No maternal diet modification helps in infantile colic

A new of its kind study published in the Cochrane report that no improvement was observed in colicky infants when breastfeeding mothers follow a low-allergen diet, or when formula-fed infants are fed a special formula. The study suggests that based on the available evidence, no dietary modifications could be recommended.

Infantile colic is a common problem afflicting otherwise healthy infants in the first three months of life. It is characterized by episodes of crying lasting for longer than three hours per day, for more than three days a week, for at least three weeks which is very distressing for parents.

Previous studies suggest that dietary changes, such as removing cows' milk from a breastfeeding mother's diet or switching formula-fed babies to a special soy-based formula, might reduce the symptoms of colic.

Gordon and associates did a systematic review to find the suitable dietary modification for improving infantile colic which included 15 randomized trials involving a total of 1121 babies with colic.

The key study findings included are:

Low-allergen diet

One study (90 infants) found that more breastfed infants responded to a low-allergen maternal diet than infants on a standard diet containing known potential allergens.

One study (120 infants) found little difference in breastfed infants whose mothers were given a low-allergen diet (10/16, 62.5%) and formula-fed babies who were given soy milk (29/44, 65.9%), but the researchers did find that breastfed babies responded more to dicyclomine hydrochloride (a tablet for treating stomach spasms) than formula-fed babies.

Hydrolyzed formula milk

Two studies (64 infants) found no difference in duration of crying between the hydrolyzed (hypoallergenic) and standard cow's milk groups. Of these, one study(43 infants) reported a greater reduction in crying time at study end in infants who were given hydrolyzed milk.

A third study (22 infants) found that two types of hydrolyzed formulas were equally effective in resolving symptoms of colic for babies started on standard formula.

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A fourth study (21 infants) reported that infants whose parents were given information and support experienced a more rapid reduction in crying time than infants who were given a hydrolyzed formula or dairy- and soy-free diet (within nine days).

A fifth study (267 infants) found that both partially hydrolyzed formula with oligosaccharides (carbohydrates) and a standard formula with simethicone (a drug for treating symptoms of gas) reduced colic episodes after seven days, but effects were greater in the hydrolyzed plus oligosaccharides group after two weeks.

Lactase enzyme supplementation

Three studies (138 infants) tested the effect of adding lactase (an enzyme which helps break down the lactose (sugar) in milk) to the infants' milk. The results were not presented in a form to allow analysis.

Fennel, chamomile and lemon balm extract

One study (93 infants) found that average daily crying time in breastfed babies reduced within one week of treatment with a fennel, chamomile and lemon balm extract.

Soy protein-based formula

One study (19 infants) found that, compared with cows' milk formula, soy formula reduced the crying time and increased the number of responders. However, the international guidance does not support the use of soy milk due to concerns that they can impact hormones in babies, so these results are not relevant.

One study (27 infants) compared soy formula plus polysaccharide (carbohydrate) with soy formula alone but did not present results in a form we could analyze.

“Based on available evidence, we are unable to recommend any intervention. Future studies of single interventions, using clinically significant outcome measures, and appropriate design and power are needed,” write the authors.

The study concluded that currently, evidence of the effectiveness of dietary modifications for the treatment of infantile colic is sparse and at significant risk of bias. The few available studies had small sample sizes, and most had serious limitations. There were insufficient studies, thus limiting the use of meta-analysis. Benefits reported for hydrolyzed formulas were inconsistent.

The study concluded that https://www.cochrane.org/CD011029/BEHAV_diet-changes-infant-colic