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Chiropractic Vs. Conventional: Dueling Perspectives On Infant Colic…..

Infant colic, while not a deadly disease by any stretch of the imagination, is an extremely troubling entity. Not only can it be quite distressing to caregivers, it is also a well-established risk factor for neglect and abuse of the child. Excessive crying in general, whether diagnosed as infant colic or not, is a frequent impetus for seeking advice from medical professionals. How science-based providers approach the evaluation of babies with excessive crying, and the management of infant colic if diagnosed, can have a powerful impact on how families perceive the health of their child and on future interactions with the healthcare system.

Infant crying is about as bread and butter as it gets in pediatrics. It is a problem which we are constantly exposed to during our training. We discuss it with families in our continuity clinics, where we learn how to truly be primary care providers. We address it on the inpatient wards, where children often cry because of illness or pain, and during our months of service in the newborn nursery. We frequently are called upon to talk anxious parents through it while taking overnight phone calls, and we learn over time with variable success the seemingly preternatural ability to understand what babies are trying to tell us with their cry.

Crying happens for a variety of reasons in young infants, ranging from the benign and expected to the life threatening. Discussing excessive crying, regardless of why it occurs, requires effective communication skills. And the evaluation of unexplained excessive crying often tests the limits of our ability to practice non-defensive medicine, avoiding unnecessary laboratory testing and imaging. Because of all this, I believe that infant crying, and in particular the entity known as infant colic, serves as a useful entry point into a discussion of the differences between a science-based approach to medicine and one based on pseudoscience like chiropractic.

Readers of this blog should be well aware of the push by alternative medical practitioners for recognition as primary care providers, with the chiropractic community leading the charge. In this post I will compare and contrast the common understanding of the etiology and treatment of infant colic held by conventional medical doctors and doctors of chiropractic. You will see that in some ways they do not differ as much as we might expect, but have little in common where it truly matters.

What is colic?

With rare exceptions, all babies cry. Infant crying is typically an intermittent phenomenon related to hunger or an environmental insult like cold air or a dirty diaper. Many babies cry only when really bothered by something while some seem to cry all the time. In general, babies get most of their crying out of the way during the first three months of life, with estimates of the average total duration in the range of two hours a day during the first six weeks. Crying trends down after that. But how much a baby should be allowed to cry before a parent should worry, or before giving them a diagnosis, is very hard to peg down and risks ignoring the infant’s environment and the caregiver concerns when a baby falls short of diagnostic criteria.

So what is infant colic? In many instances, it is simply regular crying that crosses what is essentially an arbitrary threshold while in others it may appear more consistent with actual underlying pathology. And to further confuse our understanding of the concept, the designation of an infant as “colicky” has been rendered nearly meaningless by its widespread use as a nebulous word for any young baby who is fussy for unclear reasons. The obvious linchpin of the diagnosis is the perception by caretakers that the crying is excessive and requires intervention beyond normal soothing techniques, feeding or changing. Naturally, this is a highly subjective determination that is influenced by environment, experience and culture.

Despite these difficulties, there is a classic definition that is at least generally agreed upon by most pediatricians if not actually put into practice. The Wessel criteria, or “rule of three”, states that colic is an appropriate designation when an otherwise healthy infant cries for more than three hours per day, more than three days a week, and it lasts longer than three weeks. But when the parents of a young infant who has had long and intense bouts of crying but doesn’t meet these criteria come in for help, they tend to want an answer. So there is motivation to diagnose something when a baby that is less than about three months old cries a lot. Colic is an all-too-convenient something.

Though we lack truly evidence-based diagnostic criteria, based on piles of anecdotes involving young babies that cry a lot and aren’t sick there are certain signs that most pediatricians would describe as consistent with infant colic. Crying spells with colic tend to have an equally abrupt beginning and end, with no obvious relationship to the events surrounding the spell. They often seem to cluster in the evening (“the witching hour“) and are often felt to be qualitatively different than “normal” crying in that they are more intense and turbulent in nature. For example, the cry is often described as more painful, urgent and irritating by caregivers. Colic spells are often associated with stiffness, arching the back, flushing and a tense abdomen. Finally, young infants who are having what is thought to be a colic “attack” are very hard to calm.

These particular signs are common in infants with certain medical conditions, such as gastroesophageal reflux and intolerance to various components of formula or breast milk, leading some experts to link these phenomena with colic. A number of interventions aimed at treating those underlying conditions have been studied in babies that were diagnosed with colic or felt to have excessive crying by parents. Not much has panned out but there are some promising leads. But the subjectivity of the diagnosis is such that it is extremely difficult to study, and there is a great deal of plausibility to claims that many infants are diagnosed with colic because parental perception of the crying has been warped by psychosocial factors. So is colic a disease, or is it simply one end of a spectrum of infant temperament? Or does reality lie somewhere in between? Should it even exist as a stand-alone diagnosis, where it might potentially serve as a convenient foot in the door for those who would take advantage of weary parents?

Which babies “get” colic?

Which infants actually have colic, if it even truly exists, is a very difficult question to answer. What do we base this determination on? Do we follow strict criteria, which is problematic because it relies on subjective reports from caregivers, or do we use a more relaxed approach where if the parents are worried about it, it is probably colic? Pediatric lore tells us that colic affects about a third of infants, but the literature reveals anywhere from 8 to almost 50 percent. We know that most children who are considered to have colic by the primary caregiver do not fit the strict criteria.

Unfortunately, there are no well-established clues to what infant colic might actually be buried in the numbers. There does not appear to be any variable that reliably influences the likelihood of an infant being diagnosed with colic. Researchers have looked at a number of possible factors, including birth order, gender, feeding practices, and gestational age at birth and the data has not fit well with any possible association. Even breast feeding versus formula feeding, which I would have put good money on, does not appear to matter.

