Probiotics and infant colic

In a linked paper, Sung and colleagues (doi:10.1136/bmj.g2107) describe a large, randomised, placebo controlled trial of Lactobacillus reuteri for the management of infant colic.1 This represents the most definitive and well designed study to date on this controversial topic.

Infant colic is a challenging problem for many parents, but the cause and effective treatment remain elusive. As its name suggests, colic was thought to arise in the gastrointestinal tract, but after centuries of this supposition we still do not know if this is true. A host of home remedies and drug treatments have circulated over the years, ranging from whisky, to acid suppression, to anticholinergic agents, and onwards to medicine’s most recent “hammer looking for a nail,” probiotics.

Sung and colleagues used a well defined case definition of colic (the Wessell criteria), and then enrolled patients at urgent care centres who met these criteria. In total, 167 infants were randomised to L reuteri or to placebo. At multiple follow-up intervals, the authors found no improvement in the duration of crying time in infants who received probiotic compared with placebo (in …