Do probiotics help infantile colic?

Probiotics for Colic

In a systematic review, Lactobacillus reuteri was effective for treatment of colic in breastfed infants.

Despite the potential for probiotics to be safe and effective for treatment and prevention of infant colic, studies have been inconsistent. Researchers performed a rigorous systematic review of English-language randomized-controlled trials of probiotics in infants younger than 3 months, pregnant women in the month before delivery, or both. The 12 studies meeting criteria included 1825 infants and were published in 2006–2013. Only two studies had low risk for bias (based on randomization, blinding, and baseline characteristics).

Only two (of 7) preventive trials (often with formula) showed significant reductions in mean daily crying time with probiotics compared with placebo. Three of five treatment studies in infants with diagnosed colic demonstrated probiotic effectiveness, and were sufficiently homogeneous in population (term exclusively breast-fed infants), treatment (Lactobacillus reuteri alone at 109 cfu/day), and outcome measures (crying time on day 21 as recorded by diary) to allow meta-analysis: L. reuteri significantly reduced median daily crying time by 1 hour per day (from ≥2 to ≥1 hour/day) compared with control. Notably, breast-feeding mothers in two of these studies were on dairy-free diets. No adverse effects were reported in any of the 12 trials.

COMMENT

As with most studies of probiotics, trials of the prevention and treatment of infant colic lack standardization. The probiotic strain, dose, and infant characteristics can make a difference in results. Trials in this review with the most significant findings involved L. reuteri in breast-fed infants with diagnosed colic. Given its safety, this probiotic is worth trying when a breast-fed infant’s colic is distressing to caregivers despite conservative measures. Stay tuned, because the evidence base for probiotic use in colic is still evolving.

Cornelius W. Van Niel, MD reviewing Sung V et al. JAMA Pediatr 2013 Oct 7.

CITATION(S):

Sung V et al. Probiotics to prevent or treat excessive infant crying: Systematic review and meta-analysis. JAMA Pediatr 2013 Oct 7; [e-pub ahead of print]. [PubMed® abstract]

NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright ©2013 Massachusetts Medical Society. All rights reserved.

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