Probably the closest we have to a solid association are psychosocial factors such as parental stress and a lack of parental self-confidence. It is very difficult to entertain any claims of causality though. Does stress somehow impact parental interactions with the infant, leading to more crying? Does it alter the intrauterine environment? Is it all just epigenetics/magic (that’s for you DG) at play? Or does stress and parental insecurity alter the caregiver’s perception of reality? I have absolutely experienced many discussions at the bedside where I wondered if a parent was looking at the same child that I was.

So what causes a condition composed of nothing but non-specific signs like crying, and that can be diagnosed in virtually any healthy baby on the planet? Not to mention that the diagnosis is subjective almost to the point of rendering it meaningless as a concept? And once diagnosed, what is the best approach to decreasing the amount of crying, or in some cases the caregiver perception of the crying? How do we help these families? There are no easy answers here, but let see who inspires the most confidence.

The science-based approach

What causes colic?

We don’t know what causes colic. We don’t really know for certain if it is real to begin with. Perhaps it is merely a wastebasket or a useful framing device to aid in discussions with families about parenting and psychosocial risk factors. But absolutely any discussion of etiology has to involve a possible parental role. Infant colic probably does exist as a unique entity with an underlying pathology in a small subset of kids that have been diagnosed, and some that haven’t, but many with the label are probably completely normal kids with hypersensitive parents that are set up to focus on crying.

There isn’t great evidence to support any of the proposed etiologies. That doesn’t mean that there isn’t any evidence, just nothing to support a confident claim that would help us to narrow things down a bit and focus treatment approaches. Proposed causes can be broken down into three categories: Gut specific, biologic and psychosocial. Here is the best of what we have so far:

Gut – while not implausible to think that colic stems from issues in the GI tract, I would like to point out that there is a general bias towards blaming gas every time a baby cries. I have lost count of how many times a very ill or injured infant’s pain, many times caused by a broken bone, was passed off as gas by a caregiver or medical professional. There should be a special term for anchoring related to gas. It should probably be German. They have the best words.

1. Allergy to cow milk protein – Some young infants develop inflammation of the intestines when exposed to casein or whey. They are often quite fussy and most, but not all, develop bloody stools. If the largely clinical diagnosis is correct, within a week or two of changing to a specialized formula, the symptoms completely resolve. This is a fairly common condition and it would be silly to think that there aren’t at least some children diagnosed as having colic who actually have a mild case of milk protein allergy causing excessive crying but no grossly bloody stool or failure to thrive.

2. Fruit juice intolerance – Based on some small studies, fruit juices that contain sorbitol and a high fructose to glucose ratio might actually play a role in some infants with colic. This has decent plausibility as a possible etiology of some children diagnosed with colic. You shouldn’t give infants fruit juice anyway.

3. Differences in intestinal microflora – There are small studies showing that kids with colic have bad bugs and higher markers of gut inflammation. There are even small studies showing that providing good bugs might help some kids with colic. They may have been funded by Jamie Lee Curtis.

4. Gas

Biologic – Some of these make more sense than others (migraines, I’m looking in your direction).

1. Migraines – Yeah, probably not. This is based on asking if kids with migraines had colic as a baby.

2. Underfeeding, overfeeding, poor feeding technique, etc. – Hungry baby cry more than full baby. Vomiting baby cry more than not vomiting baby. Baby fed upside down or with a straw cry more than…well, you get the point. Makes sense to me. Of course many babies diagnosed with colic are fed just fine.

3. Immaturity – The brain, the gut, the gutbrain, etc. It is certainly plausible that some infants diagnosed with colic are more sensitive to external stimuli because of a general immaturity. Pediatrician to the stars and Jenny McCarthy punching bag Harvey Karp is a vocal proponent of this hypothesis. Immaturity of the gut, specifically gut motility, has also been proposed as a potential contributing factor.

4. Exposure to nicotine and/or tobacco smoke – This is very plausible and has some decent data in support of it. Both prenatal and postnatal exposure are implicated. What do you say to that Stephen Dorff!

Psychosocial - Who says that regular doctors don’t practice holistic medicine?

1. Temperament – Some babies just cry a lot. That makes sense. A lot of babies diagnosed with colic are helped by teaching parents how to better handle crying babies.

2. Hypersensitivity – Perhaps some babies are just stressed out after a long day and take some time to vent. Seriously, that’s a thing.

3. Parents – If there is anything we have learned in pediatrics, or during a trip to the Walmart, be very careful when you imply that any child’s behavior is the fault of their parents. But … maybe … based on some okay evidence … and I am really not judging here, but parental stress and parent-baby interactions almost certainly play a role in the diagnosis of colic in some babies.

How do we treat colic?

When a caregiver comes to a pediatrician or family doctor with concerns about their infant’s excessive crying, the most important initial step is to evaluate for any condition or environment that puts the child at risk of harm. This is regardless of whether or not the parent’s description meets any potential diagnostic criteria for infant colic. Even if the baby only cries for 30 minutes a week, it is vital to take any parent asking for help seriously.

To make sure that a baby is safe, and does not suffer from a serious illness or live in a home where caregiver stress is a possible risk factor for neglect or abuse, there are important questions to ask. Naturally these involve ascertaining the nature of the crying. What does it sound like, when does it happen, and for how long? It is vital to determine what soothing techniques the parents have been putting into use. Many young first time parents don’t know any, or what they do know might actually be making things worse.

