1.2 Colic

Randomized trials suggest that breastfed newborns with colic may benefit from the probiotic Lactobacillis reuteri.(Sung, D’Amico et al. 2018) Colic in these studies (and in textbooks) is generally defined as crying at least 3 hours per day at least 3 times a week in an otherwise well infant.(Benninga, Faure et al. 2016) You are seeing a distressed mother of a breast-fed 5-week-old who cries inconsolably for about 1 to 2 hours daily. Your physical examination is normal. Does this child have colic? Would you offer a trial of probiotics?

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Although this infant does not meet the strict definition of colic used in the randomized trials, he has an entity we might call “crying distressing enough to discuss trying something different.” We can’t think of any biological reason for the benefits of probiotics to exceed the risks and costs only if the crying is at least 3 hours a day, 3 times a week.
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References

Benninga, M. A., C. Faure, P. E. Hyman, I. St James Roberts, N. L. Schechter and S. Nurko (2016). “Childhood Functional Gastrointestinal Disorders: Neonate/Toddler.” Gastroenterology.

Sung, V., F. D’Amico, M. D. Cabana, K. Chau, G. Koren, F. Savino, H. Szajewska, G. Deshpande, C. Dupont, F. Indrio, S. Mentula, A. Partty and D. Tancredi (2018). “Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis.” Pediatrics 141(1).