Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses

Carnes, Dawn; Plunkett, Austin; Ellwood, Julie; Miles, Clare

doi:10.1136/bmjopen-2017-019040

Cited by 33 publications

(42 citation statements)

References 46 publications

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“…Our evidence rating is similar to the recent 2018 systematic review and meta-analysis of infantile colic and manual therapy conducted by Carnes et al [68]. Carnes et al concluded that while small benefits were found for the overall outcome, the benefit of manual therapy for infantile colic is still unclear [68]. For pediatric enuresis, our search identified only one observational study showing favorable results; however, this level of evidence was not enough to substantiate a “favorable” rating [25].…”

Section: Discussionsupporting

confidence: 89%

Manual therapy for the pediatric population: a systematic review

Prevost

Gleberzon

Carleo

et al. 2019

BMC Complement Altern Med

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BackgroundThis systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report.MethodsSix databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study.ResultsOf the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity.ConclusionsFifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.Trial registrationPROSPERA registration number: CRD42018091835

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Section: Discussionsupporting

confidence: 89%

Manual therapy for the pediatric population: a systematic review

Prevost

Gleberzon

Carleo

et al. 2019

BMC Complement Altern Med

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“…There were no serious adverse events reported for either probiotics or manual therapy, indicating that both represent a low risk to infants, although we cannot conclude they are without any risk 27 42. Two reviews16 43 analysed the risks of adverse events with manual therapy, one showed 88% less risk of an adverse event in the manual therapy groups than in the control groups43 and the other showed one in six parents reported non-serious adverse events 16. Another study42 reported data from non-RCTs which included four case studies reporting serious incidents of harm but there was some doubt over causality as a result of the treatments given.…”

Section: Discussionmentioning

confidence: 89%

Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines

2020

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ObjectiveTo conduct a systematic review of systematic reviews and national guidelines to assess the effectiveness of four treatment approaches (manual therapy, probiotics, proton pump inhibitors and simethicone) on colic symptoms including infant crying time, sleep distress and adverse events.MethodsWe searched PubMed, Embase, Cochrane and Mantis for studies published between 2009 and 2019. Inclusion criteria were systematic reviews and guidelines that used evidence and expert panel opinion. Three reviewers independently selected articles by title, abstract and full paper review. Data were extracted by one reviewer and checked by a second. Selected studies were assessed for quality using modified standardised checklists by two authors. Meta-analysed data for our outcomes of interest were extracted and narrative conclusions were assessed.ResultsThirty-two studies were selected. High-level evidence showed that probiotics were most effective for reducing crying time in breastfed infants (range −25 min to −65 min over 24 hours). Manual therapies had moderate to low-quality evidence showing reduced crying time (range −33 min to −76 min per 24 hours). Simethicone had moderate to low evidence showing no benefit or negative effect. One meta-analysis did not support the use of proton pump inhibitors for reducing crying time and fussing. Three national guidelines unanimously recommended the use of education, parental reassurance, advice and guidance and clinical evaluation of mother and baby. Consensus on other advice and treatments did not exist.ConclusionsThe strongest evidence for the treatment of colic was probiotics for breastfed infants, followed by weaker but favourable evidence for manual therapy indicated by crying time. Both forms of treatment carried a low risk of serious adverse events. The guidance reviewed did not reflect these findings.PROSPERO registration numberCRD42019139074.

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“…Several nonmedical interventions have been developed to both decrease infant crying and support parents concerned about infant crying (Akhnikh et al, ). For example, manual therapies may provide small positive benefits in reducing the duration of crying (Carnes, Plunkett, Ellwood, & Miles, ), and interventions focusing on strategies to prevent parents from harming their baby have also been proposed (Barr et al, ). Some interventions, for example, behavioural therapy (Powell et al, ), have been developed to support parental sensitivity in dealing with excessive crying or to improve interactions and communication between parents and infants (Akhnikh et al, ; Blom, van Sleuwen, de Vries, Engelberts, & L'hoir, ).…”

Section: Discussionmentioning

confidence: 99%

Does maternal attachment to her infant mediate the link between perceptions of infant crying at 6 months and parenting stress at 24 months? A structural equation modelling approach

Bailhache

Doyle

Salmi

et al. 2019

Child

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Background: Parenting stress is influenced by many factors including maternal attachment and excessive infant crying, yet the nature of these relationships is not well understood. For example, excessive infant crying despite maternal soothing may impact maternal attachment to the child, leading to higher stress. This paper explored whether maternal perception of excessive infant crying at 6 months was associated with higher maternal parenting stress at 24 months, and whether maternal attachment mediated this relationship.Methods: All families, present at 24 months in a randomized controlled trial of a 5year early intervention programme targeting school readiness skills in disadvantaged area of Ireland, were included. At 6 months, infant crying was assessed using a maternal reported measure of duration of infant crying, and maternal attachment to the infant was assessed using the Condon Maternal Attachment Scale. Parenting stress was assessed at 24 months using the childrearing stress subscale from the Parenting Stress Index. Structural equation modelling was used to explore the direct and indirect effects of maternal perceptions of excessive infant crying on parenting stress, controlling for infant, maternal, and environmental characteristics, and focusing on the mediating role of maternal attachment.Results: Reporting excessive infant crying at 6 months was associated with lower maternal attachment at 6 months, which led to higher parenting stress at 24 months.In addition, vulnerable adult attachment style, previous maternal mental health difficulties, low paternal education, paternal involvement with the child, and not being married were associated with higher parenting stress.Conclusion: Findings suggest that the association between maternal perceptions of excessive crying at 6 months and later parenting stress may be mediated through maternal attachment to the infant. Interventions based on improving maternal attachment could be investigated to determine the effectiveness of supporting mothers with low attachment.

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Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses

Cited by 33 publications

References 46 publications

Manual therapy for the pediatric population: a systematic review

Manual therapy for the pediatric population: a systematic review

Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines

Does maternal attachment to her infant mediate the link between perceptions of infant crying at 6 months and parenting stress at 24 months? A structural equation modelling approach

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