Probiotics for Colic, Yes or No
Parents who have an infant suffering with colic know how stressful and worrisome it can be. Probiotics have been suggested as a possible treatment in past studies, but now new research says they are not helpful. So, can beneficial bacteria help infants who have colic?
The excessive crying and fussing characteristic of colic can last for three to four months for the estimated 20 percent of infants who experience this condition, but for parents it can seem like years. Thus far, no treatment option has been found that can effectively relieve the symptoms, which include loud and continuous crying that can last for hours, distended belly, legs that alternate between being flexed and extended, and clenched hands.
Probiotics help colic
Before we look at the negative results, let’s review a few studies that found probiotics to be helpful in treating colic.
In a study published in the Journal of Clinical Neonatology, researchers administered the probiotic Lactobacillus reuteri or placebo for 21 days to 80 infants younger than 5 months old. All had colic and were exclusively or mostly (more than 50% of the time) breastfed.
The rate of responders was significantly greater among infants who took the probiotic at all times checked (days 7, 14, 21, and 28). That means these infants spent less time crying each day than did those taking placebo.
In addition, there was a significant reduction in the parents’ perception of the severity of the colicky episodes among infants who took the probiotics. Parents also reported an improvement in both parental and family quality of life.
The results of a recent clinical trial, published in JAMA Pediatrics, also found L. reuteri to be effective, but in that study the probiotic was used as a preventive measure. Specifically, the authors examined whether daily use of L. reuteri during the first three months of life would reduce the onset of colic, constipation, and gastroesophageal reflux in term newborn infants.
A total of 589 infants born in nine different neonatal units in Italy were randomly assigned to take either L. reuteri or placebo daily for 90 days. At the end of the trial, results in the probiotics and placebo groups were as follows:
- Mean duration of crying time, 38 vs 71 minutes
- Mean number of regurgitations daily, 2.9 vs 4.6
- Mean number of bowel movements, 4.2 vs 3.6
Use of probiotics also resulted in a cost savings for both the families ($118.71) and the community ($140.30) for management of this condition.
Probiotics don’t help colic
The new study was the largest randomized, controlled trial to date to examine use of probiotics in babies with colic. Participants included 167 breastfed and formula-fed infants younger than three months old who were randomly assigned to take the L. reuteri probiotic (85) or a placebo (82) for 30 days.
Here’s what the researchers found:
- Infants who took probiotics were significantly more fussy than those in the placebo group at any time of the day from day seven to day 30
- At one month, infants who took probiotics fussed or cried 49 minutes more than those in the placebo group, but the increased fussing was seen only in the infants fed formula
- Use of probiotics did not have an impact on fussing or crying time in infants who were breastfed only
- Probiotic use also did not result in changes in bacterial diversity in the gut or fecal calprotectin (an indicator of inflammation in the gut) or lead to any improvement in infants’ sleep, family or infant functioning, mothers’ mental health, or quality of life
All of these findings boil down to the authors’ conclusion that probiotics “cannot be routinely recommended for all infants with colic.” Note, however, that this conclusion leaves room for identifying which subgroup of infants with colic may be helped by the beneficial bacteria.
Other suggestions for dealing with or treating colic include burping the baby more often, playing music or white noise, or infant massage. And then there’s love.
In an editorial that accompanied the latest study, William E. Bennett, Jr., assistant professor of pediatrics at Indiana University School of Medicine, suggested what some parents may think is unreasonable: not treat colic at all. Bennett suggested that “The potential harm associated with diagnostic testing and treatment of infants is likely to surpass the harm from colic itself,” since the symptoms go away with time and there’s no evidence that infants experience any long-term bad effects.
Therefore, Bennett went on to say that families with infants “may be better served if we devote more resources to studying the interventions recommended long before the discovery of probiotics: reassurance, family social support, and the tincture of time.” Given the changing face of families today, however, these interventions can be in short supply.
Anabrees J. Probiotics for the management of infantile colic in breastfed infants. Journal of Clinical Neonatology 2013 Jan; 2(1): 9-11
Bennett WE. Probiotics and infant colic. BMJ 2014; 348:g2286
Indrio F et al. Prophlactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial. JAMA Pediatrics 2014 Mar 1; 168(3): 228-33
Sung V et al. Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomized trial. BMJ 2014; 348 (apr01 2): g2107