What evidence is there for conventional colic treatments?
A quick skim over most baby advice forums often throws up the same kinds of queries. “My baby is so unsettled – do they have colic?” In response, we often see helpful parents talking about remedies and medicines, which are often easily available over the counter, and discussing what did or didn’t work for them.
Let’s get one thing straight from the off. Your baby is going to spit up, they are going to fart and burp, they are going to get a few bouts of trapped gas, and they will have periods of being very unsettled. This is completely normal baby stuff. Most babies will have periods of crying. Often these ‘witching hours’ coincide with early evening. This kind of crying tends to peak at around 6-8 weeks and then starts to subside.
Kellymom talks about fussy evenings here: fussy evenings
NHS defines colic as, “Excessive, frequent crying in a baby who appears to be otherwise healthy.”
And that is basically it. Colic is simply a ‘medical’ term for a baby who cries a lot. Colic is one of those mysteries of nature; we don’t actually know what causes it.
Conventional over-the-counter treatments for colic
The active ingredient in Infacol is simethicone. It claims to work by helping the little trapped gas bubbles join into bigger bubbles which your baby can more easily bring up as wind.
What evidence is there that Infacol is effective? Basically – not much!
A BMJ paper published in 2007 reviewing treatment of colic examined the evidence and said:
“One poor-quality randomised controlled trial (RCT) found limited evidence that simethicone reduced the number of crying attacks on days 4–7 of treatment compared with placebo.”
“But my Doctor/Health Visitor/Midwife recommended I try Infacol?” I often hear parents ask. “Why do they say this if it doesn’t work?”
Well, for the answer to this question, we can see the NICE guidance states: “Although studies of simeticone have not provided evidence of benefit in infantile colic … a 1-week trial as a placebo may still be worth a try because … the simple act of being able to give their baby something may help parents cope better with the crying.”
So basically, it is prescribed or recommended because it is known to have a placebo effect on the parent, and not because it actually works.
There have been no longer-term studies of the impact of introducing remedies like Infacol into the infantile gut.
Dentinox drops contain an activated version of simeticone called Dimeticone. Again, much like Infacol, there is no good evidence that these actually work.
Colief (Lactase Drops):
The BfN statement on assessing the evidence for colic treatments shows lactase enzymes like Colief were shown to be largely ineffective.
One small study claimed to show that lactase drops, if mixed with the milk and left for 24 hours before feeding, reduced colic in one randomised trial, but other studies have not shown this. Meanwhile, the positive study was criticised for being small and biased, because it was not independent of industry.
Homeopathy or herbal treatments – colic granules e.g. Nelsons granules, Colocynth Crystals, Fennel Tea, Star Anise:
There is no high-quality evidence to suggest homeopathic colic granules are an effective treatment for colic.
Using herbal treatments such as fennel tea or star anise is not recommended, and in some cases people believe this can be dangerous for the baby.
Gripe water is an old-fashioned remedy which has changed substantially in formulation since it was invented. The original ‘Woodward’s Gripe Water’ contained 3.6% alcohol and sugar water! These days the sugar and the alcohol have been removed for obvious reasons, but it is worth thinking about why the original may have been effective and therefore why this ‘treatment’ has been passed down through the generations.
A 2000 review found that most of the ingredients in modern gripe water are of little value in relieving discomfort. It is worth bearing in mind that the WHO says receiving any liquid other the breastmilk in the early months can have a detrimental impact on establishing breastfeeding as it can replace breastmilk intake.
At any given time, on any breastfeeding forum, you will see recommendations for mums to cut out dairy (and sometimes soya) from their diet to resolve colic.
There is some limited evidence to suggest a dairy-free or low-allergen maternal diet can help reduce the symptoms of colic.
However, it is important to remember that the current evidence for rates of cows’ milk protein allergy in babies suggests it is pretty rare in exclusively breastfed babies. The Breastfeeding Network puts the rate of CPMA in breastfed babies at 0.5% compared with 2-7% of mixed or formula fed babies. While some people believe these figures are overly conservative, it’s important not to jump to conclusions and start cutting out food groups without guidance from a dietician and without ruling out other causes of baby’s distress first.
