Infantile Colic: New Insights into an Old Problem

Tu Mai, Nicole Y Fatheree, Wallace Gleason, Yuying Liu, Jon Marc Rhoads, Tu Mai, Nicole Y Fatheree, Wallace Gleason, Yuying Liu, Jon Marc Rhoads

Abstract

Infant colic is a characteristic group of behaviors seen in young infants. The most prominent feature is prolonged crying. Additional characteristics, including clenching of the fists and flexion of the hips, have led to the suggestion that these behaviors are related to abdominal discomfort. In this article, we show emerging evidence to support the concept that infant colic could represent gut inflammation and microbial dysbiosis that impacts brain function and even brain development.

Keywords: Barr diary; Crying; Infant; Microbiome; Neutropenia.

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Fig. 1.
Fig. 1.
Barr diary. (From Barr RG, Kramer MS, Boisjoly C, et al. Parental diary of infant cry and fuss behavior. Arch Dis Child 1988;63:384; with permission.)
Fig. 2.
Fig. 2.
Daily breakdown of crying time in infants with colic: crying and fussing in minutes (n = 27). Means +/− SEM. (Adapted from Rhoads JM, Collins J, Fatheree NY, et al. Infant colic represents gut inflammation and dysbiosis. J Pediatr, in press; with permission.)
Fig. 3.
Fig. 3.
([ISP]A, [ISP][ISP]B): Relationship between fecal calprotectin, colic, and feeding modality in infants. (C, D): Fecal microbial community composition in infants with and without colic. (A) Infants with colic (n = 29) have significantly higher levels of fecal calprotectin than normal controls (n = 25) (P<.0001, Wilcoxon rank sum test). (B) Breastfed infants significantly higher levels of fecal calprotectin than Formula fed infants (P = .019, Kruskal-Wallis with post hoc Dunn’s test and correction for multiple comparisons). (C) Phylum/Classlevel composition of colic (n = 37) vs control (n = 28) samples. Normal control samples have a significantly higher abundance of Actinobacteria, (P = .032, Wilcoxon rank sum tests withcorrection for multiple comparisons). (D) Microbial β-diversity composition of infants with and without colic is significantly different (P = .003, permutational multivariate analysis of variance). (Adapted from Rhoads JM, Collins J, Fatheree NY, et al. Infant colic represents gut inflammation and dysbiosis. J Pediatr, in press; with permission.)

