BABIES & NURSING

Breaking it Down: Infant Colic and Probiotics

By:  Lauren R. Crosby, MD, FAAP

October 29, 2019

Colic in infants, though considered a benign condition, can bring a lot of stress to a family. What is colic? For me, it was a very, very long 3 months! Colic is traditionally defined as a condition that starts in the first 3-6 weeks of life when an infant cries at least 3 hours a day for at least 3 days a week for at least 3 weeks. Babies tend to outgrow it by 3-4 months old. It is usually a diagnosis of exclusion, meaning that no other cause can be found for the crying, although there are many theories as to why it occurs as well as various remedies to try to help the baby and parents get over this bump in the developmental road.

Prevalence of infants who experience colic

My oldest son started to cry when he was almost 3 weeks old. It was at a pretty predictable time of day and was every day. Except for when he was eating, he needed to be in motion to be calm and not cry.  Sometimes he cried anyway. It was really rough. I was a pediatric resident at the time and took him to his pediatrician because I wanted to make sure there wasn’t anything else wrong — and there wasn’t.  This is a common scenario, as up to 25 percent of infants experience colic. (1)

The causes of colic are thought to be multifactorial, in other words, clinical research studies have identified various correlations but have not found any single explanation. Contributing factors may include a general immaturity of the baby’s nervous system or digestive system, intestinal hypermotility, cow’s milk protein allergy, relative lactase deficiency, an imbalance in the bacterial population in the baby’s intestine (“the microbiome”), an overstimulated infant, or other psychological factors. (2)

Until recently, all parents could do was try various methods to soothe the baby such as walking with or rocking the baby, more frequent burping, using a swing or vibrating seat, going on a car ride (this technique usually worked for me), turning on white noise such as a clothes dryer or vacuum, or trying so-called “gas drops.”  Sometimes your pediatrician will recommend dietary changes as well. Some studies have indicated that dietary changes in the mother or infant may help some of these babies, however a recent review of research did not find any strong evidence to support this. (3)

Colic and probiotics

Fortunately, research has uncovered something that may be beneficial for colic: probiotics! Probiotics in general are bacteria or yeasts that are good for you. Studies were done based on the hypothesis that a dysbiosis, which is an imbalance of bacteria in the gut, could be the cause of colic. (4)  Infants with colic were found to have increases in the percentage of the intestinal bacteria E. coli compared to those without colic. E. coli is well known to cause gas and abdominal bloating, which may contribute to the symptoms we see as colic.

There is growing evidence that probiotics, specifically Lactobacillus reuteri strain DSM17938 (L. reuteri), can reduce the average crying time in breastfed babies with colic by as much as 46 min. Further research still needs to be done among formula fed babies. (5)

Research on the use of the probiotic L. reuteri as a method to ameliorate colic sounds promising!  It is great news to me both as a parent and pediatrician that a natural product could give some relief to a colicky baby. And yes, although colic does eventually resolve on its own, there may now be a way to help these babies and families deal with it so that it is a little less stressful.

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References

1.  Ong TG, et al: “Probiotics to prevent infantile colic (Review),” Cochrane Database of Systematic Reviews 2019, Issue 3, Art. No.: CD012473.
2.  Savino, Francesco et al: “Crying Time and RORgamme/FOXP3 Expression in Lactobacillus reuteri DSM17938-Treated Infants with Colic: A Randomized Trial,” Journal of Pediatrics 2018, 192:171-192.
3.  Gordon, M et al: “Dietary modifications for infantile colic (Review),” Cochrane Database of Systematic Reviews 2018, issue 10, Art. No. CD011029.
4.  Rivas-Fernandez M et al: “Do probiotics help babies with infantile colic?”, Archives of Diseases in Children 2019, 104(9):919-923.
5.  Sung, Valerie et al: “Lactobacillus reuteri to Treat Infant Colic: A Meta-Analysis,” Pediatrics 2018, 141(1):e20171811.

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