Tools assessment and diagnosis to infant colic: a systematic review

Maternal Psychological Well-Being as a Protector in Infantile Colic

(1) Background: Infantile colic (IC) is a functional gastrointestinal disorder that affects around 20% of infants, and postpartum (PPD) depression is a common disorder that affects between 15 and 22% of mothers. In this study, our objective was to evaluate the relationship between the maternal psychological state in the first postpartum year and IC, with the aim of assessing the importance of feeding type in infants and maternal well-being. (2) Methods: A cross-sectional study was conducted in women in their first year postpartum. Demographic, medical, and obstetric data of the mothers and infants were collected, and the type of feeding was identified. The emotional status of the mother was evaluated using the Edinburgh Postnatal Depression Scale (EPDS), and the Infant Colic Severity Questionnaire (ICSQ) was used for IC diagnosis. (3) Results: A total of 528 women were analyzed, of which 170 (32%) were diagnosed with possible PPD. Two-thirds of the women without depression breastfed their babies on demand; therefore, we report that exclusive breastfeeding (EBF) appears to reduce the risk of possible PPD (p < 0.001; OR = 2.353). IC was present in 39% of babies, and around 70% of babies without colic were breastfed on demand. Infants who were not exclusively breastfed showed almost double the risk of developing colic (p = 0.016; OR = 1.577). There was a significant association between the EPDS and ICSQ scores (p < 0.001). More than half of the women with PPD had babies with colic. However, our results show that 75% of babies without colic had mothers who reported optimal postpartum emotional well-being (p < 0.001; OR = 2.105). (4) Conclusions: The results of this study suggest that postpartum maternal psychological well-being reduces the risk of IC. Therefore, we report that EBF on demand, together with a healthy emotional state in new mothers, may be a protective factor against colic in infants.

Psychometric Assessment of Infant Colic Scale in Iranian Population

Introduction

Infant colic, causing excessive crying, poses anxiety for parents and a challenge for pediatricians and nurses. The Infant Colic Scale (ICS) serves to assess the severity and causal factors of colic. Despite its significance, the psychometric properties of ICS have not been evaluated in the Iranian population. This study seeks to address this gap by assessing the psychometric properties of ICS in Iran.

Methods

A sample of 220 mothers with 2-16-week-old term infants diagnosed with infantile colic was selected through convenience sampling. Following forward and back-translation, the face validity, content validity, and construct validity of ICS were systematically evaluated. Reliability was examined through both internal consistency (Cronbach's alpha) and test-retest stability methods.

Results

Content validity index (CVI) and content validity ratio (CVR) values for ICS were 0.94 and 0.81, respectively. The good fit indices confirmed the validity of the five-factor structure. Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were 0.71 and 0.94, respectively.

Conclusion

The Persian version of ICS is a valid and reliable tool, suitable for assessing infantile colic in the Iranian population. Future studies and clinical practice can utilize this tool to identify major causes of this disorder in the Iranian context.

Osteopathic Manual Therapy for Infant Colic: A Randomised Clinical Trial

BACKGROUND

Infant colic is a multifactorial syndrome for which various therapeutic strategies have been proposed. In this study, we evaluate the effectiveness of osteopathic manual therapy in treating symptoms related to infant colic.

METHOD

A prospective, randomised, blinded clinical trial was conducted of patients diagnosed with infant colic. The treatment group were given osteopathic manual therapy, and their parents received two sessions of counselling. The control group received no such therapy, but their parents attended the same counselling sessions. The non-parametric Mann-Whitney U test was applied to determine whether there were significant differences between the groups for the numerical variables considered. For the qualitative variables, Fisher's exact test was used. The threshold assumed for statistical significance was 0.05.

RESULTS

A total of 42 babies were assigned to each group. Those in the experimental group presented less severe infant colic with a trend towards statistical significance after the first session (p = 0.09). In sucking, excretion, eructation and gas there were no significant differences between the groups. Crying was a statistically significant dimension both after the first intervention (p = 0.03) and two weeks after (p = 0.04). Regurgitation values were significantly lower in the experimental group during the three weeks of follow-up (p = 0.05). Values for sleep were lower in the experimental group, but the differences were not statistically significant. In both groups, colic severity decreased over time, with no side effects.

CONCLUSIONS

Treatment with osteopathic manual therapy alleviates the symptoms of infant colic and could be recommended for this purpose from the onset of the condition.

