Infant Colic Protocol

Colic

Colic is a common problem in infants that usually causes sharp abdominal pains and bloating causing the infant to clench their fists, draw their legs up into their abdomen and crying. The colic tends to be more common in bottle fed rather than breast-fed infants.  There is good evidence to suggest that the colic is related to a reaction to cow’s milk-based infant formula[1]^,[2]

The crying tends to be at its worse during their first two weeks and can go on for hours at a time, this gradually begins to reduce after four months.  However, some babies are unable to settle up to 12 months.     

Symptoms  

·         Inconsolable crying that tends to happen at the same time each day after feeding

·         bloating

·         flatulence

·         grimacing

·         pulling up of feet into the abdomen whilst clenching fists

Pathophysiology

The true pathophysiology of colic is unknown. However babies that are born through C-section or are not

breastfed seem to double the chances that there will be an error in the infants metabolism making them

less able to digest lactose from milk.  The poor metabolism has been theorized to be due to the lack of

microflora that is passed on from mother to baby through the birth canal and/or through breastmilk. The World Health Organization (WHO) recommends breastfeeding exclusively for the first six months as breast milk contains antibodies which will help your baby’s immune system develop and protect against certain infections.  Not breastfeeding may affect digestion due to increase intestinal permeability making them intolerant to lactose or other milk proteins.  Bottle feed tends to take on average 4 hours to digest in comparison to breastmilk which takes 1.5hrs. 

Medical Management

Medical treatment is often not suggested unless symptoms are severe. In severe cases Simeticonedrops are added to the feed and used short term to help disperse any bubbles that may be cause  discomfort inthe digestive tract. Lactase enzymes are also recommended to be added to the feed to support the breakdown of the sugar lactose in the feed and the other option is removing cow milk from the diet

Clinical Considerations

Confirm diagnosis as some symptoms can be similar to G.E.R.D.

Nutritional Interventions

·         Lactase enzyme- has been shown to be effective in treating colic in 40% of incubated babies in a study at Guys Hospital in London[3].  

·         Bifidobacterium lactis -  long term consumption of formulas supplemented with B. lactis  resulted in reduction of colic and irritability[4]^,[5].

Diet/Adjuncts

·         Following the WHO guidelines with exclusive breastfeeding for the first 6 months is most effective

·         If lactation is not an option use formulas free of cow’s milk.  Using alternatives such as coconut milk can be effective as it contains some fats that are also present in breast milk, however, a combination of vitamins and minerals and probiotics would need to be added to make it into a formula.  Other alternatives could be

·         Mothers breastfeeding should avoid cabbage, broccoli, cauliflower, onion and chocolate which may help reduce gastrointestinal symptoms in the infant[6].

·         Feed on demand prevents blood sugar dips appears to relieve colic[7]

·         Massaging the abdomen and spinal area with almond oil can help in reducing the trapped bubbles that have built up in the intestinal tract.

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[1] Lothe L, et al. (1989) Cow’s milk whey protein elicits symptoms of infantile colic in colicky formula-fed infants: A double-blind crossover study. Pediatr 83(2):262-266

[2] Lothe L, et al. (1982) Cow’s milk as a cause of infantile colic: A double- blind study. Pediatr 70(1):7-10

[3] Kanabar, D.; Randhawa, M.; Clayton, P. (2001). "Improvement of symptoms in infant colic following reduction of lactose load with lactase". Journal of Human Nutrition and Dietetics 14 (5): 359–63. doi:10.1046/j.1365-277X.2001.00304.x. PMID 11906576.

[4] He F, Morita H, Ouwehand AC: Bifidobacteria and lactobacilli exhibited different mitogenic activity on murine splenocytes.Int J Probiotics Prebiotics1 :77– 82,2006 .

[5] Saavedra JM, et al. Long-term consumption of infant formulas containing live probiotic bacteria: tolerance and safety. Am J Clin Nutr 2004; 79:261-267

[6] Lust KD, et al. Maternal intake of cruciferous vegetables and other foods and colic symptoms in exclusively breast-fed infants J AM Diet Assoc 96:47-48 

[7] Taubman B. (1984) Clinical trial of the treatment of colic by modification of parent-infant interaction. Pediatr 74:998-1003