Infantile colic: Is there a role for dietary interventions?

Question 1

What is infantile colic?

Answer 1

Rome III Criteria: In an infant <4mo:

1. Paroxysms of irritability, fussiness, or crying that start and stop without obvious cause
2. Episodes lasting 3h or more per day and occurring at least 3d per week for at least one week
3. No FTT

Question 2

What is the evidence regarding hypoallergenic diets in breastfeeding mothers?

Answer 2

Some studies have demonstrated a reduction in colic when breastfeeding mothers consumed a hypoallergenic diet, although there is conflicting evidence. Maternal consumption of a hypoallergenic diet may reduce colic in a small number of infants.

Question 3

What is the evidence regarding hypoallergenic formulas in bottle fed infants?

Answer 3

Extensively hydrolyzed protein formulas may reduce colic in a small number of bottle-fed infants. Of note, partially hydrolyzed formulas are not hypoallergenic and should not be used for the dietary management of colic due to cow’s milk protein allergy

Question 4

What is the evidence regarding soy based formula in bottle-fed infants?

Answer 4

Soy formula may reduce the symptoms of colic in some bottle-fed infants but is not recommended as it is a frequent allergen in infants

Question 5

What is the evidence for the effect of lactase treatment?

Answer 5

The evidence does not support the use of lactase in the treatment of colic. It is important to emphasize that congenital lactase deficiency is rare

Question 6

What is the evidence for probiotics and prebiotics in infants?

Answer 6

There is insufficient evidence to recommend for or against the use of probiotics or prebiotics in the management of colic.

Question 7

What are the recommendations regarding dietary modifications in colic?

Answer 7

1. Avoid making nutritional interventions in the vast majority of infants with colic
2. For infants with severe colic, if there is a concern of cow’s milk protein allergy, an empiric time-limited (two weeks) therapeutic trial of a hypoallergenic diet could be considered.
3. For the breastfed infant with colic where there is the relatively rare concern of a cow’s milk protein allergy, one can consider eliminating cow’s milk from the maternal diet. If this is done, one must ensure that breastfeeding is not prematurely discontinued, and that the mother and infant receive the appropriate nutritional support (ensuring sufficient caloric, calcium and vitamin D intake). If there is no definite benefit after two weeks, the dietary restrictions should be lifted.
4. For the bottle-fed infant with colic where there is the relatively rare concern of a cow’s milk protein allergy, the use of a time-limited (two weeks) empiric trial of an extensively hydrolyzed formula may be considered.
5. The use of soy formulas in the treatment of infantile colic should be avoided.
6. Currently, evidence does not support the use of lactase in the management of infantile colic.
7. There is insufficient evidence to make recommendations on the use of probiotics or prebiotics.