Systematic review and meta-analysis showed that complementary and alternative medicines were not effective for infantile colic

AIM

Osteopathy and chiropractic techniques are used for babies for different reasons, but it is unclear how effective they are. The aim of this study was to evaluate their effectiveness in reducing crying time and increasing sleeping time in babies with infantile colic.

METHODS

A systematic review and meta-analysis was conducted on infantile colic studies that used complementary and alternative medicine techniques as interventions. The outcome measures were hours spent crying and/or sleeping. We used the PubMed, Physiotherapy Evidence Database, Cochrane Library, Embase, Web of Science, Scopus, Osteopathic Medicine Digital Database and Google Scholar databases from inception to 11 November 2022.

RESULTS

The methodological quality of the randomised control trials ranged from fair to high. We focused on five studies with 422 babies. Complementary treatments failed to decrease the crying time (mean difference -1.08, 95% CI: -2.17 to 0.01, I2  = 92%) and to increase sleeping time (mean difference 1.11, 95% CI: -0.20 to 2.41; I2 : 91%), compared with no intervention. The quality of the evidence was rated as very low for both outcome measures.

CONCLUSION

Osteopathy and chiropractic treatment failed to reduce the crying time and increase sleeping time in babies with infantile colic, compared with no additional intervention.

The effect of topical olive oil application on the symptoms of infantile colic: A randomized, double-blind, placebo-controlled clinical trial

Background and Aims

Infantile colic is one of the most common disorders in the first months of infants' lives. This condition hurts parents' moods. This study was carried out to investigate the effect of the topical use of olive oil on infantile colic symptoms.

Methods

The study was carried out on 80 infants 1-3 months old, randomly allocated into two groups, receiving abdominal massage with olive oil thrice a day in the intervention group (n = 40) and the same procedure with liquid paraffin in the placebo group (n = 40), for 14 successive days. During this period, the parents recorded the episodes of colic, duration of colic, crying intensity, and episodes of defecation. These variables were assessed and compared at the beginning and on the 7th and 14th days.

Results

The mean crying duration changed from 4.05 ± 2.44 to 1.41 ± 1.03 h/day (65% decrease) in the olive oil group and from 3.85 ± 1.37 to 1.60 ± 1.32 h/day (58% decrease) in the paraffin group (p = 0.38). The episodes of crying were reduced from 5.79 ± 4.56 to 2.51 ± 4.93 episodes/day (↓57%) in the olive group and from 6.01 ± 3.40 to 3.01 ± 2.40 episodes/day (↓50%) in the paraffin oil group (p = 0.14). Furthermore, the intensity of crying was decreased from 9.04 ± 1.54 to 4.48 ± 2.17 (p < 0.001) in the olive oil group and from 9.0 ± 1.20 to 4.77 ± 1.68 (p < 0.001) in the paraffin oil group. On the 14th day, the crying intensity showed no significant difference between the two groups.

Conclusion

Abdominal massage with olive oil has the same effect as massage with paraffin oil in reducing the symptoms of infantile colic.

Predictive validity and cut-off point of the Turkish version of the Infant Colic Scale in the diagnosis of colic

OBJECTIVE

To investigate the predictive validity and cut-off point of the Turkish version of the Infant Colic Scale (ICS) in the diagnosis of colic.

METHODS

This methodological study was carried out in a pediatric outpatient clinic of a university hospital in Turkey with infants aged 6-16 weeks (n = 133). The data were collected using the Mother-Infant Description Form, the ICS, and the Rome IV criteria form. The scale is a 6-point Likert-type scale consisting of 19 items in total. A low total mean score obtained from it indicates that the probability of colic increases, while a high mean score indicates that the probability of colic decreases. The Rome IV criteria were used as the gold standard.

RESULTS

The mean score obtained from the ICS was 59.4 ± 13.7. According to the Rome IV criteria, 26.3% of the infants had colic. The area under the ROC curve was 87.4% (95% CI = 0.815-0.934, SE = 0.30, p = 0.001), and the cut-off point for the best sensitivity value (88.6%) and the best specificity value (70.5%) of the ICS was determined to be 60.5. According to the cut-off point, the positive predictive value was 51%, and the negative predictive value was 94%.

CONCLUSION

The predictive validity of the Turkish version of the ICS was found to be at a good level with high sensitivity and acceptable specificity for a cut-off point of 60.5. Healthcare professionals working in the child field can use the ICS to exclude colic in infants.

