Approach

Severity of infantile colic is highly subjective and depends on the tolerance of the parents. Parental reassurance and education is advocated, but evidence of effectiveness is sparse.[30][31][32]

Some parents become so exhausted by the crying that they need a break from the infant, and they should be advised to have some time away. Parents should be encouraged to discuss their feelings and concerns with each other to achieve mutual emotional support.[21]

General recommendations

Overfeeding or underfeeding the infant should be avoided. Feeding the infant in a semi-upright position is recommended to prevent aerophagia, and the infant should be adequately burped.

There is no scientific basis for the use of dummies (pacifiers). Parents may pick up, cuddle, or carry their infant as much as they wish. Colicky infants may benefit from avoiding excessive stimulation.[28]

No behavioural, dietary, or pharmacological interventions are strongly recommended.[30][33] One Cochrane review found poor-quality evidence to suggest that baby massage may reduce time spent crying or fussing.[34] Methodologically robust clinical trials are required.

Breastfed infants

Breastfeeding mothers should continue breastfeeding.[35]

Use of hypo-allergenic diets by breastfeeding mothers should be considered at least for those infants with severe colic or with atopic features, such as atopic dermatitis (eczematous skin lesion), asthma (wheezing, cough), and allergic rhinitis (red eyes, sneezing).[35] These mothers should consider eliminating cow's milk from their diet and avoid potentially allergenic substances such as caffeine, chocolate, eggs, and nuts.[32][35]​​​

Formula-fed infants

In bottle-fed babies, the hole in the bottle teat should be the correct size for the individual infant. Holes or slits in the teat should be made larger for babies that suckle enthusiastically; otherwise, the infant cannot get the milk fast enough and swallows excessive air. Bottles containing collapsible bags may further decrease air swallowing.[21]

Hypo-allergenic formulae

May have a beneficial effect in the management of some infants with infantile colic. In formula-fed infants, colic may improve after changing from a standard cow's milk formula to an alternative formula. However, the consensus is that changing to another formula is usually not necessary for formula-fed infants with mild to moderate colic.[35]

Infants with severe colic, especially those with atopic features or a strong family history of atopy, may benefit from hypo-allergenic formulae, such as whey hydrolysates or casein hydrolysates.[32][35]​​​ Periodic food challenges at monthly intervals are used to ensure that the improvement is related to dietary modification and not as a result of natural resolution.[35] One Cochrane review found that benefits attributed to hydrolysed formulas were inconsistent.[33]

Soya formulae and fibre-supplemented formula should be avoided in most infants

The use of soya formulae in the treatment of infantile colic should generally be avoided because soya protein is an important allergen in infancy, and its use might have long-term harmful effects on reproductive health.[35][36][37][38] In addition, there are concerns regarding the potential risks for those infants who receive their sole sources of nutrition from them. In particular, the use of soya-based formulae should be avoided in premature infants and infants with congenital hypothyroidism.

Fibre-supplemented formula has been found to have no effect in the treatment of colic.[39]

Persistent colic

Although some infants may not respond to the above-outlined treatment and parents may be very distressed during the colicky crying sessions, they should be reassured that the infant will outgrow the condition and continue to thrive.[21][32]

Medicines are not indicated

Medicines that are safe to use in the first few months of life have not been shown to have any benefit. Although dicycloverine (dicyclomine) has been found to be an effective drug for the treatment of infantile colic, it is contraindicated in infants <6 months of age following reports of respiratory difficulties, apnoea, coma, and death associated with its use.[21]

There is no evidence to support the use of simeticone as a pain-relieving agent for infantile colic.[40]

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