Probiotics such as BabyGaia, Biocare Baby and Biokult Infantis
An emerging area in the treatment of infant colic is the use of probiotics, particularly ones containing the strain L reuteri.
Over recent years there have been several studies with conflicting outcomes, however a recent meta analysis concluded that they may help with colic. However, a note of caution; much of the research done has been conducted by a major manufacturer of probiotics and so may not be impartial. Remember your breastmilk also contains probiotics and it is also important to be sure that you are using a good quality supplement.
We are expanding our knowledge all the time in this area, so it is always worth keeping up to date with the research as things can change quickly!
Research looking at the effects of cranial osteopathy on infants is mixed, with some trials showing a benefit and others showing no benefit when compared with ‘sham’ manipulation.
While some parents will say they found osteopathic treatment useful, unfortunately the evidence around these therapies is fairly inconclusive. On the positive side, cranial osteopathy is a gentle and non-invasive intervention, it doesn’t involve introducing new things into a baby’s delicate gut, and many parents report their babies enjoy it.
Baby massage is another common suggestion for help with colic. Research has shown baby massage is a great way to promote parent-child bonding. In terms of its use as a colic treatment, more research needs to be done as the results have been a mixed bag, but it is certainly a gentle and non-invasive way to soothe a baby, with the added bonus that it gets all those lovely bonding hormones flowing!
One thing most breastfeeding supporters wish they could stop people recommending willy-nilly is the suggestion that “oversupply” is the cause of a baby’s colic, wind or reflux.
Block feeding – where a mother offers baby the same breast for a set number of hours – is an effective technique used to reduce supply in mothers who have an over-abundance of milk. Where oversupply has been identified by a breastfeeding professional, this may help with an unsettled baby.
However, the problem is that the symptoms of oversupply are remarkably similar to the symptoms of shallow attachment. If baby isn’t attached to the breast deeply enough, they may struggle to handle the flow and splutter, cough, gag and take in lots of air.
Parents who block feed in this situation may start out with a perfect milk supply for their baby’s needs but end up with a low milk supply, simply because the breasts are not being stimulated enough. If you are concerned about oversupply, your best course of action is to seek out an experienced breastfeeding professional to observe a feed and take things from there.
So what works?
In conclusion the word on the street from NICE is, “Although there are many studies of interventions for infantile colic, most are of poor methodological quality, making it difficult to evaluate the effectiveness of any treatment. No treatment has been clearly shown to be of substantial benefit.“
So, if you think baby has colic or reflux, what can you do?!
1. Look at breastfeeding management, attachment and positioning
There is some evidence to suggest that making sure a baby is well positioned during breastfeeding may lead to a reduction in colic-type symptoms. There is also evidence for allowing the baby to finish feeding on the first breast before offering them the second breast. So there’s no need to time feeds per breast, and it’s best not to remove baby from the breast before they decide they are done themselves.
Sometimes a little chat and some work on attachment and positioning with a peer supporter or breastfeeding counsellor can solve the problem completely!
2. Find experienced breastfeeding support from a breastfeeding counsellor or IBCLC
If simple adjustments do not help, this is when skilled help to assess your baby feeding can be really useful. A breastfeeding counsellor or IBCLC who is skilled enough to look at baby’s suck/swallow/breathe technique, and who can do an examination of baby’s mouth, will be able talk to you in detail and may be able to pinpoint some things for you to try.
3. The BfS&I List
This is our list for dealing with cranky babies in helpful meme form!
4. Talk to somebody
When you have a baby who is unsettled and cries a lot, it can be incredibly hard. It can really shake your confidence in your ability as a parent, and affect how you view your breastfeeding relationship.
Research has shown that talking to somebody about the situation can go a long way towards helping parents feel better about the situation, even if the colic doesn’t improve instantly.
So if your baby has colic, and if you just take one thing away from this blog, remember this too will pass. Remember, you are doing a GREAT JOB. Time is the number one treatment for infant colic, and it is nearly always the cure.
If you are struggling with a crying baby and really need to talk to somebody urgently, the breastfeeding helplines will be happy to talk to you.
If you would like to see a copy of this blog with references please get in touch.
written by Paula Rowley