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Diagnosis and treatment of Infantile Colic PowerPoint Presentation
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Diagnosis and treatment of Infantile Colic

Diagnosis and treatment of Infantile Colic

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Diagnosis and treatment of Infantile Colic

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  1. Diagnosis and treatment of Infantile Colic Aaron E. Carroll, MD, MS

  2. Disclosure • Aaron E. Carroll, MD, MS has documented that he has no relevant financial relationships to disclose or COIs to resolve.

  3. Definition • Infantile colic is unexplained inconsolable crying in otherwise health infants in early weeks of life • Peaks 6-8 weeks, and resolves by 3-4 months • Wessel Criteria: • Crying episodes for more than 3 hours per day • Three or more days per week • Three or more weeks

  4. Epidemiology • Accounts for up to 20% of pediatrician visits in the first four months of life • Proposed causes include: • Alterations in gut hormones or microflora • Gas • Lactoste intolerance or cow milk protein allergy • Behavioral issues, family tension, parental anxiety • Nervous system imbalance

  5. Confusion • Variety of causes have led to a variety of treatments • Very few proven to work • Most confounded by the fact that pretty much all colic resolves • The vast majority of colic needs no workup

  6. This doesn’t make parents feel better • Colic is extremely stressful • Leads to parental exhaustion • Loss of patience • Ready frustration • Difficulties with concentration • Fears of harming child • Early discontinuation of breast feeding • Reduced face-to-face time with infant • Potentially increases risk of maternal depression

  7. Many, many studies • Fortunately, colic is well studied • There have been a number of systematic reviews • Will review many of them and offer results • Will help when talking to parents of infants with colic

  8. Dietary Management • 2012 Systematic review examined studies of dietary interventions for infantile colic • After reviewing 742 articles, 24 met inclusion criteria • 23 of these were randomized controlled trials • All examined infants less than 6 months of age • Babies had to be healthy and developing normally • Moms had to be 18-45 and also healthy

  9. Dietary Management - Findings • Six studies looked at breastfeeding mom’s diets • One found mom changing to hypoallergenic diet reduced colic from 56% to 15% • NNT = 2.5 • A small RCT found that eliminating milk had no effect • Other studies had no effect

  10. Dietary Management - Findings • Thirteen studies examined the use of hydrolyzed formulas • One RCT found an effect, but no non-hydrolyzed formula was used • NNT=5 to resolve symptoms • Other studies found a similar effect, diminishing with time • In fact, most studies found that hydrolyzed formulas reduced the symptoms of colic, even in breastfed infants

  11. Dietary Management - Findings • Three studies examined the effects of soy based formulas • These were not the best quality • Results suggest that soy based formulas might reduce the symptoms of colic, but more evidence is needed to recommend them as strongly as hydrolyzed formulas • One study found that fiber enriched formula didn’t work • Three studies examining fruit juice were similarly negative

  12. Pharmacologic Management - Findings • Simethicone has been studied, based on the idea that gas is causing colic • Studies show no difference between simethicone and placebo • Dicyclomine hydrochloride reduced infant crying time from 4 hours to 1 hour per day • Side effects make this hard to justify • Cimetropium bromide worked as well, but is similarly plagued by side effects • All of these studies have methodological issues

  13. Behavioral Management - Findings • One study found no improvement with increased carrying during episodes • One study found that two weeks of counseling for strategies to manage colic made no difference • One study found an improvement with decreased stimulation, but was significantly flawed

  14. Naturopathic Management - Findings • Lactobacillus findings have been mixed • Some trials positive, but flawed and contested • Future studies are pending • Glucose and sucrose have been studied • “Positive” results, but not in a meaningful way • Not enough evidence to recommend this strongly

  15. Naturopathic Management - Findings • Herbal remedies are popular • But many of the studies are hard to “replicate” • A study of fellel oil found it superior in achieving a response • NNT = 2.5 • Herbal tea containing chamomile, vervain, licorice, fennel, and balm-mint also reduced colic criteria • NNT = 3

  16. Manipulative Management - Findings • Some studies of spinal manipulation have been done • Many have non-significant results • Some studies have actually had results go in the opposite direction • Little evidence for this to work at all • Almost no studies are blinded and therefore subject to significant bias

  17. What to do? • REASSURE • Reassure again • Do not work up • Do not use drugs or manipulative treatments

  18. What to do? • If breastfeeding, consider a hypoallergenic diet • If bottlefeeding, consider a hydrolyzed formula • Consider herbal tea or fennel oil, but be sure of ingredients • Weigh the benefits versus the harms

  19. Questions? • Email: aaecarro@iupui.edu • Twitter: @aaronecarroll • YouTube: Healthcare Triage