Colic and Probiotics: What you need to know.
It is normal for babies to cry. It is their way of communicating their needs be it hunger, tiredness, a dirty nappy, a thermic change or digestive discomfort. Colic is quite different from the normal crying seen in healthy babies.
Infant colic is described as “recurrent and presents with prolonged periods of crying, fussing or irritability in otherwise healthy infants under the age of 5 months of age” (1). It usually presents in the first weeks of life. Colic is a diagnosis that is given after you’ve seen a doctor and other conditions have been ruled out such as gastrointestinal reflux disease (GERD), food allergies, food protein-induced enterocolitis, eosinophilic esophagitis (EO) plus other medical conditions. Having a baby with colic can be very distressing, tiresome and frustrating, as the cause is unknown and treatments are limited. There are some theories of the etiology of colic inccluding; indigestion, trapped wind and gut sensitivities to some proteins.
Often “colicky” babies are given a proton pump inhibitor (PPI), a medication that reduces stomach acid in the hope of alleviating symptoms and crying episodes. This type of medication is more effective cases of true GERD and EO presentations rather than in colic.
Full discloser; I’m no expert on drugs and I’m not a doctor, but what I will give you is my perspective on the effects of PPI’s in infants, dietary information and some promising study results on specific probiotics so that you can make an informed decision on how to best go about dealing with colic in your baby.
About Protein Pump Inhibitors
PPI’s reduce the acidic secretions in the stomach. This can be helpful in cases of GERD and to allow healing of the oesophageal lining when the damage has occurred due to abnormally high acidity.
Stomach acid is your first line of defense against ingested bacteria. When stomach acidity is decreased, bacteria can enter the digestive system potentially causing infective enterocolitis and diarrhea. Another common side effect of PPI’s is small intestinal bacterial overgrowth (SIBO). The small intestine is not supported to be colonised with bacteria. SIBO can cause constipation, bloating, diarrhea, inhibit digestion and absorption of nutrients and potentiate food intolerances.
Potential Maternal Dietary Triggers and Allergies
There is some awareness around the mother’s diet and how it affects the baby. In colicky babies, one of the most common potentiating food triggers is dairy products. Most of the time, mum eliminating all dairy can resolve the unsettledness in the infant. Occasionally soy also needs to be excluded.
Always trust your gut when it comes to identifying potential food trigger and allergens. A lot of mums are able to pinpoint exactly what foods trigger colic in their baby. Mum really does know best! I always emphasise, when eliminating foods from your diet to (a) do one food or food group at a time so you can easily identify what is working and (b) make sure you are making up for nutritional losses with either alternative foods or need be supplements.
Not Just Any Old Probiotics
It’s important to note that not all probiotics are created equally, and different species have specific therapeutic indications. Most infant probiotics supply Bifidobacterium species (mainly infantis) as this is the most common strain found in breastfed infants (1).
Lactobacillus reuteri is the probiotic strain that has been the most researched and has been shown to be effective in different 5 randomized controlled double-blind trials of colicky infants. Lactobacillus reuteri is most effective in breast-fed infants with reflux or colic, either used concurrently with proton pump inhibitors or without (2). When used concurrently with PPI’s, Lactobacillus reuteri helps to reduce small intestinal bacterial overgrowth (3). A daily dose of 10 billion colony forming units for 21 days was used in the studies and produced a beneficial effect on reducing crying time and/or fussing time in breastfed infants (1).
Further studies are needed to confirm the effectiveness of probiotics in formula-fed infants in reducing colic symptoms.
It's best to speak to your healthcare practitoner when deciding on how best to treat colic in your baby. There is nothing quite like personalised advice.
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1. A. Pärtty, S. Rautava and M. Kalliomäki, Nutrients, 2018, 10, 1836.
2. V. Sung, 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, Pediatrics, 2018, 141, e20171811.
3. O. Belei, L. Olariu, A. Dobrescu, T. Marcovici and O. Marginean, J. Neurogastroenterol. Motil., 2018, 24, 51–57.