Better Choices For Colic

As I work with small children in my practice, I am witnessing a distressing trend in the pediatric medical care of infantile colic.

Colic is described as a complex of symptoms in early infancy characterized by inconsolable crying that persists for long periods of time, apparent abdominal pain visualized by drawing of the legs to the chest or arching of the back with stiffening or rigidity of the legs, and irritability.¹ It has been defined by periods of crying or fussing for more than three hours a day, more than three days per week and lasting for more than three weeks.² It is most common in the late afternoon or evening hours and often starts around two weeks of age and can continue up to twelve weeks of age. Colic occurs in 20% to 39% of infants making it a very common parenting nightmare.³ Most infants with colic seem to eat well and gain weight appropriately. It has been speculated that colic may be associated with immaturity of the central nervous system, gastrointestinal intolerance to milk, or family distress.⁴ Other gastrointestinal causes include excessive intestinal gas, intestinal hypermotility, or digestive hormone imbalance.⁵ Excessive crying can cause aerophagia, swallowing of air, resulting in flatulence and abdominal distension,which may also be an early manifestation of an insistent and impatient personality.¹ The persistence of day after day crying spells brings chaos and family strain. Parents are distraught over the unexpected challenges their newborn brings, fatigued with sleeplessness, and desperate for any help. With the high rate of colic affecting so many infants, the help, support, and encouragement we can provide may help prevent occurrences of child abuse like shaken baby syndrome.

There is no unified definition and therefore no unified treatment protocol for infantile colic. Correct diagnosis is the key. A skilled doctor must first rule out other conditions with similar presentations such as allergies, vaccine reactions, viral infections, or bacterial infections as in thrush. A child should be referred if vomiting, cold symptoms with Respiratory Syncytial Virus (RSV) association, fever, hard stools, or lack of weight gain is present.

Without surprise, the typical western medical approach has fallen to the drug companies to help manage colic. Recommendations include, in exceptional circumstances, sedatives such as phenobarbital to be given to the child one hour prior to anticipated fussy period.¹ I am seeing increased use of other newer drugs like Zantac,which has not yet been safely and effectively established for use in infants less than one month of age.⁶ Many doctors have also recommended the use of over-the-counter gas drops,managing the symptoms without addressing the cause. The use of these drugs does not come without side effects. Adverse reactions to prescribed drugs are estimated to be 2.2 million per year. In annual deaths due to drug therapy⁷ in children under 2 years of age, 41% happened during the first month of life and 84% during the first year.⁸ I feel we need to step in and offer a safer way to care for our nation’s infants.

It is this doctor’s opinion that there are other options in the treatment of colic that are much safer. Some children respond well to being held,walked, rocked, or patted gently. Swaddling the child in a tight blanket may help them feel comfortably secure. Riding in the car or sitting on top of a running clothes dryer can sometimes provide relief. Soothing white noise like running a vacuum cleaner,washing machine, blow dryer, or clothing dryer may be used. Holding the infant close and making “shushing” noises into their ear along with rhythmic rocking has been shown to ease and calm the infant. Of course baby-wearing and co-sleeping offer the infant the contact comfort they are often craving.

If the infant has a strong sucking urge after eating, with a seemingly continued need to suckle, parents may want to ask their doctor of chiropractic about cranial care for their infant. Frequently, cranial misalignment causes a distress that is relieved by the sucking mechanism. Bottle feeding should be reduced to a minimum and when absolutely necessary. If bottle-feeding takes less than twenty minutes, a nipple with smaller holes should be tried. Gently massaging the child’s back with soothing oils or placing a warm water bottle on the infant’s stomach may offer relief. Darkening the child’s room and controlling household noise at naptimes may allow for uninterrupted rest.

Nursing mothers should take their diets into consideration. Eating warm cooked food like soup or broth while avoiding cold raw food is recommended. Mothers should remove dairy (except butter) from their diet and limit sugar intake as these are transferred to the infant. Foods that induce gas for the nursing mother should be avoided like broccoli, cabbage, cauliflower, lettuce, onions, peppers, garlic, or spicy foods. Caffeine and alcohol should be eliminated. Maternal use of diluted herbal tea remedies like chamomile, comfrey, fennel, dill, anise, and caraway can offer some help. Allergenic foods should also be avoided like cow’s milk, milk products,wheat, corn, citrus, eggs, yeast, soy or peanuts. Additionally,when mothers take digestive enzymes, their digestive processes are improved and frequently this improves the quality of their milk supply.

