One of the most trying problems for parents of young infants is colic, those awful bouts of evening crying and inconsolable fussiness between the ages of three weeks and three months. Severe colic is miserable for parents—there is nothing worse than being unable to comfort your suffering baby—and frustrating for doctors. But now a new study describes a promising treatment from an unlikely source: a germ. In particular, a probiotic, or live culture of a bacterium often found in the gastrointestinal tract.
Colicky infants appear to be in pain when they fuss, and the pain seems to be located in the intestines. Yet the problem often isn’t taken seriously enough by pediatricians. For one thing, that’s because it’s self-limiting—colic clears up on its own in almost all babies by their fourth month. For another, colic causes no physical injury. Colicky infants tend to grow faster than kids without colic, perhaps because they are taking in a lot of milk to comfort themselves. Still, colic matters. In addition to the babies’ pain, it erodes parents’ sense of confidence and competence.
Beginning in the 1950s, a quite effective medication existed for colic. Called dicyclomine, it was an antispasmodic that was thought to decrease tight contractions of the smooth muscle of the bowels of colicky infants. Dicyclomine’ s benefits were confirmed by high-quality research, but it was reclassified as “contraindicated for children under 6 months,” in the mid-1980s out of concern that it might be harmful. * (Some infants were seen to gasp after being given a dose, and a few died after taking dicyclomine, though there was evidence that some of the victims had been given a large overdose.) When I had to give it up, I felt as if penicillin had been taken away from me.
Currently there is one rather less effective medication available—hyoscyamine, a weak plant extract that is also an antispasmodic—and an almost useless one, simethicone drops, which prevent intestinal gas from accumulating as a stable foam. Which is why the new probiotic treatment seems so attractive.
In a study of 83 breastfed colicky infants, divided into two equal groups, Dr. Francesco Savino and his colleagues at the University of Turin, Italy, compared treatment with live probiotic bacteria (five drops daily) to treatment with simethicone. The results were pretty amazing. Within a week, the probiotic treatment produced a measurable, statistically significant improvement in the amount of time the treated babies spent crying, compared to the group of infants treated with simethicone. After four weeks (at the end of the study), 95 percent of the colicky babies responded favorably to this treatment, compared to only 7 percent of the infants treated with simethicone. By then, the simethicone-treated infants were spending about three times as many minutes crying as the probiotic-treated babies—145 minutes a day as opposed to 51 minutes. This result is better than I ever achieved with dicyclomine.
The probiotic treatment Savino’s team tracked has been used safely for many years in treating adults and children for various gastrointestinal problems. Other recent studies suggest that it is also safe for infants, including premature babies, when used to treat or prevent diarrhea. Still, Savino and his co-authors (and I) suggest waiting a while before trying this treatment for colic so its safety and efficacy can be confirmed.
In the meantime, I’m reminded of an observation about newborn feeding behavior I made many years ago that I think relates to colic. A remarkably large number of babies become excessively fussy and demanding about feeding—often wanting to be fed hourly—on or very near the 12th day of life. This occurs with great regularity whether or not the infant is born prematurely, close to his or her due date, or a couple of weeks late. So, the 12th-day phenomenon can’t be the result of some aspect of neurological development (which begins during pregnancy and continues after birth). Instead, the cause must be some process whose clock begins ticking at the moment of birth. The most likely cause, it seems to me, is immunological.
Here is my speculation about what’s going on. At birth, bacteria—from the mother, from the delivery room, from the hands of the nurse who weighs the baby—begin to colonize infants’ bowels. This much we know. And many of the early colonizing bacteria are relatives of the very bacteria used in the probiotic treatment for colic tested by Savino. After nine or 10 days, the baby’s body begins to recognize these bacteria as foreign and starts to produce an immune response to ward them off. The bowel wall acquires antibody-producing cells, and these antibodies change the ecological balance of bacteria in the bowel, because some species of bacteria are more sensitive to them than others.
The antibodies produced by the cells in the intestinal walls help protect us against disease for the rest of our lives. (We don’t properly appreciate our intestines.) The problem with this early natural shift in the body’s ecology, however, is that many of the bowel bacteria of later infancy, as well as adulthood, ferment milk sugar (lactose) and thus produce gas and other irritating byproducts of fermentation. When gas stretches the bowel wall, the intestines feel pain. That’s why these early-in-life bacterial shifts may be linked to colic. And it may be that the probiotic treatment, by administering lots of live bacteria from a baby’s first days of life, tends to push the ecological balance away from the gassiness-producing germs.
Now, as I warned, there’s a lot of speculation here. We know about the early bacteria of the bowel and about the change in the bowel’s ecology, but we don’t know if the shift occurs around the 12th day of life and so could neatly explain the discomfort I typically observe. And even if the timing is right, there is no research to date that endorses (or refutes) my hypothesis about cause and effect. Also, we have no idea how—or even if —the 12th-day feeding frenzy relates to colic more generally.
Still, in my practice I have found a huge payoff in warning mothers and fathers to expect this 12th-day phenomenon, and in assuring them that their babies’ frequent demands for feeding don’t represent hunger—there isn’t really a growth spurt—but rather a baby’s attempt to feel more comfortable. If nursing mothers know what to expect, I find, they are less likely to give up breast-feeding, because they don’t have to worry that their baby isn’t getting enough milk. For many babies, the problem fixes itself in a day or two, whatever the parents do. (Though carrying, singing, and giving the kid to your in-laws are all recommended.)
But maybe soon I won’t need to issue 12th-day warnings anymore. Perhaps we’ll be giving infants an early dash of probiotic to prevent colic, and even paving the way for a smooth day 12, too. I’m not ready to prescribe this treatment yet. But I am waiting anxiously for the follow-up research.
Correction, Jan. 31: The sentence originally stated that dicyclomine was taken off the market. In fact, it was only reclassified as “contraindicated” for infants. It is still used as a treatment for irritable bowel syndrome for adults and sometimes children. (Return to the corrected sentence.)