Treatment of infant colic with craniosacral therapy. A randomized controlled trial

OBJECTIVE

To evaluate the number of craniosacral therapy sessions that can be helpful to obtain a resolution of the symptoms of infantile colic and to observe if there are any differences in the evolution obtained by the groups that received a different number of Craniosacral Therapy sessions at 24 days of treatment, compared with the control group which did not received any treatment.

METHODS

Fifty-eight infants with colic were randomized into two groups of which 29 babies in the control group received no treatment and those in the experimental group received 1-3 sessions of craniosacral therapy (CST) until symptoms were resolved. Evaluations were performed until day 24 of the study. In this study crying hours served as primary outcome. The secondary outcome were the hours of sleep and the severity, measured by an Infantile Colic Severity Questionnaire (ICSQ).

RESULTS

Significant statistical differences were observed in favor of experimental group compared to the control group on day 24 in crying hours (mean difference = 2.94, at 95 %CI = 2.30-3.58; p < 0.001) primary outcome, and also in hours of sleep (mean difference = 2.80; at 95 %CI = - 3.85 to - 1.73; p < 0.001) and colic severity (mean difference = 17.24; at 95 %CI = 14.42-20.05; p < 0.001) secondary outcomes. Also, the differences between the groups ≤ 2 CST sessions (n = 19), 3 CST sessions (n = 10) and control (n = 25) were statistically significant on day 24 of the treatment for crying, sleep and colic severity outcomes (p < 0.001).

CONCLUSION

Babies with infantile colic may obtain a complete resolution of symptoms on day 24 by receiving 2 or 3 CST sessions compared to the control group, which did not receive any treatment.

Infant colic, young children's temperament and sleep in a population based longitudinal cohort study

Background

Colic and sleep problems are common among infants, constitute challenges and distress for parents, and are often reasons for seeking help from health professionals. The literature debates whether infant colic and sleep problems are linked together or not. Further, limited evidence exists on how colic impacts on child temperament and sleep during early childhood. Thus, the purpose of this study was to increase our knowledge of the characteristics of infants with a history of colic compared to infants without, and to study how infant colic is associated with the development of child temperament and sleep over time.

Methods

The study is based on The Norwegian Mother, Father and Child Cohort Study (MoBa), a population-based cohort study conducted by the Norwegian Institute of Public Health. This sample contains 88,186 mothers and children. Data was retrieved from questionnaires distributed to mothers at recruitment (in pregnancy) and when the child was 6 months, 18 months, 3 years, and 5 years. Data was analysed using linear mixed models and GLM models for repeated measures.

Results

At 6 months, infants with reported colic are described as fussier, present more sleeping problems, are breastfed less, and the families visit the child health centre more often when compared to the non-colic group. Mothers of children with reported colic perceive their children’s temperament significantly more challenging from the age of 6 months to 5 years. Further, children with reported colic were more likely to sleep less than recommended (22%) and to have more frequent night awakenings (14%) than usual for their age (6 months to 5 years).

Conclusion

Infant colic often occurs together with other signs of regulatory problems which may amplify the load on the parents. Moderate differences in temperament and sleep-problems across time, between those with colic and those without, indicate that the diagnosis of colic is moderately associated with later behavioural difficulties. However, it is demanding for the parents, and important to be aware of and act upon symptoms of colic in the child health centres to reduce the parents’ load and prevent adverse long-term outcomes.

The Gastrointestinal Microbiome in Infant Colic: A Scoping Review

ABSTRACT

The significant crying of infantile colic adds stress to the infant and their family, yet it has no recognized etiology. Gastrointestinal health problems and dysfunction have been suspected in the etiology of colic. Disruptions to the microbiome colonization of the gastrointestinal system may lead to excess gas and inflammation that are associated with the crying of colic. Infants with colic have increased colonization with gas-producing bacteria, like Escherichia coli and Klebsiella, and they have lower colonization of anti-inflammatory bacteria, like Bifidobacterium and Lactobacillus. Colic is known to self-resolve around 3 months of age. However, few researchers have investigated how the microbiome may be changing at colic's natural resolution without the intervention of a probiotic. With a better understanding of what leads to colic's self-resolution, future researchers may be able to identify more effective therapies for colic prevention or treatment. This scoping review presents the collective evidence from 21 original, primary research articles on what is known about the gastrointestinal microbiome at colic onset and resolution.

