Probiotics and infant colicBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2286 (Published 01 April 2014) Cite this as: BMJ 2014;348:g2286
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Rarely does one encounter such a balanced editorial which seeks to de medicalise what is essentially a normal part of life, in such a constructive manner. Infantile colic is essentially a medicalised term to excuse health seeking behaviour by anxious parents and to permit health care professionals to prescribe rather than reassure. Apart from the potential harms of such actions, so ably demonstrated, it also reinforces the seeking of a pill for every ill. In turn this encourages more and more health seeking behaviour, often inappropriate, with an expectation of investigation and/ or treatment which activities themselves may cause more harms than benefits. Furthermore, failure to reassure and use time appropriately effectively disempowers parents from making decisions about their child, a trait which may ultimately be passed on to the child, perhaps explaining the other old aphorism "little belly-achers grow up to be big belly achers".
Competing interests: No competing interests
LEARNING ROCKABYE BABY AVOIDS PROBIOTICS FOR “INFANT COLIC”
A recommendation for de-medicalising a normal paediatric condition.
We are delighted to read that William E. Bennett Jr 1 has drawn attention to the randomised placebo controlled trial by Sung and colleagues 2 definitively arguing against probiotics for managing infant colic. Nobody has yet explained why infants (children younger than three months) commonly cry for hours during the day or at night. Nor do we know whether we should define prolonged crying as infant colic. Despite intensive and independent research including three Cochrane protocols and a review suggesting manipulative therapies, the perfect remedy for this exceedingly frequent and stress-inducing problem remains elusive.3 Given that crying resolves spontaneously within months, paediatricians tend to underestimate the related parental stress and anxiety instead of seeking simple and immediate solutions.4 Tending to overtreatment, they send the parents to the chemist to get probiotics or other similar useless and costly medications for the baby.1 Researchers, in league with Big Pharma, also often design costly randomised-controlled trials to investigate complex social functional problems that could be otherwise addressed without medicalising infants and increasing pharmaceutical sales.5
My long experience in treating infants with “colic” prompts me to suggest an immediate, simple, safe and cost-free manoeuvre. This expedient invariably works, it soothes the baby and relaxes the mother. With the crying baby sucking or not sucking its dummy, the mother, father or caregiver lifts the baby up, the infant’s head resting in the right forearm, rocks the baby to and fro, rhythmically patting its bottom with the left hand (Figure). Placing the baby on its right side presumably blocks the cardiac sphincter, causes the baby to regurgitate a small amount of milk and immediately stops crying. The whole procedure reminds the baby of its fetal swinging movements in the womb and patting the baby’s bottom with the left hand imprints memories of mothers’ footsteps. According to my still unpublished retrospective study, of the 434 newborn babies and infants younger than 3 months brought to my personal observation in the children outpatients’ unit between 2009 and 2014 for various problems, 80 (36 boys, median days of life 38.80 ± 21.49 and 44 girls, 38.75 median days of life ± 22.25) had symptoms suggesting infant colic. Of these 80 children, 26 (72.2%) boys and 30 (68%) girls were exclusively breastfed, 56 (29 boys, 70%) were from single-child families and overanxious parents dealing with their first crying baby (one mother was being treated for depression) and 15 babies needed no follow up visits. Using my rockabye baby manoeuvre I have nearly always succeeded in resolving “infant colic”, and mothers were happy and surprised to find that their babies stopped crying. All the babies in whom my manoeuvre failed (6/80) cried for other reasons: three were treated for gastro-oesophageal reflux and three for sepsis. When these disorders were treated, the rockabye baby manoeuvre invariably worked.
My empirical evidence therefore strongly suggests that the problem labelled as infant colic or “vulnerable child syndrome” reflects certain babies’ difficulty in adapting to life outside the womb. It also underlines that instead of labelling a crying infant as a sick child, we should seek an easy and cost-free solution reducing parental anxiety and saving national health service expenses. We entirely agree with William E. Bennett 1 that until we know more about infants’ intestinal flora, we cannot prescribe babies potentially harmful and useless medications for what may be mistakenly described as “infant colic”.
1 Bennett EW. Probiotics and infant colic BMJ 2014;348:g2286.
2 Sung V, Hiscock H, Tang MLK, Mensah FK, Nation ML, Satzke C, et al. Treating infant colic with the probiotic Lactobacillus Reuteri: double blind, placebo controlled randomized trial. BMJ 2014;348:g2107.
3 Dobson D, Lucassen PLBJ, Miller JJ, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD004796. DOI: 10.1002/14651858.CD004796.pub2.
4 Rosati P. Smiling doctors help parents’ views not to get lost in translation, and prevent overdiagnosis, overtreatment and “overprognosis” in a children’s hospital. BMJ online
5 Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002; 324(7342):886–891.
Competing interests: No competing interests