In formula-fed infants, one must rule out dairy intolerance or constipation due to the high iron content in formulas. A whey-based formula may be a suitable substitute, but soy-based formulas should not be used due to their high aluminum and phytoestrogen content.⁹ There are suggestions for natural formulas on the ICPA website: www.icpa4kids.org.

Intestinal flora colonization may also contribute to infantile colic. Flora colonization is essential for health and a strong immune system. Flora are also responsible for controlling cholesterol levels, increased resistance to disease, better sleep, and increased energy. The primary source of flora is maternal vaginal and fecal floras that are usually ingested at the time of delivery.¹⁰ Infants born of cesarean delivery do not have an opportunity to ingest maternal flora and have some delay in the acquisition of permanent flora as the child then must acquire them from their environment.¹¹ In 2001, 24% of births were delivered cesarean giving us a greater number of infants with decreased or absent intestinal flora.⁷ Also antibiotic use kills off the normal needed essential flora. Excessive unnecessary use of antibiotics prescribed for viral infections is estimated to 20 million prescriptions per year.⁷

There are nutritional probiotics that babies can take to help restore decreased or absent intestinal flora.

I believe chiropractic care has a significant role in the care of infants with colic. The vertebral subluxation complex could be a direct or indirect contributor as it affects the nervous system and therefore the entire function of the body. Stimulation of the interspinous tissues in the thoracic and lumbar spine was associated with arrest of peristaltic movement and a sharp decline in gastric muscle tone.¹² This indicates that adjusting the spine of these infants could have an affect on the digestive tract, immune system and nervous system resulting in normalization of an improperly functioning body. Vertebral subluxation with special attention to the upper cervical spine, especially occiput through C2, and mid-thoracic spine, T4 through T9, should be addressed.¹³ I have noted in my practice that the sacral segments also seem to be significant. Studies have shown that spinal adjustment is effective in relieving infantile colic when compared to medication.¹⁴ A 1999 study showed that chiropractic care had a positive short-term effect on the symptoms and discomfort of infantile colic.¹⁵ This has been confirmed in additional studies as well.¹⁶

the management of infantile colic. Your family wellness doctor of chiropractic will offer you information on safe and effective approaches. To find a doctor of chiropractic in your area who works with children, visit our website at www.icpa4kids.org

References:

1. Beers MH, Berkow R: The Merk Manual, Seventeenth Edition. Merk Research Laboratories, 1999;256:2109.
2. Helseth S, Begnum S:  A comprehensive definition of infant colic: parent’s and nurse’s perspectives.  Journal of Clinical Nursing. September, 2002;11(5):672-680.
3. Colon AR, DiPalma JS: Colic. American Family Physician 1989; 40(6):122-124.
4. Anrig C, Plaugher G: Pediatric chiropractic. Lippincott Williams & Wilkins, 1998;201.
5. Miller AR, Bar RG:  Infantile colic: is it a gut issue?  Pediatric Clinics of North America. 1991;38(6):1407-1423.
6. Murray L et al: Physicians’ Desk Reference, Fifty Eight Edition. Thompson PDR, 2004.
7. Null G, Dean C, Feldman M, Rasio D, Smith D:  Death by Medicine article.
8. Moore TJ, Weiss SR, Kaplan S, Blaisdell CJ:  Reported adverse drug events in infants and children under two years of age.  Pediatrics, November, 2002, Vol. No. 5.
9. Babies with colic helped by whey hydrolysate formula.  Pediatrics. December 2000; 106:1349-1354.
10. Stark PL, Lee A: The microbial ecology of the large bowel of breast-fed and formula-fed infants during the first year of life.  Journal of Medical Microbiology. 1982;15:189-203.
11. Hall MA, Cole CB, Smith SL, Fuller R, Rolles CJ: Factors influencing the presence of fecal lactobacilli in early infancy.  Arch Dis Child. 1990;65:185-188.
12. Budgell, Brian: Reflex effects of the subluxation: The autonomic nervous system. JMPT. 2000;23(2).
13. Anrig HC: Chiropractic approaches to pregnancy and pediatric care.  In Plaugher G, Ed. Textbook of clinical chiropractic: a specific biomechanical approach.  Baltimore: Williams & Wilkings, 1993:383-432.
14. 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 blind observer.  Journal of Manipulative Physiologic Therapy.  June, 2000; 23(5):365.
15. Jasper et al: The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. JMPT. 1999;22 (8).
16. Klougart et al: Infantile colic treated by chiropractors: a prospective study of 316 cases. JMPT.0 1989; 12 (4).