Once while taking diaper duty in the middle of the night, I secured my screaming 1-month-old daughter’s pacifier in her mouth with Scotch tape during a particularly rough crying spell. I stood there, nearly delirious with fatigue, for about ten seconds before I took the tape off even though it was actually working. I was a 2nd year pediatric resident and luckily knew enough to realize that I was probably increasing her chance of dying from SIDS despite my foggy brain. Stress, fatigue and excessive infant crying can be dangerous combination. Even two pediatric residents needed help. What we learned from our daughter’s pediatrician and our own research improved our lives dramatically over the next few months.

How is the baby fed? How do the parents feel about the crying and about being a parent in general? How is the family unit as a whole reacting to the crying? What are any beliefs that the family has about why the child is crying? Answers to these questions might give insight into the possible cause of the child’s crying and greatly assist in determining what the next step should be.

After discussing the problem, a thorough exam is necessary. How is the child growing? Are there any concerning physical finding that could be a clue to illness or abuse? Are there any signs of pain that might not be related to possible colic? I once took a direct admission from a local pediatrician who was unable to determine the cause of a young infant’s persistent crying. After a thorough history and exam, she wasn’t convinced that infant colic was the right call. She didn’t anchor on the suggestion of it and asked for me to watch the child closely in the hospital after a reasonable work-up. The only reason I caught the clavicle fracture and she didn’t, luckily before labs were drawn, was that I had the benefit of time and multiple examinations. Infant colic is a diagnosis of exclusion.

There is no one-size-fits-all treatment approach to infant colic. But if after a thorough evaluation and assessment of the need for parental support infant colic is the diagnosis, a reasonable approach in many cases is to do exactly nothing. Infant colic will stop on its own, often by 3 months of age, and nearly all infants have significantly improved by 4 months. This is why infant colic is such a perfect condition for practitioners of irregular medicine. Colic will get better, and whatever is being done when it does will get the credit.

So what is the appropriate approach when a pediatrician and family decide together that an intervention is necessary? I do not think anyone would describe any of the proposed treatments as well-supported in the pediatric literature, but some have a better evidence base than others. First and foremost is addressing and managing parental stress. This may lead to a new perspective on the crying and remove the desire to intervene medically. Teaching simple soothing techniques can be an instant cure in many cases.

Based on the available evidence, which isn’t great, the additional intervention that has the best chance of helping decrease the duration and intensity of crying episodes is a trial of specialized formula which contains no intact cow milk protein or having a breast feeding mother observe a hypoallergenic diet. After that it goes downhill fast and any interventions likely work via parental placebo. These include feeding techniques to reduce swallowed air, probiotics, and distracting techniques. Distracting techniques involve things like pacifiers, baby swings and massage.

No medication is both effective and safe for use in the treatment of infant colic and drugs are rarely prescribed. Still, I wish all pediatricians and family doctors would have the concept of a pharmaceutical intervention for infant colic wiped from their minds, including even the ever-present simethicone (Mylicon). Though an uncommon practice now, I have seen anticholinergics, antihistamines, barbituates and opiates all used for healthy babies with infant colic. Herbal remedies, as they often do, show some promise in small and poorly designed studies but are poorly regulated. There are many examples of them being contaminated and/or adulterated.

What about other alternative approaches? The big ones when it comes to colic are homeopathy and chiropractic, which I lump together with cranial osteopathy as “manipulative techniques”. Homeopathy has no effect beyond parental placebo. Bet you didn’t see that coming. The manipulative techniques don’t hold up to scrutiny either. They follow the expected pattern of small and poorly-designed studies showing equivocal to weakly positive effects, while larger and better-controlled studies show no benefit.

The study that I found to be most commonly touted by chiropractors involved the unblinded use of spinal manipulation on roughly 300 infants diagnosed, using strict criteria, with infant colic. Based on maternal diaries and interviews, 94% of the infants showed significant improvement in crying after an average of 2 weeks of treatment, which persisted until the end of the study (at least 3 months post-treatment). None of this is surprising. It is merely another in a long line of examples of pragmatic pediatric studies that rely on parental placebo to achieve positive results. Add to that the fact that at 6 weeks most infants with colic are at the peak of their crying. Remember it typically starts at 3 weeks and is usually gone by 12 weeks.

Interestingly, some well-known traditional approaches that are still frequently recommended haven’t stood up to randomized study. Going for a drive doesn’t work, for instance. And speaking of things that don’t work…

The chiropractic approach

What causes colic and how do they treat it?

Most coverage of colic in the chiropractic literature or on individual practice websites will state much of what I just covered, although not in such detail and with considerably less accuracy. They keep it simple, speaking more in absolutes. None of the information discussed so far comes from chiropractic researchers of course. As with chiropatter about almost any topic, the first half to two-thirds is comprised of information derived from scientific investigation and the last bit consists of bashing conventional medicine while offering up a chiropractic solution. The most glaring difference is the lack of any discussion of the nuance and complexity of the diagnosis of infant colic.

As you might guess, the primary purpose of any article on colic placed on a chiropractic website is to convince parents to seek out chiropractic care for their children. There are many blatant factual errors and misleading statements employed to do just that.

One website uses the following definition of colic:

Colic is defined as severe, often fluctuating pain in the abdomen caused by intestinal gas or obstruction in the intestines and suffered especially by babies.

This is the textbook medical definition of colic in general, rather than infant colic. While they do share a name, they are not the same. One is a descriptive term for pain localized to the abdomen and one is what I have been writing about. Any healthcare professional desiring to be a primary care practitioner who sees children should be aware of the difference.

There are two extremely common chiromemes evident when researching the chiropractic approach to infant colic. The following quotes are prime examples of the measures taken to paint physicians in a negative light and make chiropractors out to be caring and competent healers:

Chiropractors address the underlying cause of your baby’s colic; they don’t just treat symptoms.

Medical doctors haven’t discovered the cause or solution to this common problem. The medical solution is not promising. Medical recommendations include drug therapy that is not very effective.

Treatment within mainstream medicine often includes drug therapy or simply waiting for your baby to outgrow this condition.

This doesn’t exactly do justice to the science-based approach and it does a disservice to parents. It simply isn’t true. Chiropractors haven’t discovered the cause of infant colic either and clearly have no understanding of it. They pay homage to some of the possible causes of excessive crying in some kids, like milk protein allergy, but they mindlessly recommend many of the treatments discussed above that have been disproven or have no good evidence to support them. They believe that the primary cause of infant colic is the vertebral subluxation and resulting nerve irritation or dysfunction. They see science-based discussion of immaturity of the nervous system as a possible but unproven etiology of colic in some infants and twist it to their advantage:

From a chiropractor’s perspective many of the resulting symptoms of colic may be due to nerve dysfunction, which results in poor communication between the brain and digestive organs.

The one true treatment according to chiropractors is of course the spinal adjustment:

Chiropractic adjustments for the correction of vertebral subluxations (nerve dysfunction) have long been acknowledged as an excellent therapeutic tool for infantile colic. In fact Chiropractic has been shown to have a 94% success rate with Colic.

I have yet to see a rational discussion of the role of psychosocial factors in the diagnosis of infant colic in anything written by a chiropractor. Many websites provide tips on how to soothe a crying infant which are borrowed from conventional medical recommendations. There is also a very good chance that the parent of a child with excessive crying will be offered herbal or homeopathic remedies.

Conclusion

Infant colic is a complicated clinical entity. It has the potential for negatively impacting an infant’s environment, thus indirectly causing harm, but in many cases is likely nothing more than a wastebasket diagnosis. The scientific consensus is that while some infants diagnosed with colic may have an underlying organic condition like an allergy to cow milk protein, or are manifesting symptoms of general immaturity of the brain and/or intestines, most are probably responding to their specific environment in a way that simply does not fit well with their caregiver. There is likely a spectrum of normal infant crying and some just fall on one end of it. And some infants may have what the majority of parents would consider normal crying but their caregivers have an altered perception of the duration and intensity because of psychosocial factors.

Most of the treatments aimed at improving infant colic are not supported in the literature but can appear to work because infant colic is self-limiting and does not last longer than two to three months. The best intervention is parental support and education in the hopes of improving skills to soothe a crying infant, and the development of a contingency plan when those skills fail. Changing parental expectations about infant crying in a positive way and reducing family stress as much as possible is also a vital aspect of management.

In contrast, the chiropractic community displays an overly simplistic understanding of infant colic that makes use of scientific knowledge which fits into its world view while ignoring the rest. Treatment recommendations unique to chiropractic are unsupported by well-designed studies. I believe that using infant colic as a litmus test for the readiness of chiropractors to act as primary care providers for children is a reasonable thought experiment, and one that reveals serious inadequacies in their knowledge base and ability to interpret the medical literature.

Posted in: Chiropractic

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35 thoughts on “Chiropractic Vs. Conventional: Dueling Perspectives On Infant Colic…..

  1. Jeff says:

    It was very hard to read past “doctors of chiropractic”. I don’t have any issue with the rest of your article’s wording.

    I think in general non specific symptoms that could be caused by a number of things and with no easy solution are the bread and butter of CAM. Confirmation bias run rampant around these things. I am a recently new father and my now 5 month old had some bouts of crying and I really did not like how friends and family immediately jumped to “oh its colic.” She is a baby, babies cry. Thankfully my baby never had colic and the small bouts of inconsolable crying made me very empathetic for parents with children who have actual colic.

    Did you find anything to indicate that alternative medicine practitioners were prone to jump to the conclusion that a baby crying was “definitely colic” more often than actual medical practitioners?

  2. Colic might be an area where the home visit would be especially useful. Bring back visiting nurses.

    I never thought to call any of my four children’s crying “colic”, so never sought counsel. Each was different and I found feeding on demand,(breast for three, bottle for one–no pacifiers ever (although the tape did occur to me on occasion) to do the trick, at least to the point of feeling things were “normal”. But then, my own mother commented with my first that I was an extremely confident mother. She was only comparing me to herself, however, so that’s how worthless anecdotes are!

    The mere thought of anyone taking a tiny baby to a chiropractor to be manipulated in any way is absolutely horrifying to me–even when I was a bit into altie stuff myself (briefly), I would never have considered such a thing.

  3. Sullivanthepoop says:

    I am glad you wrote an article about this because me and my SIL were just talking about it. We were noticing that a lot of babies we know are either diagnosed with colic or reflux. My son was born at 35 weeks 3 days and he had an immature sphincter that caused horrible reflux diagnosed by endoscopy. I have never seen a baby spit up like he did. Although, my brother had a friend whose baby spit up a lot and was diagnosed with reflux and did not have an immature sphincter. The other 10 babies I know that were diagnosed with reflux hardly spit up at all.
    It left us wondering if reflux is the new colic as far as diagnosis goes.

  4. My eldest had colic, it was incredibly distressing. Parents of a colicky baby are extremely vulnerable, so it’s no surprise at all that chiroquacktors prey on them. All it takes is a couple of cases where people present when the symptoms are at their worst – and thus about to improve anyway – and a profitable myth is born.

    Unfortunately, chiropractic is an ethical vacuum.

  5. cphickie says:

    As a pediatrician, my biggest goal for treating a crying infant that fits the colic diagnosis, (which means the medical history (outside of crying) and exam are normal), is reassuring parents (often new parents) that babies do cry, sometimes even after you’ve taken care of all the obvious possible reasons (such as hungry, wet, poopy, too hot, too cold or just wanting to be held). That can be tough to do, but when I can relate to my own crying babies (I still have an infant at home) and how there are times I, as parent/pediatrician, can’t do anything more than hold and rock them and wait for the crying to stop, well, I think that helps.

    The other key point, as mentioned early on, is that parents need to know it’s ok to put the crying infant in the crib and walk away if they feel like they are about to lose it. Non-accidental trauma (aka child abuse) is the biggest danger to babies with colic, and there aren’t any studies (that I know of) that show there is any danger to letting a colicky baby cry if the parent needs to step away to regain composure. Of course, I did have a parent a few years back telling me that one the nepotistic pediatrician sons of Dr. William Sears had gone on a TV show (Oprah, I believe) and told parents that a baby could become hypoxic and be hurt if they let it cry–which is pure rubbish, since the ultimate extreme of a crying baby not breathing is a breath holding spell where the baby passes out, and those do not cause damage from a very transient loss of consciousness (and the reason it is very transient is that as soon as the infant loses consciousness, the autonomic nervous system takes over and immediately starts respiration again. But, of course, nothing is beyond belief when it comes to selling quackery and just plain bad medicine by the Sears clan, so none of us should be surprised. I made sure to let that parent know that crying, in and of itself, is not dangerous to an infant.

    1. @CPHickie: From a sample of two (me and my son) I can say that automobile therapy gives effective if temporary relief.

      Place screaming infant in car. Drive until screaming infant falls asleep. Pull over and sleep until infant wakes. Repeat until the habitual finish time of the episode (for us, it normally went away by about 3am). Alternate the routine between parents to ensure that each gets a half decent night’s sleep at least every other night.

      On the plus side, having survived this tramuma, the lad is now commencing the five year MEng course at Birmingham University (UK), is about 6ft tall, weighs close to 200lb, none of it fat, and plays rugby. Thus we may safely conclude that no lasting harm was done. Then and now the best thing for the frazzled parent is the reassurance that it is only temporary, it will pass, and you only need to learn to cope for a few months.

      Sometimes, as we both know, support and sympathy really is the best that can be done, and these are the times when the facile pretences of quacks are at their most unethical.

  6. Clay Jones says:

    No, I think that use of the term is primarily used on websites in order to catch parents using google for help. In practice, and this is just a hunch, I bet that they just go straight into nerve irritation and subluxation based chiropatter.

  7. Clay Jones says:

    @Sullivanthepoop
    I think that reflux is a common diagnosis given to babies that cry and I know some GI docs who say reflux is the cause of colic. In some babies perhaps, but I don’t buy it as playing a significant role. There isn’t good data to support use of anti-reflux medications for kids with colic that I have seen.

  8. nancy brownlee says:

    Thirty-three years ago my pediatrician had the (usual) tolerant, mildly amused attitude to my younger son’s colic- “We don’t even know that colic exists, babies do cry, you know”, etc. Then his wife gave birth to their third child. A roaring, screaming, flailing, farting, howling, eight-pound infant, a really extremely colicky baby boy- like mine- who ‘cried’ twelve hours out of every twenty-four. Or more. The doctor, and his (very successful attorney) wife could afford the two nannies it took to manage the situation. I couldn’t, of course.

    It did, at least, make a believer out of him. And he had the grace to tell me so.

  9. Cynical Pediatrician says:

    Very amusing that chiropractors assert that “treatment within mainstream medicine often includes drug therapy or simply waiting for your baby to outgrow this condition.”
    Leaving aside the reflux issue, the main “drug” for colic as mentioned in the post, is simethicone–which probably rivals homeopathic tinctures for both safety and efficacy. OOOOOOHHH. Unless they are thinking of paregoric–from 100 years ago. Or, most likely, they just think that MDs treat everything with drugs.
    Actually, the “watchful waiting” part is not incorrect; both because that’s what we do tell folks, and because that’s what ends up happening. (Kinda like the old adage that colds last for 1 week, unless you give amoxicillin, in which case they resolve after 7 days.) Unlike chiropractors, however, MDs tend not to make up nonsense treatments to convince people of our superlative healing powers. (How ironic–us MDs relying on the “body’s natural healing process”, while the chiropractors are advocating intervention!) Not to say we send parents out the door with no good coping advice. Harvey Karp has a great book, “The Happiest Baby on the Block”, which goes into the “5 S’s”–which the parents can do on their own, no doc required.

  10. Newcoaster says:

    A good article, and also reminded me why I didn’t go into pediatrics. Not that I ever had any predispositions that way, but my 6 week rotation in the Childrens ER…sneezers, wheezers and cryers all through the night, and desperate frazzled parents looking for a diagnosis cured me of EVER considering it as a career option. I’m glad to see pediatricians struggle with this as much as us family/ER doctors !

    The comment about “are they looking at the same child as me?” struck home. Many is the time I’ve examined some “sick” child in the ER in the middle of the night. They look fine. Happy, cooing and obviously “well”. With a sense of relief you finish the exam and give the good news to the parents, only to be met with “there must be something wrong, aren’t you going to do some tests, call a specialist, send him to the big hospital etc? I KNOW my child and they AREN’T FINE!” Sigh.

  11. pmoran2013 says:

    Babies’ necks are already like jelly and it is a nonsense to think that anything therein could be safely “adjusted” and made to remain so.

    While reassuring contact with any kind of practitioner, even a chiropractor, might be helpful, the soundest advice would be to leave necks alone. There have been cases of injury from spinal manipulation, even in babies.

  12. Denise says:

    It occurs to me how odd it is that the same patients and sometimes the same practitioners and institutions manage to embrace so many incompatible ideas about health at the same time, without any apparent cognitive dissonance. There is no overarching theory of disease that explains why chiropractic manipulation, acupuncture, homeopathy, Ayurvedic detoxification through vomiting, and the various other CAM treatments would all be effective.

    If you genuinely believe that subluxations of the spine are what cause ill health, then how can you at the same time believe that you can be cured by sticking needles in your feet or taking homeopathic remedies?

    The shameless mainstream institutions that are offering and promoting a variety of so-called integrative treatments should be forced to admit not only that there is no evidence to support them, but also that they are based on beliefs that contradict each other. Either science-based medicine rests on valid theory, or chiropractic does, or Chinese medicine does, or Ayurveda does, or homeopathy does. If one does then the others don’t. Make up your minds.

  13. davdoodles says:

    “Chiropractors address the underlying cause of your baby’s colic; they don’t just treat symptoms. Medical doctors haven’t discovered the cause or solution to this common problem.”

    So, chiropractors purport to address (whatever that means) “causes” which they happily admit haven’t been discovered?
    .

  14. weing says:

    Here’s an anecdote. Two of my kids had what could be described at colic phase that lasted a couple of weeks. They were crying and looked very uncomfortable. Being an internist and not a pediatrician, I dug up an old copy of Barnett’s Pediatrics from med school, and found the Q-tip solution. Dab a Q-tip into vaseline and gently twirl it into the crying infant’s anus. They let out some gas or poop and immediately stopped crying. Put them back to sleep. We were both happy. This was over 20 years ago.

  15. Carl says:

    “Oh why is your neck,
    in such a harsh wreck?”
    said the ox to the fox in the meadow.

    “‘Twas up in that tree,
    when I tripped on my knee,
    and my feet could do none more than let go.

    “I fell to the grass,
    landing flat on my ass,
    and my neck flung ’round under my torso.

    “Then straight from God’s wrath,
    came a naturopath,
    who fucked me up worse from the get-go.

    “She couldn’t fix me,
    with chiropracty,
    nor with herbs nor with turds nor with reiki.

    “But she dug into me,
    with needles like bees,
    and hit me with placebo fees.

    “So my neck is like rope
    and I haven’t a hope,
    for my science-based medical needs.

    “I’m helplessly low,
    and to darkness I go,”
    said the fox to the ox in the meadow.

  16. Carl says:

    Crud, I meant to post that to the naturopath thread over on Orac’s side. It’s not much fun mocking a naturopath who isn’t even here.

  17. Annie Goodwin says:

    Back in the 1970s while in college I had a sweet gig — somehow I got the reputation of being a colicky baby’s best friend. My trick? Arrive near sundown and take baby out of the house for a 3-5 mile walk.

    Wear big boyfriend shirt and when out of sight of the house disrobe baby and pop down the front of the shirt — like babywearing rigs today only with elderly chambray.

    My theory back then was something fuzzy along the lines of “that’s how First Nations folk….” Before I learned much about the diversity of child rearing practices inNorth America….

    With hindsight I think the babies grizzled just as much but a) they weren’t MY babies so I didn’t care b) the gentle rhythmic jostling was soothing c) infants back in the 70s may have spent much more time horizontal. So an hour of vertical time may have had somethingt to it d) I was usually talking to myself (used the time to memorize or rehearse required coursework) so just human voice soothing…..

  18. cphickie says:

    @weing, #15– This is what I would tell a parent is dyschezia, or “painful pooping”, which typically happens in the first 2 months of life. This is the infant who grunts and fusses and can even get to crying and screaming until they pass their gas or stool. Almost always, the stool is soft, which leaves an observant parent wondering why their newborn was working so hard to pass it. The belief in pediatrics is that the newborn has coordinated the pushing out of the gas (by tightening the abdominal muscles and doing a valsalva maneuver with relaxing of the rectal sphincter and surrounding muscles. You can trigger relaxation by something like a qtip or rectal thermometer, but I don’t recommend it in a healthy infant out of concern that the infant could become dependent on rectal stimulation to trigger the muscle relaxation needed for stooling. If, in taking the medical history for a crying baby, the parents tell me the crying always stops after this type of stooling pattern, it’s not colic.

    1. weing says:

      @cphickie,
      Thanks for the explanation. I figured it had to be something like that. Sure seemed like what I heard about colic. I wonder how much of colic is really dyschezia?

    2. Maybe this is what my nephew had. My sister said he’d cry for about an hour or more every evening…and he would look like he was uncomfortable and straining so she thought it was gas that was hard to pass. She said it seemed to help to take his ankles or feet and gentle put his knees up to his chest/tummy and hold them, then bring them down, then back up and hold, slow repetition. It seemed to sooth him somewhat, whether because it helped his muscles relax or just distraction…hard to tell.

      This is the extent of my infant knowledge. I never baby sat an infant (my sister lived several states away) and we adopted our children at age 1 and 2, so infants completely mystify me.

      1. Chris Hickie says:

        Could well be, mousethatroared. While I don’t recommend rectal stimulation (typically done with Qtips, gloved fingers, or (rectal) thermometers) to evoke the defecation reflex for healthy infants, anything that can sooth them while they are straining is worth trying, such as singing to your infant, gently bicycling their legs or gently rubbing their tummy (which I’ve all had parents tell me work, but I don’t know of any controlled studies on this). Also, keeping them upright while they are straining could help, too (how many of us pass gas or stool laying down unless we have to?).

        1. Alia says:

          Gently rubbing the baby’s tummy reminds me of what you need to do if you need to raise small kittens that have lost their mother. They won’t pass stool, unless you rub their tummy, normally their mother would lick them until they do.

          1. Yeah with baby mice, after feeding, you wipe their rear with a warm damp q-tip till they poop.

          2. WilliamLawrenceUtridge says:

            That is a less than ringing endorsement of them as pets.

          3. WLU – Yeah waking up every 2 or 3 hours to feed a tiny mouse with a paintbrush probably doesn’t sound so fun either. That’s all supposed to be their mother’s job. It seemed like a good idea at the time. Cat brings home a living baby wild mouse (don’t read this Mark Crislip) and you decide it’d be cool to raise it with the help of the kids, Raising small wild animals is somewhat of a tradition in our family. The good news is they mature very quickly, you don’t have to do it for long (unlike the years of changing diapers with children).

            But, In spite of the fact that I do like our little house mouse. I can’t say they make good pets.

  19. tgobbi says:

    davdoodles: “So, chiropractors purport to address (whatever that means) “causes” which they happily admit haven’t been discovered?”

    Reminds me of an ad I saw for a supplement some time ago. The ad claimed that it had such-and-such known ingredients as well as some that had yet to be discovered! Go figure…

  20. Jann Bellamy says:

    “As with chiropatter about almost any topic, the first half to two-thirds is comprised of information derived from scientific investigation and the last bit consists of bashing conventional medicine while offering up a chiropractic solution.”

    I see this over and over in the chiropractic and naturopathic literature. There is a discussion of a medical problem that appears to be distilled from the medical literature (sometimes it looks like they just copied it word for word). Whether the authors actually understand what they are talking about is not clear. Then the article or textbook veers off the rails into a discussion of the chiropractic or naturopathic approach to the problem. The departure from science and into pseudoscience is so sudden and so obvious it would be funny if actual patients weren’t being affected by this.

  21. Birdy says:

    For the first few months if their lives, almost like clockwork from 6-9pm, both of my kids would scream. While I didn’t call it colic, others did and it seems to fit the criteria for it. Turns out in both cases, just letting them nurse as much as they wanted, usually just for a few seconds at a time, was what got us through it. ‘Cluster nursing.’ Nurse, scream, nurse, scream, conk out for five hours. It was a pattern, if a crappy and tiring one. Didn’t last forever, though.

    Many of my friends who experienced this too were told by their doctors to supplement with formula to ‘fill them up’ (even for babies that were eliminating and growing well) since the mom’s milk may be insufficient. I can’t help but think that may have made it worse since some babies don’t take well to sudden food changes.

    Whenever someone on one of my mom groups online would recommend chiropractic for this (‘because birth puts their spines all out of alignment!’) I would cringe. Desperate, exhausted parents will often do anything if someone swears up and down it will help; it makes them easy prey for quacks.

  22. Dan says:

    I have a two-year old daughter, who, when she was an infant, experienced fairly severe colic. It began when she was one-and-a-half to two weeks old and was not resolved until she was between 4 and 5 months old. My wife had been exclusively breast feeding (because that was highly recommended). When my wife first suspected the baby was crying excessively, I was skeptical. I chalked it up to “babies cry a lot, that’s why babies have a reputation for crying”. But it got progressively worse, and even I started to suspect this was not normal. My wife first, with support from the pediatrician, started an elimination diet. She was literally only eating rice, turkey, apples, and a couple of other foods which I presently cannot recall. There absolutely was no dairy in her diet, whatsoever (no butter, no cheese, no baked goods, nothing). She didn’t even eat any herbs or seasoning. Her diet consisted mainly of plain rice and plain turkey. All to no avail. Meanwhile, as we consulted with the pediatrician, he seemed convinced that perhaps some dairy was sneaking in somewhere (not likely, I assure you we both know what is and is not dairy) — even though there was never any trace of blood in the baby’s stool (the pediatrician tested several times over the course of the four to five months).

    We also noticed, during the worst bouts of crying she would expel lots of gas. And I mean, lots of gas (I know! Hear me out!). It was only after the expulsion of the gas that she would calm down and fall back asleep.

    Eventually the pediatrician recommended that we switch the baby to Alimentum hypoallergenic formula, because he felt it may be a milk protein allergy (despite the lack of blood in the stool). He said that if it worked, we should see gradual improvement in her symptoms. So we switched. There was improvement. But, it wasn’t gradual — it was like somebody flipped a switch. The very same day we started her on Alimentum, it was like we had a completely different baby. For the first time ever, we had a kid who could be happy all day long. She almost never cried. And when she did cry, it was always for the obvious reasons (something hurt her, or scared her, etc).

    After a full week of being completely colic free, we decided to let her try breastmilk once more — my wife absolutely wanted to be able to breastfeed and was devastated by the thought that she might not be able to continue it. And the symptoms came quickly back. So immediately we went straight back to Alimentum, and immediately we had a happy baby again. Clearly, the Alimentum was working. But why? Did the baby have a milk protein allergy? The pediatrician thought so. I was less sure.

    Fast forward a few more weeks, all totally colic free, and we started her on solid foods. It went very well at first. Rice, fine. Oatmeal, no problem. Sweet potatoes… uh oh, she started waking in the middle of the night screaming just like she used to, but maybe just a little less severe. So we stopped the sweet potatoes. Problems went away. Next: apples. Holy cow, symptoms back with a vengeance. Apples seemed to be the absolute worst. So we stopped apples. She could eat carrots and peas just fine. Bananas, too. But it wasn’t until she was around a year old that she could tolerate eating apples.

    In the end, I’m pretty convinced in this case the culprit was fructose. She seemed to have some kind of intolerance to it. It was probably being passed in the breast milk. While Alimentum doesn’t contain milk protein, it also contains little fructose, and what little it does have is in a one-to-one ratio with glucose. It contains primarily corn maltodextrin, which has no fructose in it. It’s the only plausible explanation I’m left with for why the early elimination diet didn’t work (my wife was eating apples, after all) and why our daughter had the exact same symptoms after we introduced apples into her diet. If it had been milk protein, as the pediatrician had suspected, the elimination diet should have resolved it. The gas that seemed to accompany the attacks was probably a symptom of the fructose intolerance, and perhaps it acted to worsen the symptoms.

    I’ve found some studies (such as this one http://pediatrics.aappublications.org/content/109/5/797.short) that seem to support this possibility. I also read somewhere else, but cannot find it now, that most very young infants (something like 80%) test positive for at least some level of fructose malabsorption via hydrogen breath testing, but that the majority of them rapidly outgrow it. By one year of age something like 95% or more had outgrown it completely. It makes me wonder if our daughter was simply at the extreme end of a condition that is fairly normal. Perhaps by age 3 months most kids stop having the problem with fructose, and this explains the disappearance of colic by 3 months in most infants.

    1. Dan says:

      Oh, and I forgot to mention. On her first birthday we gave her cows milk and she’s been drinking it by the gallon since, without any issues whatsoever.

      1. WilliamLawrenceUtridge says:

        If it makes you feel any better, the benefits of breastfeeding are pretty grossly oversold. One fewer incidence of ear infections, GI tract infections and upper respiratory tract infections per year. No long-term benefits (the closest they ever come is a 5-point difference in IQ, but between being unable to control for the socioeconomic status of parents able to breastfeed for 6 months or more, and the variability of the IQ tests, 5 points, realistically the result is probably null and you’re better off with a baby who isn’t screaming all the time), you’re not really missing anything.

  23. As I read some of these posts, I see within a certain faction of the chiropractic profession a push to get more into primary care. I think that that is a mistake, but also remember that some of the schools are prepping students up for that role and they are getting away from the basics of adjusting and understanding the why our profession adjusts. Not only do you have poor adjusters entering into a health care arena where their identity is not known, but the diagnostics are getting more medical and less Chiropractic. Now, I understand how more Chiropractic diplomate programs are getting into internal disorders, nutritional response testing and possibly offering some sound nutraceutical advice, but with medicine sometimes offering drugs as the only weapon, is it any surprise that patients want to know the CAUSE of what is ailing them as well not only just covering up symptoms. No DC ever Cures a patients rather they act as a facilitator more so. I take no credit having cured or treated my patients rather their body functions better when we stimulate the nurology in their body through the adjustment process and help to correct posutal permutations of the spine. The subluxated vertebral segment (lesion, segmental dysfunction, articular or somatic dysfunction, osteoarthritic joint) what ever you want to label it involves a neurological component ….has been researched and well documented for years. Any MD who does not know this needs to update themselves on the research. As I say MD’s cannot badmouth a profession they know nothing about without addressing the negative aspects of your own first. Hence Chiro’s enjoy the lowest malpractice rates and MD’s the highest. So when you talk about Chiropractic applications for colic, it is not that the DC is “treating” the colic rather they are simply allowing that body to work better by removing pressure on the sympathetics allowing that child to be more calm. And yes , I do agree with this panel that DC’s should NOT be allowed prescrpition drug rights and the majority of the Chiropractic profession agrees with me. It is the MINORITY of the Chiropractic profession that wants to expand into this realm of medi-practing that is a dangerous place for our profession to be. Just my thoughts.
    Scott A. Darragh DC, MPH, MT(ASCP)
    Melrose, MA

    1. WilliamLawrenceUtridge says:

      Scott, you’re describing straights and mixers, but are missing a larger point – how is your profession different from physiotherapy? Particularly given the latter’s adoption of spinal manipulation for mechanical back problems?

      And as for the subluxation itself – isn’t it a myth? It’s existence is asserted, but has testing converged on the ability to even identify it, let alone improve it? The whole point of the term is that it’s less than a full dislocation, therefore a matter of judgement. Where is this research and documentation you talk about?

      And medicine can absolutely bash a profession without addressing its own negative aspects. You are engaging in a false dilemma, that chiropractic care is justified because medicine is not perfect. The two are utterly uncorrelated; antibiotics work or don’t irrespective the existence of the subluxation, and vice-versa. Rather than saying “because doctors aren’t perfect, chiropractic care works”, why not engage in high-quality testing and publications to improve your own practice, instead of taking the lazy approach of merely criticizing another profession that actually has a vigorous tradition of self-scrutiny and continuing education? Medicine changes in response to new information, normally waits for peer-reviewed proof before adopting a new practice, and abandons practices when they are proven to work. Perhaps chiropractic could learn from this.

      Chiropractic care’s low malpractice rates, if true, more reflects the robustness of the human body and the fortunate rarity of the greatest risk of the profession – cerebral artery dissection. Doctors must work with sicker patients, with real, serious conditions rather than made up ones like “subluxations”, and must carefully review risk-versus-benefit. Chiropractors have a “when all you have is a hammer” approach, and similar to homeopaths, they are lucky their treatments are mostly harmless.

      Your claim that chiropractic care can treat colic is at best a hypothetical, merely because you can assert it doesn’t mean it is true. Where is the proof? Where are the clinical trials? “In my experience” doesn’t work as proof, it merely shows your failure to appreciate the self-justifying nature of human thought and memory.

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