Q&A

Effective and ineffective interventions for infant colic

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  • CLINICAL QUESTION: What interventions are effective in the treatment of infantile colic?
  • STUDY DESIGN: Systematic review
  • SETTING: Various (meta-analysis)
  • SYNOPSIS: Numerous interventions are recommended for the treatment of colic, although few have been rigorously evaluated for their effectiveness. The authors of this meta-analysis performed a careful search of multiple databases, including Medline, the Cochrane Clinical Trials Registry, bibliographies of relevant reviews, and the Medical Editors Trial Amnesty for randomized controlled trials (RCTs) published in the English language. Only trials using the official definition of colic—unexplained paroxysmal bouts of fussing and crying lasting longer than 3 hours a day, for more than 3 days a week, for more than 3 weeks of duration—were included. Trials were individually assessed for adequacy of allocation concealment and blinding of individuals assessing outcomes.


 

BOTTOM LINE

Interventions with some evidence of effectiveness for infantile colic include hypoallergenic diets and formula, soy formula, decreased infant stimulation, herbal tea, and dicyclomine (Bentyl). Reports of severe adverse effects of dicyclomine in infants younger than 7 weeks caused a black-box warning for use in those aged less than 6 months. The following interventions are essentially equal to or worse than placebo treatment: simethicone (Mylicon, Gas-X), scopolamine, lactase enzyme (Lactulose), fiber-enriched formula, increased carrying, car-ride simulators, and sucrose. (Level of evidence [LOE]=1a–)

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