crying time by at least 50% compared to a placebo. The evidence also supports the safety, cost-effectiveness, and efficacy of probiotics in reducing colic symptoms.
Probiotics, like Lactobacillus reuteri, have been explored as a treatment for infant colic. L. reuteri, a natural human gut coloniser, may correct gut flora imbalances, reduce inflammation, and alleviate colic symptoms. Its effects on the intestinal epithelium involve inhibiting pathogenic bacteria growth, immune system modulation, anti-inflammatory actions, and reducing visceral pain through direct interaction with enteric nerves. These actions collectively contribute to the potential relief of colic symptoms in infants.
A study involving 162 clinically healthy infants aged less than five months meeting the Rome-IV diagnostic criteria for infantile colic showed that treatment with probiotics resulted in fewer days with colic and increased parental satisfaction with the improvement in their child’s attitude, attentiveness, activity level, and oral intake. All the babies responded well to the lactase treatment, and no significant side effects were recorded.
Probiotic drops are easily accessible options for treating colic, and those with vitamin D3 are especially beneficial. In a study by Narang et al, a clinically significant decrease in the duration of crying and fussing was observed in children who received lactase drops added to milk formula or breast milk before feeding, as compared to those who received a placebo during the entire four-week treatment period.
It’s important for healthcare professionals to inform parents that infantile colic is generally a self-resolving condition and supportive strategies like swaddling, soothing music, pacifiers, tummy time, and avoiding overstimulation or overfeeding can help. Clinicians should also stress the importance of seeking support from friends and family and provide clear guidance against striking or shaking a baby, and rule out other potential causes of infant fussiness, such as hunger, infection, trauma, constipation, or reflux.
Notably, L. reuteri is the most extensively studied probiotic and has proven effectiveness in treating colic. Probiotic supplements containing Bifidobacteria, Lactobacillus GG, and mixed strains also reduced colic symptoms in breastfed infants.
REFERENCES
Hjern A, et al. A systematic review of prevention and treatment of infantile colic. Acta Paediatrica, 2020: 1733-1744.
Johnson JM, et al. The gastrointestinal microbiome in infant colic: A scoping review. MCN: The American Journal of Maternal/Child Nursing, 2020; 47.4 (2022): 195-206.
Narang M, et al. Oral lactase for infantile colic: a randomized double-blind placebo-controlled trial. BMC Pediatrics 22.1, 2022: 1-8.
Simonson J, et al. Probiotics for the management of infantile colic: a systematic review. MCN: The American Journal of Maternal/Child Nursing 46.2, 2021: 88-96.
