Recent advances in understanding and managing infantile colic

Abstract

A newborn brings joy to the family. Crying belongs to the spectrum of normal behaviour of young infants. However, although it occurs in about 20% of all infants, unsoothable and persistent crying in young infants distresses the family, although it is usually benign. The aetiology of infantile colic remains unknown, although an unbalanced gastro-intestinal microbiome, increased intestinal permeability, and chronic inflammation are involved, as well as behavioural factors, including over- and under-stimulation. It is a challenge for healthcare professionals to decide when organic disease needs to be excluded. Parental stress is a reason for babies to cry more, inducing a vicious cycle. Therefore, parental reassurance with explanatory guidance is the cornerstone of management. The placebo effect is estimated to be as high as 50%. If an intervention is felt to be necessary to offer further support to the baby and family, it is important to choose the options for which there is some efficacy without adverse effects. There is evidence that some specific probiotic strains such as Lactobacillus reuteri DSM 19378, especially in breastfed infants, are effective. However, there are also promising data for some synbiotics and/or killed or tyndallized bacteria, as well as substances decreasing intestinal permeability. Formula management with extensive and/or partial hydrolysates may also bring relief. But, above all, offering parental support remains imperative.

Health Benefits of Heat-Killed (Tyndallized) Probiotics: An Overview

“…Heat treatments of bacterial suspensions can use a range of temperatures between 70 and 100 °C and in some cases, inactivation is obtained with the combination of heat treatments with incubation periods at lower temperatures (ambient temperatures, cooling or freezing temperatures), a process known as tyndallization, due to the similarities with the method of sterilization to remove spores based on repeating boiling and incubation, developed by the physicist Dr John Tyndall during the nineteenth century [86,87].…”

“…With the use of new sequencing techniques, gut microbiota and the characteristics of dysbiosis is currently being assessed in detail in pediatric populations, particularly in infants and preterm infants. Recent findings suggest that the immature intestinal mucosa and gut dysbiosis in infants precedes the development of relevant severe diseases, as late-onset sepsis [153] or necrotizing enterocolitis (NEC) [54], and also as less severe, but particularly stressful for parents, infantile colic [87]. It has been recently shown that at weaning the intestinal microbiota induces a vigorous immune response (the “weaning reaction”) that is programmed in time, and inhibition of this effect leads to pathological imprinting and increased susceptibility to colitis, allergic inflammation, and cancer later in life [154].…”

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

“…There is also no evidenced‐based medical approach to manage excessive or persistent infant crying (Daelemans, Peeters, & Hauser, ). In pediatrics, colic is a diagnosis of exclusion when no organic/physiological cause for excessive crying is found, and physicians are advised to reassure parents that the infant is healthy and that colic is a self‐limiting condition (Roberts, Ostapchuk, & O'Brien, ).…”

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

“…It is presumed that the disorder results from a complex reaction between a newborn and the environment. Colic may also manifest as a result of immaturity of the structure and function of the gastrointestinal tract (GI) [9,10]. Both psychosociological factors, such as anxious parents, and gastrointestinal factors, such as allergy to cows' milk or gastroesophageal reflux (GER), also play pathophysiological roles [11][12][13].…”