Assessment of the severity of infant crying and its impact on parents: Development and validation of the ColiQ Questionnaire in France

OBJECTIVES

The purpose of this study was to develop and validate a questionnaire that comprehensively assesses symptoms and severity of crying, symptoms suggesting infant functional gastrointestinal discomfort, and its impact on parents' quality of life: the Infant Colic Questionnaire (ColiQ©). For the first time, parents had access to a web application to follow their infants' evolving symptoms with a daily questionnaire.

METHODS

The ColiQ was developed with a board of clinical experts (physicians and psychologists) based on extensive parent input. A longitudinal, observational study was conducted in France for 3 months. ColiQ assessments were collected online at six different time points. Psychometric testing demonstrated that ColiQ has acceptable psychometric properties (reliability, internal consistency, construct validity, and responsiveness).

RESULTS

The ColiQ is a 16-question instrument developed in French including ten questions describing symptoms (Infant score) and six questions describing impacts (Parent score). The ColiQ demonstrated good test-retest reliability (ICC >0.70), internal consistency for both the Symptom and Impact subscale scores (Cronbach's α >0.70), and construct validity. Responsiveness was good; the ColiQ was able to detect significant improvement in the target population as early as 1 month (p<0.05). The global ColiQ score discriminated between severity levels (mild, medium, severe).

CONCLUSIONS

The ColiQ was developed with input from parents and healthcare professionals and has shown validity, reliably, and responsiveness to change. Parents can use the web application to follow how their infants' symptoms evolve. The ColiQ can help parents quantify and verbalize their concerns during consultations, and provides an opportunity to facilitate conversations between the physician and parents.

Dietary modifications for infantile colic

BACKGROUND

Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. This condition appears to be more frequent in the first six weeks of life (prevalence range of 17% to 25%), depending on the specific location reported and definitions used, and it usually resolves by three months of age. The aetiopathogenesis of infantile colic is unclear but most likely multifactorial. A number of psychological, behavioural and biological components (food hypersensitivity, allergy or both; gut microflora and dysmotility) are thought to contribute to its manifestation. The role of diet as a component in infantile colic remains controversial.

OBJECTIVES

To assess the effects of dietary modifications for reducing colic in infants less than four months of age.

SEARCH METHODS

In July 2018 we searched CENTRAL, MEDLINE, Embase , 17 other databases and 2 trials registers. We also searched Google, checked and handsearched references and contacted study authors.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of dietary modifications, alone or in combination, for colicky infants younger than four months of age versus another intervention or placebo. We used specific definitions for colic, age of onset and the methods for performing the intervention. We defined 'modified diet' as any diet altered to include or exclude certain components.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Our primary outcome was duration of crying, and secondary outcomes were response to intervention, frequency of crying episodes, parental/family quality of life, infant sleep duration, parental satisfaction and adverse effects.

