Colic is often defined by the "rule of three": crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy. Medications available in the U.S. have not been proved effective in the treatment of colic, and most behavior interventions have not been proved to be more effective than placebo.1
In 1998, Lucassen, et al., performed a systematic review and concluded that dicyclomine was effective, but serious side effects had been reported such as breathing difficulties, seizures, syncope, asphyxia, muscular hypotonia, and coma. No benefit was shown for simethicone.2 In 2012, Hall, et al., published a systematic review of 19 studies and found there is little scientific evidence to support the use of simethicone, dicyclomine hydrochloride and cimetropium bromide.3
That same year, Bruyas, et al., conducted a systematic review and concluded that pharmaceuticals have not proven effective (simethicone, lactase), and some (dicyclomine) can cause potentially serious adverse reactions. Furthermore, the study concluded that the most validated treatments for infantile colic is the substitution of a hydrolysed cow's milk formula, the use of Lactobacillus reuteri and fennel extracts.4
Spinal Manipulative Therapy
In 1999, Wiberg, et al., designed a randomized, controlled trial comparing chiropractic to dimethicone and found that by trial days 4-7, hours of crying were reduced by one hour in the dimethicone group compared with 2.4 hours in the manipulation group. On days 8 through 11, crying was reduced by one hour for the dimethicone group, whereas crying in the manipulation group was reduced by 2.7 hours. From trial day five onward, the manipulation group did significantly better that the dimethicone group.5
In 2011, Alcantara, et al., conducted a systematic review of 26 articles and concluded that chiropractic care is an alternative approach to the care of the child with colic.6 And in 2018, Carnes, et al., performed a systematic review and meta-analysis of published, peer-reviewed primary research articles from the previous 26 years, searching nine databases. This study found moderate strength evidence for the effectiveness of manual therapy on reduction in crying time.7
In 2016, Harb, et al., carried a systematic review of 17 randomized, controlled trials which revealed that probiotics, in particular L. reuteri, and preparations containing fennel oil appear effective for reducing colic.8 In 2017, Schreck Bird, et al., performed a systematic review of five randomized, controlled trials and concluded that supplementation with the probiotic L. reuteri in breastfed infants appeared to be safe and effective for the management of infantile colic.9
Also in 2017, Gutierrez-Castrellon. et al., conducted a systematic review with network meta-analysis of 32 randomized, controlled trials including more than 2,000 patients. This study found that L. reuteri DSM17938 and some dietetic approaches are better to other interventions for treatment of infantile colic.10
In 2018, Sung, et al., published a meta-analysis of four double-blind, randomized, controlled trials involving over 300 patients. This study concluded that L. reuteri DSM17938 is effective and can be recommended for breastfed infants with colic.11
Spinal manipulative therapy and probiotics appear to be effective, natural interventions for the treatment of infantile colic. Further studies are warranted to confirm these findings.
- Roberts DM, Ostapchuk M, O'brien JG. Infantile colic. Am Fam Phys, 2004;70(4):735-40.
- Lucassen PL, Assendelft WJ, Gubbels JW, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ, 1998;316(7144):1563-9.
- Lucassen PL, Assendelft WJ, Gubbels JW, et al. Infantile colic: crying time reduction with a whey hydrolysate: A double-blind, randomized, placebo-controlled trial. Pediatrics, 2000;106(6):1349-54.
- Bruyas-bertholon V, Lachaux A, Dubois JP, Fourneret P, Letrilliart L. [Which treatments for infantile colics?]. Presse Med, 2012;41(7-8):e404-10.
- Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manip Physiol Ther, 1999;22(8):517-22.
- Alcantara J, Alcantara JD, Alcantara J. The chiropractic care of infants with colic: a systematic review of the literature. Explore, 2011;7(3):168-74.
- Carnes D, Plunkett A, Ellwood J, Miles C. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open, 2018;8(1):e019040.
- Harb T, Matsuyama M, David M, Hill RJ. Infant colic - what works: a systematic review of interventions for breast-fed infants. J Pediatr Gastroenterol Nutr, 2016;62(5):668-86.
- Schreck Bird A, Gregory PJ, Jalloh MA, et al. Probiotics for the treatment of infantile colic: a systematic review. J Pharm Pract, 2017;30(3):366-374.
- Gutirrez-castrelln P, Indrio F, Bolio-galvis A, et al. Efficacy of Lactobacillus reuteri DSM 17938 for infantile colic: systematic review with network meta-analysis. Medicine, 2017;96(51):e9375.
- Sung V, D'amico F, Cabana MD, et al. Lactobacillus reuteri to treat infant colic: a meta-analysis. Pediatrics, 2018;141(1).
Dr. Adrian Isaza is both a physician and an academic. As an academic, he authored a chapter of the book, The Role of Functional Food Security in Global Health, has authored more than 30 papers advocating the use of alternative medicine, and teaches graduate students at Everglades University for the alternative medicine degree program. As a clinician, he holds a diplomate in diagnosis (American Board of Chiropractic Internists) and a diplomate in nutrition (American Clinical Board of Nutrition).