References

    1. Wessel MA, Cobb JC, Jackson EB, et al. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics 1954;14:421–35.
    1. Groopman J The colic conundrum: the crying that doctors can’t stop. Ann Med. 2007. Available at: . Accessed September 17, 2007.
    1. Barr RG, Rotman A, Yaremko J, et al. The crying of infants with colic: a controlled empirical description. Pediatrics 1992;90:14–21.
    1. Barr RG. Crying as a trigger for abusive head trauma: a key to prevention. Pediatr Radiol 2014;44(Suppl 4):S559–64.
    1. Levitzky S, Cooper R. Infant colic syndrome—maternal fantasies of aggression and infanticide. Clin Pediatr (Phila) 2000;39:395–400.
    1. Adamsbaum C, Grabar S, Mejean N, et al. Abusive head trauma: judicial admissions highlight violent and repetitive shaking. Pediatrics 2010;126:546–55.
    1. Wolke D, Bilgin A, Samara M. Systematic review and meta-analysis: fussing and crying durations and prevalence of colic in infants. J Pediatr 2017;185:55–61.
    1. Gelfand AA. Infant Colic. Semin Pediatr Neurol 2016;23:79–82.
    1. Hall B, Chesters J, Robinson A. Infantile colic: a systematic review of medical and conventional therapies. J Paediatr Child Health 2012;48:128–37.
    1. Parker S, Magee T, Colic. The Zuckerman Parker handbook of developmental and behavioral pediatrics for primary care. In: Augustyn M, Zucerkman B, Caronna EB, editors. 3rd edition Philadelphia: Lippincott Williams & Wilkins; 2011. p. 182.
    1. Thomas DW, McGilligan K, Eisenberg LD, et al. Infantile colic and type of milk feeding. Am J Dis Child 1987;141:451–3.
    1. Rhoads JM, Fatheree NY, Norori J, et al. Altered fecal microflora and increased fecal calprotectin in infants with colic. J Pediatr 2009;155:823–8.
    1. Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics 2000;106:184–90.
    1. Lucassen PL, Assendelft WJ, Gubbels JW, et al. Effectiveness of treatments for infantile colic: systematic review. BMJ 1998;316:1563–9.
    1. Lust KD, Brown JE, Thomas W. Maternal intake of cruciferous vegetables and other foods and colic symptoms in exclusively breast-fed infants. J Am Diet Assoc 1996;96:46–8.
    1. Moore DJ, Robb TA, Davidson GP. Breath hydrogen response to milk containing lactose in colicky and noncolicky infants. J Pediatr 1988;113:979–84.
    1. Fatheree NY, Liu Y, Ferris M, et al. Hypoallergenic formula with Lactobacillus rhamnosus GG for babies with colic: a pilot study of recruitment, retention, and fecal biomarkers. World J Gastrointest Pathophysiol 2016;7:160–70.
    1. Hyams JS, Geertsma MA, Etienne NL, et al. Colonic hydrogen production in infants with colic. J Pediatr 1989;115:592–4.
    1. Miller JJ, McVeagh P, Fleet GH, et al. Breath hydrogen excretion in infants with colic. Arch Dis Child 1989;64:725–9.
    1. Treem WR. Infant colic. A pediatric gastroenterologist’s perspective. Pediatr Clin North Am 1994;41:1121–38.
    1. Barr RG, Wooldridge J, Hanley J. Effects of formula change on intestinal hydrogen production and crying and fussing behavior. J Dev Behav Pediatr 1991;12:248–53.
    1. Kanabar D, Randhawa M, Clayton P. Improvement of symptoms in infant colic following reduction of lactose load with lactase. J Hum Nutr Diet 2001;14:359–63.
    1. Liebman WM. Infantile colic. Association with lactose and milk intolerance. JAMA 1981;245:732–3.
    1. Fazil M. Prevalence and risk factors for infantile colic in District Mansehra. J Ayub Med Coll Abbottabad 2011;23:115–7.
    1. Talachian E, Bidari A, Rezaie MH. Incidence and risk factors for infantile colic in Iranian infants. World J Gastroenterol 2008;14:4662–6.
    1. Young SN, Leyton M. The role of serotonin in human mood and social interaction. Insight from altered tryptophan levels. Pharmacol Biochem Behav 2002;71: 857–65.
    1. Kurtoglu S, Uzum K, Hallac IK, et al. 5-Hydroxy-3-indole acetic acid levels in infantile colic: is serotoninergic tonus responsible for this problem? Acta Paediatr 1997;86:764–5.
    1. Vartabedian B Colic solved: the essential guide to infant reflux and the care of your crying, difficult-to-sooth baby. New York (NY): Ballantine Books; 2007. Version 3.1.
    1. Karp HN. Safe swaddling and healthy hips: don’t toss the baby out with the bathwater. Pediatrics 2008;121:1075–6.
    1. Karp H The happiest baby on the block: the new way to calm crying and help your newborn baby sleep longer. 2nd edition New York (NY): Bantam Books; 2015.
    1. Paradise JL. Maternal and other factors in the etiology of infantile colic. Report of a prospective study of 146 infants. JAMA 1966;197:191–9.
    1. Sondergaard C, Olsen J, Friis-Hasche E, et al. Psychosocial distress during pregnancy and the risk of infantile colic: a follow-up study. Acta Paediatr 2003;92: 811–6.
    1. van den Berg MP, van der Ende J, Crijnen AA, et al. Paternal depressive symptoms during pregnancy are related to excessive infant crying. Pediatrics 2009; 124:e96–103.
