EFFECTIVENESS OF TREATMENTS FOR INFANTILE COLIC - SYSTEMATIC REVIEW

Objective: To evaluate the effectiveness of diets, drug treatment, and behavioural interventions on infantile colic in trials with crying or the presence of colic as the primary outcome measure. Data sources: C ontrolled clinical trials identified by a highly sensitive search stra tegy in Medline (1966-96), Embase (1986-95), and the Cochrane Controll ed Trials Register, in combination with reference checking for further relevant publications. Keywords were crying and colic. Study selectio n: Two independent assessors selected controlled trials with intervent ions lasting at least 3 days that included infants younger than 6 mont hs who cried excessively. Data synthesis: Methodological quality was a ssessed by two assessors independently with a quality assessment scale (range 0-5). Effect sizes were calculated as percentage success. Effe ct sizes of trials using identical interventions were pooled using a r andom effects model. Results: 27 controlled trials were identified. El imination of cows' milk protein was effective when substituted by hypo allergenic formula milks (effect size 0.22 (95% confidence interval 0. 09 to 0.34)). The effectiveness of substitution by soy formula milks w as unclear when only trials of good methodological quality were consid ered. The benefit of eliminating cows' milk protein was not restricted to highly selected populations. Dicyclomine was effective (effect siz e 0.46 (0.33 to 0.60)), but serious side effects have been reported. T he advice to reduce stimulation was beneficial (effect size 0.48 (0.23 to 0.74)), whereas the advice to increase carrying and holding seemed not to reduce crying. No benefit was shown for simethicone. Uncertain ty remained about the effectiveness of low lactose formula milks. Conc lusions: Infantile colic should preferably be treated by advising care rs to reduce stimulation and with a one week trial of a hypoallergenic formula milk.