Infantile colic, also known as three-month colic, is a phenomenon that has not yet been fully explained. It manifests as excessive crying or fussiness and irritability in the infant and occurs without an obvious cause. Up to 20% of all newborns are affected (Lucassen et al. 2001). Infantile colic resolves spontaneously within the first three to four months. Three-month colic is a diagnosis of exclusion of organic causes, which occur in around 10% of newborns, and it is considered medically harmless (Gormally et Barr 1997). However, it places a considerable burden on families and healthcare professionals. Both infantile colic and persistent crying are associated with high maternal depression scores (Vik et al. 2009). They also represent the greatest risk factor for shaken baby syndrome (Barr 2012) and early weaning (Howard et al. 2006). In a meta-analysis, severe colic early in life was associated with later sleep problems, allergic diseases, family dysfunction, and behavioral abnormalities (Hemmi et al. 2011).As already mentioned, despite intensive efforts by researchers, the etiology of infantile colic remains unknown, and many different theories about this clinical picture are in circulation. “Does colic represent the most severe end of the spectrum of normal infant complaints, or is it a manifestation of underlying gastrointestinal, neurological, or psychosocial disorders?” (Barr 1998).Postulated hypotheses on the origin of infantile colic
- Gastrointestinal mechanisms: increased intraluminal gas, intestinal dysmotility and visceral pain (Gupta 2002), changes in the gut microbiome (Sung et Cabana 2017), casein allergy (Barr 2003)
- Neurological or psychosocial causes: childhood migraine or maternal migraine (Qubty et al. 2016, Romanello et al. 2013), maternal anxiety, depression (Räihä et al. 2002), smoking (Canivet et al. 2008)
- Osteopathic explanatory approach: perinatal forces or birth trauma acting on the occipital bone and causing irritation of cranial nerves IX, X, XI, and XII in the region of the jugular foramen or at the transition of the upper craniovertebral joints (Frymann 2007)
Possible treatment optionsThe probiotic Lactobacillus reuteri is effective in reducing crying and agitation in breastfed newborns. The role of the probiotic in formula-fed infants with colic still requires further research (Sung et al. 2018). Lactobacillus reuteri is the only treatment option supported by sufficient evidence. However, acupuncture, a hypoallergenic diet for the breastfeeding mother, reduced stimuli for the baby, parental counseling, and hydrolyzed formula are also being investigated (Sung 2018). Manual therapy approaches, including osteopathy, are currently being intensively researched to reduce the severity of symptoms in infantile colic. In 2012, the Cochrane Collaboration published a high-quality review on this topic. Overall, data from 325 infants were analysed. The review concluded that manipulative therapies (OMT, cranial manipulation, chiropractic) are able to significantly reduce average crying time by 1 hour and 12 minutes and improve sleep duration (Dobson et al. 2012). These findings were reproduced in a recent systematic review (Ellwood et al. 2020). Cranial osteopathic manipulation in particular appears to be helpful in the treatment of infantile colic. In an open, controlled, prospective study, 28 infants were randomised into an intervention group (which received OMT) and a control group (no treatment). In those newborns who received cranial treatment, crying duration decreased and sleep duration improved significantly. In addition, parents reported that the treated infants required less parental attention than at the beginning of the study (Hayden et Mullinger 2006). Osteopathy is used, for example, to treat compression of the os temporale, the os occipitale, the occipito-mastoid suture, the atlanto-occipital joint, as well as irritation of the vagus nerve. A type of fluid or membranous shock state and the diaphragm, as well as the coeliac ganglion and the digestive tract, are also targets of osteopathic treatment.
Literature
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