    1. Raiha H, Lehtonen L, Huhtala V, et al. Excessively crying infant in the family: mother-infant, father-infant and mother-father interaction. Child Care Health Dev 2002;28:419–29.
    1. Canivet CA, Ostergren PO, Rosen AS, et al. Infantile colic and the role of trait anxiety during pregnancy in relation to psychosocial and socioeconomic factors. Scand J Public Health 2005;33:26–34.
    1. Canivet CA, Ostergren PO, Jakobsson IL, et al. Infantile colic, maternal smoking and infant feeding at 5 weeks of age. Scand J Public Health 2008;36:284–91.
    1. Crowcroft NS, Strachan DP. The social origins of infantile colic: questionnaire study covering 76,747 infants. BMJ 1997;314:1325–8.
    1. Carlsson C Acupuncture mechanisms for clinically relevant long-term effects— reconsideration and a hypothesis. Acupunct Med 2002;20:82–99.
    1. Madsen MV, Gotzsche PC, Hrobjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ 2009;338:a3115.
    1. Sato A, Sato Y, Suzuki A, et al. Neural mechanisms of the reflex inhibition and excitation of gastric motility elicited by acupuncture-like stimulation in anesthetized rats. Neurosci Res 1993;18:53–62.
    1. Yuan M, Li Y, Wang Y, et al. Electroacupuncture at ST37 enhances jejunal motility via excitation of the parasympathetic system in rats and mice. Evid Based Complement Alternat Med 2016;2016:3840230.
    1. Zeng F, Qin W, Ma T, et al. Influence of acupuncture treatment on cerebral activity in functional dyspepsia patients and its relationship with efficacy. Am J Gastroenterol 2012;107:1236–47.
    1. Landgren K, Kvorning N, Hallstrom I. Acupuncture reduces crying in infants with infantile colic: a randomised, controlled, blind clinical study. Acupunct Med 2010; 28:174–9.
    1. Reinthal M, Lund I, Ullman D, et al. Gastrointestinal symptoms of infantile colic and their change after light needling of acupuncture: a case series study of 913 infants. Chin Med 2011;6:28.
    1. Landgren K, Hallstrom I. Effect of minimal acupuncture for infantile colic: a multicentre, three-armed, single-blind, randomised controlled trial (ACU-COL). Acupunct Med 2017;35:171–9.
    1. Reinthal M, Andersson S, Gustafsson M, et al. Effects of minimal acupuncture in children with infantile colic—a prospective, quasi-randomised single blind controlled trial. Acupunct Med 2008;26:171–82.
    1. Skjeie H, Skonnord T, Fetveit A, et al. Acupuncture for infantile colic: a blinding-validated, randomized controlled multicentre trial in general practice. Scand J Prim Health Care 2013;31:190–6.
    1. Dobson D, Lucassen PL, Miller JJ, et al. Manipulative therapies for infantile colic. Cochrane Database Syst Rev 2012;12:CD004796.
    1. Savino F, Ceratto S, De MA, et al. Looking for new treatments of infantile colic. Ital J Pediatr 2014;40:53.
    1. Anheyer D, Frawley J, Koch AK, et al. Herbal medicines for gastrointestinal disorders in children and adolescents: a systematic review. Pediatrics 2017; 139 [pii:e20170062].
    1. Paregoric. Available at: . Accessed March 12, 2018.
    1. Savino F, Tarasco V. New treatments for infant colic. Curr Opin Pediatr 2010;22: 791–7.
    1. Moore DJ, Tao BS, Lines DR, et al. Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. J Pediatr 2003;143: 219–23.
    1. Orenstein SR, Hassall E, Furmaga-Jablonska W, et al. Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatr 2009;154:514–20.
    1. Hudson B, Alderton A, Doocey C, et al. Crying and spilling—time to stop the over-medicalisation of normal infant behaviour. N Z Med J 2012;125:119–26.
    1. Ringel Y, Ringel-Kulka T. The intestinal microbiota and irritable bowel syndrome. J Clin Gastroenterol 2015;49(Suppl 1):S56–9.
    1. Gevers D, Kugathasan S, Denson LA, et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe 2014;15:382–92.
    1. Olesen SW, Alm EJ. Dysbiosis is not an answer. Nat Microbiol 2016;1:16228.
    1. Jandhyala SM, Talukdar R, Subramanyam C, et al. Role of the normal gut microbiota. World J Gastroenterol 2015;21:8787–803
    1. Savino F, Cresi F, Pautasso S, et al. Intestinal microflora in breastfed colicky and non-colicky infants. Acta Paediatr 2004;93:825–9.
    1. Savino F, Cordisco L, Tarasco V, et al. Molecular identification of coliform bacteria from colicky breastfed infants. Acta Paediatr 2009;98:1582–8.
    1. Fatheree NY, Liu Y, Taylor CM, et al. Lactobacillus reuteri for infants with colic: a double-blind, placebo-controlled, randomized clinical trial. J Pediatr 2017;191: 170–8.
    1. Martinez I, Muller CE, Walter J. Long-term temporal analysis of the human fecal microbiota revealed a stable core of dominant bacterial species. PLoS One 2013;8:e69621.
    1. de Weerth C, Fuentes S, Puylaert P, et al. Intestinal microbiota of infants with colic: development and specific signatures. Pediatrics 2013;131:e550–8.
    1. Partty A, Kalliomaki M, Endo A, et al. Compositional development of Bifidobacterium and Lactobacillus microbiota is linked with crying and fussing in early infancy. PLoS One 2012;7:e32495.
