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

Abstract

Summary Background Therapeutic diets for infantile colic lack evidence. In breastfed infants, avoiding “windy” foods by the breastfeeding mother is common. Aim To examine the effects of a maternal low‐FODMAP (Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, And Polyols) diet compared to a typical‐Australian diet on infant crying‐fussing durations of infants with colic in a randomised, double‐blind, crossover feeding study. Methods Between 2014 and 2016 exclusively breastfed infants aged ≤9 weeks meeting Wessel criteria for colic were recruited. Mothers were provided a 10‐day low‐FODMAP or typical‐Australian diet, then alternated without washout. Infants without colic (controls) were observed prospectively and mothers remained on habitual diet. Infant crying‐fussing durations were captured using a Barr Diary. Measures of maternal psychological status and samples of breast milk and infant faeces were collected. Results Mean crying‐fussing durations were 91 min/d in seven controls compared with 269 min/d in 13 colicky infants (P < 0.0001), which fell by median 32% during the low‐FODMAP diet compared with 20% during the typical‐Australian diet (P = 0.03), confirmed by a two‐way mixed‐model analyses‐of‐variance (ƞp2 = 0.719; P = 0.049) with no order effect. In breast milk, lactose concentrations remained stable and other known dietary FODMAPs were not detected. Changes in infant faecal calprotectin were similar between diets and groups, and faecal pH did not change. Median maternal anxiety and stress fell with the typical‐Australian diet (P < 0.01), but remained stable on the low‐FODMAP diet. Conclusions Maternal low‐FODMAP diet was associated with enhanced reduction in crying‐fussing durations of infants with colic. This was not related to changes in maternal psychological status, gross changes in breast milk or infant faeces. Mechanisms require elucidation. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12616000512426 ‐ anzctr.org.au

The therapeutic efficacy of Bifidobacterium animalis subsp. lactis BB‐12® in infant colic: A randomised, double blind, placebo‐controlled trial

“…Butyrate modulates intestinal transit time, visceral and central pain perception and gut‐brain axis, and exerts a potent anti‐inflammatory action . The faecal calprotectin features have been explored by only few authors with conflicting results . We found a different modulation of calprotectin in responder infants to BB‐12 intervention, suggesting that calprotectin could be involved in the modulation of the gut inflammatory state elicited by this probiotic.…”

“…[35][36][37][38][39][40][41][42][43][44][45][46] The faecal calprotectin features have been explored by only few authors with conflicting results. 47,48 We found a different modulation of calprotectin in responder infants to BB-12…”

Increasing parenting self‐efficacy: The Fussy Baby Network® intervention

“…Pharmaceutical and dietary interventions focus on the infant and have been shown to be effective for a subset of excessively crying infants who have an organic physiological condition (approximately 5–10%) but cannot be considered an effective treatment for most excessively crying infants (Hill et al., ; Oggero, Garbo, Savino, & Mostert, ; Wolke, ). For example, probiotics and other maternal diet changes may reduce excessive infant crying among breastfed infants, but not a broader group of infants (Iacovou et al., ; Sung et al., ). Even if effective for reducing infant crying, dietary interventions may do little to reduce maternal anxiety (Iacovou et al., ).…”

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