The incessant crying episodes after bathing, feeding, and changing a baby’s diaper could leave parents irritated and in despair, trying to find solutions to soothe their newborn. Babies with colic usually tend to be sensitive to stimulation and may cry more when they are surrounded by worried, anxious, or depressed people. While parents have become reliant on probiotics to treat excessive infant crying, a study in the British Medical Journal found the common probiotic treatment Lactobacillus reuteri — a bacterium that can help improve digestion — does not help infants with colic, and suggests it should not be routinely recommended for all infants with the condition.
“Previous small trials suggest that the probiotic Lactobacillus reuteri effectively treats colic in breastfed infants," wrote the international group of researchers, according to the press release. “These studies, however, had limitations as they examined only a highly selective group of infants with colic. The effects of L reuteri on formula fed infants with colic are unknown.” Although lactobacillus GG is used for most intestinal upsets, and help feed the “good” bacteria in the gut, the team of Australian and Canadian researchers believe it is not an effective treatment in a broad community.
To determine whether L. reuteri reduces crying or fussing in a broad community, 167 breastfed and formula fed healthy term infants with colic, aged less than 3 months were recruited for the study. The researchers defined colic based on Wessel’s criteria — crying or fussing for three hours or more a day for three days or more per week for three weeks in those less than 3 months old. Fussing was defined as behavior that is not quite crying, but not awake or content either. Eighty-five infants were randomized to receive the probiotic treatment, and 82 were set to receive the placebo.
The dose administered to the participants was the same used in the three previous trials that showed the effective of the probiotic in the treatment of colic. L. reuteri DSM 17938 in an oil suspension, was given once daily (five drops orally) for one month at the same time each day by the caregivers. Researchers also examined the levels of gut microbial diversity, fecal calprotectin (a market of gut inflammation), and E. coli colonization.
The findings revealed the probiotic group fussed significantly more than the placebo group at all-time points from day seven to one month. The probiotic group cried or fussed 49 minutes more than the placebo group, but the increased fussing only occurred in formula fed infants. However, L. reuteri did not affect crying or fussing time in exclusively breastfed infants. The treatment did not lead to any changes in fecal microbial diversity, E. coli colonization, or calprotectin levels, the researchers wrote in their report.
The Australian and Canadian researchers concluded that the probiotic “did not reduce crying or fussing in infants with colic, nor was it effective in improving infant sleep, maternal mental health, family or infant functioning, or quality of life.” This finding warrants further research as to which subgroups of infants with colic may benefit from probiotics. Until this is established, the international group suggests "probiotics therefore cannot be routinely recommended for all infants with colic."
In a similar study published in the Journal of Clinical Neonatology, a team of researchers found full term infants younger than 5 months with infantile colic, who were exclusively or predominately breastfed, had more than a 50 percent reduction in the daily average of crying time. Although it has yet to be explained why breastfed babies in this scenario benefitted from probiotics, it may be due to the antibodies in breastmilk that help give their immune system a boost. The conflicting results from this trial, and the most recent study add to this controversial topic.
William E Bennett Jr, an assistant professor of pediatrics at Indiana University School of Medicine, questions whether society’s labelling of the infant condition may have a substantial impact on parents’ expectations for treatment, even if they are informed the treatment is ineffective. “We should be careful not to walk this same road with probiotics and colic,” Bennett said in his editorial, comparing the prescriptions for acid suppressants in infants, and the increased risk of respiratory and gastrointestinal infections. Children with colic do not experience serious long term effects from the disorder, and the symptoms abate over time, which leads to the question if colicky babies should be treated at all.
Babies cry, and perhaps rather than turning to probiotics to alleviate symptoms, doctors should focus on resources that can provide reassurance and family social support during this time. In the U.S., one in five babies cry long enough to be labeled as colicky, says Medline Plus, with the disorder commonly appearing at 4 to 6 weeks of age. Colicky babies typically begin their crying spells at the end of the day around the same time. The symptoms of colic go away by 12 weeks.
Barr RG, Heine RG, Hiscock H, et al. Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomized trial. British Medical Journal. 2014.
Szajewska H, Gyrczuk E, Horvath A, et al. Lactobacillus reuteri DSM 17938 for the Management of Infantile Colic in Breastfed Infants: A Randomized, Double-Blind, Placebo-Controlled Trial. Journal of Pediatrics. 2012.