Probióticos
Os probióticos, como o Lactobacillus reuteri, podem ser benéficos para lactentes com cólica.[41]Hjern A, Lindblom K, Reuter A, et al. A systematic review of prevention and treatment of infantile colic. Acta Paediatr. 2020 Sep;109(9):1733-44.
https://onlinelibrary.wiley.com/doi/10.1111/apa.15247
http://www.ncbi.nlm.nih.gov/pubmed/32150292?tool=bestpractice.com
[42]Harb T, Matsuyama M, David M, et al. Infant colic - what works: a systematic review of interventions for breast-fed infants. J Pediatr Gastroenterol Nutr. 2016 May;62(5):668-86.
https://journals.lww.com/jpgn/Fulltext/2016/05000/Infant_Colic_What_works__A_Systematic_Review_of.3.aspx
http://www.ncbi.nlm.nih.gov/pubmed/26655941?tool=bestpractice.com
[43]Skonieczna-Żydecka K, Janda K, Kaczmarczyk M, et al. The effect of probiotics on symptoms, gut microbiota and inflammatory markers in infantile colic: a systematic review, meta-analysis and meta-regression of randomized controlled trials. J Clin Med. 2020 Apr 2;9(4):999.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231167
http://www.ncbi.nlm.nih.gov/pubmed/32252419?tool=bestpractice.com
[44]Sung V, D’Amico F, Cabana MD, et al. Lactobacillus reuteri to treat infant colic: a meta-analysis. Pediatrics. 2018 Jan;141(1):e20171811.
https://pediatrics.aappublications.org/content/141/1/e20171811
http://www.ncbi.nlm.nih.gov/pubmed/29279326?tool=bestpractice.com
Revisões sistemáticas relatam redução do tempo de choro, principalmente em lactentes amamentados.[32]Johnson JD, Cocker K, Chang E. Infantile colic: recognition and treatment. Am Fam Physician. 2015 Oct 1;92(7):577-82.
https://www.aafp.org/pubs/afp/issues/2015/1001/p577.html
http://www.ncbi.nlm.nih.gov/pubmed/26447441?tool=bestpractice.com
[41]Hjern A, Lindblom K, Reuter A, et al. A systematic review of prevention and treatment of infantile colic. Acta Paediatr. 2020 Sep;109(9):1733-44.
https://onlinelibrary.wiley.com/doi/10.1111/apa.15247
http://www.ncbi.nlm.nih.gov/pubmed/32150292?tool=bestpractice.com
[44]Sung V, D’Amico F, Cabana MD, et al. Lactobacillus reuteri to treat infant colic: a meta-analysis. Pediatrics. 2018 Jan;141(1):e20171811.
https://pediatrics.aappublications.org/content/141/1/e20171811
http://www.ncbi.nlm.nih.gov/pubmed/29279326?tool=bestpractice.com
[45]Ong TG, Gordon M, Banks SS, et al. Probiotics to prevent infantile colic. Cochrane Database Syst Rev. 2019 Mar 13;3(3):CD012473.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012473.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/30865287?tool=bestpractice.com
[46]Ellwood J, Draper-Rodi J, Carnes D. Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines. BMJ Open. 2020 Feb 25;10(2):e035405.
https://bmjopen.bmj.com/content/10/2/e035405.long
http://www.ncbi.nlm.nih.gov/pubmed/32102827?tool=bestpractice.com
[47]Vaz SR, Tofoli MH, Avelino MAG, et al. Probiotics for infantile colic: is there evidence beyond doubt? A meta-analysis and systematic review. Acta Paediatr. 2024 Feb;113(2):170-82.
https://onlinelibrary.wiley.com/doi/10.1111/apa.17036
http://www.ncbi.nlm.nih.gov/pubmed/37962097?tool=bestpractice.com
No entanto, uma revisão Cochrane de 2019 concluiu que não há evidências claras de que os probióticos sejam mais eficazes que o placebo na prevenção da cólica infantil.[45]Ong TG, Gordon M, Banks SS, et al. Probiotics to prevent infantile colic. Cochrane Database Syst Rev. 2019 Mar 13;3(3):CD012473.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012473.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/30865287?tool=bestpractice.com
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How do probiotics compare with placebo for preventing colic in healthy babies?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2516/fullMostre-me a resposta[Evidência C]391d63e3-497b-4141-9163-3b5474e8df54ccaCComo os probióticos se comparam ao placebo na prevenção de cólicas em bebês saudáveis? Com base nessa revisão Cochrane, a orientação do Reino Unido não recomenda o uso de probióticos para lactentes com cólicas.[48]National Institute for Health and Care Excellence. Scenario: management of infantile colic. Dec 2022 [internet publication]. No entanto, as orientações na Austrália, no Canadá e em países do Médio Oriente recomendam considerar L reuteri DSM 17938 como uma opção de tratamento para cólicas em lactentes em aleitamento materno exclusivo.[49]Indrio F, Enninger A, Aldekhail W, et al. Management of the most common functional gastrointestinal disorders in infancy: the middle east expert consensus. Pediatr Gastroenterol Hepatol Nutr. 2021 Jul;24(4):325-36.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279821
http://www.ncbi.nlm.nih.gov/pubmed/34316467?tool=bestpractice.com
[50]Schneider R, Sant'Anna A. Using probiotics in paediatric populations. [in fre]. Paediatr Child Health. 2022 Dec;27(8):482-502.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9792287
http://www.ncbi.nlm.nih.gov/pubmed/36583073?tool=bestpractice.com
[51]The Royal Children's Hospital Melbourne. Unsettled or crying babies. Aug 2019 [internet publication].
Dieta pobre em FODMAPs
Em um estudo randomizado e cruzado de mães que amamentavam, uma dieta materna pobre em FODMAPs foi associada a menor duração do choro e do desconforto em lactentes com cólica em comparação com uma dieta ocidental típica.[52]Iacovou M, Craig SS, Yelland GW, et al. Randomised clinical trial: reducing the intake of dietary FODMAPs of breastfeeding mothers is associated with a greater improvement of the symptoms of infantile colic than for a typical diet. Aliment Pharmacol Ther. 2018 Nov;48(10):1061-73.
http://www.ncbi.nlm.nih.gov/pubmed/30306603?tool=bestpractice.com
O efeito pareceu ser independente de mudanças na ansiedade e no estresse maternos.