MAIN RESULTS

We included 15 RCTs involving 1121 infants (balanced numbers of boys and girls) aged 2 to 16 weeks. All studies were small and at high risk of bias across multiple design factors (e.g. selection, attrition). The studies covered a wide range of dietary interventions, and there was limited scope for meta-analysis. Using the GRADE approach, we assessed the quality of the evidence as very low.Low-allergen maternal diet versus a diet containing known potential allergens: one study (90 infants) found that 35/47 (74%) of infants responded to a low-allergen maternal diet, compared with 16/43 (37%) of infants on a diet containing known potential allergens.Low-allergen diet or soy milk formula versus dicyclomine hydrochloride: one study (120 infants) found that 10/15 (66.6%) breastfed babies responded to dicyclomine hydrochloride, compared with 24/45 (53.3%) formula-fed babies. There was little difference in response between breastfed babies whose mother changed their diet (10/16; 62.5%) and babies who received soy milk formula (29/44; 65.9%).Hydrolysed formula versus standard formula: two studies (64 infants) found no difference in duration of crying, reported as a dichotomous outcome: risk ratio 2.03, 95% confidence interval (CI) 0.81 to 5.10; very low-quality evidence. The author of one study confirmed there were no adverse effects. One study (43 infants) reported a greater reduction in crying time postintervention with hydrolysed formula (104 min/d, 95% CI 55 to 155) than with standard formula (3 min/d, 95% CI -63 to 67).Hydrolysed formula versus another hydrolysed formula: one study (22 infants) found that two types of hydrolysed formula were equally effective in resolving symptoms for babies who commenced with standard formula (Alimentum reduced crying to 2.21 h/d (standard deviation (SD) 0.40) and Nutramigen to 2.93 h/d (SD 0.70)).Hydrolysed formula or dairy- and soy-free maternal diet versus addition of parental education or counselling: one study (21 infants) found that crying time decreased to 2.03 h/d (SD 1.03) in the hydrolysed or dairy- and soy-free group compared with 1.08 h/d (SD 0.7) in the parent education or counselling group, nine days into the intervention.Partially hydrolysed, lower lactose, whey-based formulae containing oligosaccharide versus standard formula with simethicone: one study (267 infants) found that both groups experienced a decrease in colic episodes (secondary outcome) after seven days (partially hydrolysed formula: from 5.99 episodes (SD 1.84) to 2.47 episodes (SD 1.94); standard formula: from 5.41 episodes (SD 1.88) to 3.72 episodes (SD 1.98)). After two weeks the difference between the two groups was significant (partially hydrolysed: 1.76 episodes (SD 1.60); standard formula: 3.32 episodes (SD 2.06)). The study author confirmed there were no adverse effects.Lactase enzyme supplementation versus placebo: three studies (138 infants) assessed this comparison, but none reported data amenable to analysis for any outcome. There were no adverse effects in any of the studies.Extract of Foeniculum vulgare, Matricariae recutita, and Melissa officinalis versus placebo: one study (93 infants) found that average daily crying time was lower for infants given the extract (76.9 min/d (SD 23.5), than infants given placebo (169.9 min/d (SD 23.1), at the end of the one-week study. There were no adverse effects.Soy protein-based formula versus standard cows' milk protein-based formula: one study (19 infants) reported a mean crying time of 12.7 h/week (SD 16.4) in the soy formula group versus 17.3 h/week (SD 6.9) in the standard cows' milk group, and that 5/10 (50%) responded in the soy formula group versus 0/9 (0%) in the standard cows' milk group.Soy protein formula with polysaccharide versus standard soy protein formula: one study (27 infants) assessed this comparison but did not provide disaggregated data for the number of responders in each group after treatment.No study reported on our secondary outcomes of parental or family quality of life, infant sleep duration per 24 h, or parental satisfaction.

AUTHORS' CONCLUSIONS

Currently, evidence of the effectiveness of dietary modifications for the treatment of infantile colic is sparse and at significant risk of bias. The few available studies had small sample sizes, and most had serious limitations. There were insufficient studies, thus limiting the use of meta-analysis. Benefits reported for hydrolysed formulas were inconsistent.Based on available evidence, we are unable to recommend any intervention. Future studies of single interventions, using clinically significant outcome measures, and appropriate design and power are needed.

Three-Month Feeding Integration With Bifidobacterium Strains Prevents Gastrointestinal Symptoms in Healthy Newborns

Infantile functional gastrointestinal disorders are common in the first months of life. Their pathogenesis remains unknown although evidences suggest multiple independent causes, including gut microbiota modifications. Feeding type, influencing the composition of intestinal microbiota, could play a significant role in the pathogenesis. Previous studies supported probiotic supplementation success against colics, however mainly Lactobacillus spp. were tested. The aim of this study was to evaluate the effectiveness against functional gastrointestinal disorders of a Bifidobacterium breve based probiotic formulation including in the study both breast-fed and bottle-fed subjects. Two hundred and sixty-eight newborns were enrolled within 15 days from birth. One hundred and fifty-five of them effectively entered the study and were randomized in probiotic and placebo group, receiving the formulation for 90 days. The probiotic formulation consists of a 1:1 mixture of 2 strains of B. breve prepared in an oily suspension and administered in a daily dosage of 5 drops containing 108 CFU of each strain. Absolute quantification of selected microbial groups in the faeces was performed using qPCR. Anthropometric data, daily diary minutes of crying, number of regurgitations, vomits and evacuations, and colour and consistency of stools were evaluated before and after treatment. The study confirmed the positive role of breast milk in influencing the counts of target microbial groups, in particular the bifidobacteria community. No adverse events upon probiotic administration were reported, suggesting the safety of the product in this regimen. B. breve counts increased significantly in all administered newborns (p < 0.02). The study demonstrates that a 3 months treatment with B. breve strains in healthy breast-fed newborns helps to prevent functional gastrointestinal disorders, in particular reducing 56% of daily vomit frequency (p < 0.03), decreasing 46.5% of daily evacuation over time (p < 0.03), and improving the stool consistency (type 6 at the Bristol Stool chart instead of type 5) in those at term (p < 0.0001). Moreover, a significant reduction (8.65 vs. 7.98 LogCFU/g of feces, p < 0.03) of B. fragilis in the bottle-fed group receiving the probiotic formulation was observed.