    1. Savino F, Quartieri A, De MA, et al. Comparison of formula-fed infants with and without colic revealed significant differences in total bacteria, Enterobacteriaceae and faecal ammonia. Acta Paediatr 2017;106:573–8.
    1. Savino F, Garro M, Montanari P, et al. Crying time and RORgamma/FOXP3 expression in Lactobacillus reuteri DSM17938-treated infants with colic: a randomized trial. J Pediatr 2017;192:171–7.e1.
    1. Mai V, Young CM, Ukhanova M, et al. Fecal microbiota in premature infants prior to necrotizing enterocolitis. PLoS One 2011;6:e20647.
    1. Warner BB, Deych E, Zhou Y, et al. Gut bacteria dysbiosis and necrotising enterocolitis in very low birthweight infants: a prospective case-control study. Lancet 2016;387:1928–36.
    1. Olafsdottir E, Aksnes L, Fluge G, et al. Faecal calprotectin levels in infants with infantile colic, healthy infants, children with inflammatory bowel disease, children with recurrent abdominal pain and healthy children. Acta Paediatr 2002;91: 45–50.
    1. Sung V, Hiscock H, Tang ML, et al. Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomised trial. BMJ 2014; 348:g2107.
    1. Savino F, De MA, Ceratto S, et al. Fecal calprotectin during treatment of severe infantile colic with Lactobacillus reuteri DSM 17938: a randomized, double-blind, placebo-controlled trial. Pediatrics 2015;135(Suppl 1):S5–6.
    1. Savino F, Pelle E, Palumeri E, et al. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics 2007;119:e124–30.
    1. Barr RG, Kramer MS, Boisjoly C, et al. Parental diary of infant cry and fuss behaviour. Arch Dis Child 1988;63:380–7.
    1. Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics 2010;126: e526–33.
    1. Szajewska H, Gyrczuk E, Horvath A. Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial. J Pediatr 2013;162:257–62.
    1. Chau K, Lau E, Greenberg S, et al. Probiotics for infantile colic: a randomized, double-blind, placebo-controlled trial investigating Lactobacillus reuteri DSM 17938. J Pediatr 2015;166:74–8
    1. Mi GL, Zhao L, Qiao DD, et al. Effectiveness of Lactobacillus reuteri in infantile colic and colicky induced maternal depression: a prospective single blind randomized trial. Antonie Van Leeuwenhoek 2015;107:1547–53.
    1. 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;62: 668–86.
    1. Xu M, Wang J, Wang N, et al. The efficacy and safety of the probiotic bacterium Lactobacillus reuteri DSM 17938 for infantile colic: a meta-analysis of randomized controlled trials. PLoS One 2015;10:e0141445.
    1. Sung V, Cabana MD, D’Amico F, et al. Lactobacillus reuteri DSM 17938 for managing infant colic: protocol for an individual participant data meta-analysis. BMJ Open 2014;4:e006475.
    1. Liu Y, Fatheree NY, Dingle BM, et al. Lactobacillus reuteri DSM 17938 changes the frequency of Foxp3+ regulatory T cells in the intestine and mesenteric lymph node in experimental necrotizing enterocolitis. PLoS One 2013;8(2):e56547.
    1. Partty A, Lehtonen L, Kalliomaki M, et al. Probiotic Lactobacillus rhamnosus GG therapy and microbiological programming in infantile colic: a randomized, controlled trial. Pediatr Res 2015;78:470–5.
    1. Kianifar H, Ahanchian H, Grover Z, et al. Synbiotic in the management of infantile colic: a randomised controlled trial. J Paediatr Child Health 2014;50:801–5.
    1. Vandenplas Y, Bacarea A, Marusteri M, et al. Efficacy and safety of APT198K for the treatment of infantile colic: a pilot study. J Comp Eff Res 2017;6:137–44.
    1. Indrio F, Di MA, Riezzo G, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial. JAMA Pediatr 2014;168:228–33.
    1. Savino F, Ceratto S, Poggi E, et al. Preventive effects of oral probiotic on infantile colic: a prospective, randomised, blinded, controlled trial using Lactobacillus reuteri DSM 17938. Benef Microbes 2015;6:245–51.
    1. Savino F, Castagno E, Bretto R, et al. A prospective 10-year study on children who had severe infantile colic. Acta Paediatr Suppl 2005;94:129–32.
    1. Kelly JR, Minuto C, Cryan JF, et al. Cross talk: the microbiota and neurodevelopmental disorders. Front Neurosci 2017;11:490.
    1. Rea K, Dinan TG, Cryan JF. The microbiome: a key regulator of stress and neuro-inflammation. Neurobiol Stress 2016;4:23–33.
    1. Vuong HE, Yano JM, Fung TC, et al. The microbiome and host behavior. Annu Rev Neurosci 2017;40:21–49.
    1. Zheng P, Zeng B, Zhou C, et al. Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism. Mol Psychiatry 2016;21:786–96.
    1. Messaoudi M, Lalonde R, Violle N, et al. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr 2011;105:755–64.
    1. Partty A, Kalliomaki M, Wacklin P, et al. A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood: a randomized trial. Pediatr Res 2015;77:823–8.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere