EARLY CHILDHOOD: COLIC, CHILD DEVELOPMENT, AND POISONING PREVENTION A Systematic Review of Treatments for Infant Colic

Objective: To conduct a systematic review of rigorously evaluated treatments for infant colic. Methods. Online bibliographic databases were searched for the term “colic” in articles classified as clinical trials or randomized controlled trials and conducted in infants. Reference lists from review articles, meta-analyses, and the selected articles were also reviewed for potential studies. The abstracts or full-text articles of 57 relevant studies were examined, of which 22 met the selection criteria. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study methods, intervention studied, outcomes measured, and results. Results. Four of the interventions studied had data of adequate quality and statistically significant numbers needed to treat (NNT): hypoallergenic diet (NNT 5 6), soy formula (NNT 5 2), reduced stimulation (NNT 5 2), and herbal tea (NNT 5 3). Conclusions. There are some effective therapies for infant colic, but additional rigorous studies of existing and alternative therapies are needed. Pediatrics 2000; 106:184–190; colic, treatment, infant, systematic review. ABBREVIATIONS. RCTs, randomized controlled trials; NNT, number needed to treat; RR, relative risk; CI, 95% confidence interval. Affecting as many as 16% to 26% of newborn children in the first months of life, colic remains a frustrating problem for both parents and caregivers.1–3 Over the years, numerous remedies from behavioral to pharmacological have been studied as treatments for colic, although few have had rigorous scientific evaluation in the form of randomized controlled trials (RCTs). A recent meta-analysis of therapies for colic was limited for 3 reasons. First, it inappropriately collapsed heterogeneous interventions with differing outcome measures into specific categories of treatment.5–7 Second, it used standardized effect sizes, which are prone to bias,8 as the primary outcome. And finally, it did not include all of the interventions studied for the treatment of colic. We therefore undertook a systematic review of all rigorously tested therapies for infantile colic. Our goals in this article are to present the findings of the studies in a coherent and systematic way so that practitioners can evaluate each potential therapy in terms of its proven benefits and risks as well as the rigor with which it has been evaluated. Because of their clinical and statistical heterogeneity, we have not aggregated the studies and present the findings as answers to specific questions related to therapeutic modalities.