Study: Colic improves with acupuncture

reference

Landgren K, Kvorning N, Hallstrom I. Acupuncture reduces crying in infants with infantile colic: a randomized, controlled, blind clinical trial.Acupuncture Med.2010;28:174-179.

design

Ninety otherwise healthy infants aged 2 to 8 weeks with infantile colic were randomized to receive acupuncture or no treatment. The infants underwent a structured program of six visits over three weeks at an acupuncture clinic in Sweden. The parents met with a blind nurse. The infant was then handed over to another nurse in a separate room. This nurse treated the infants in a similar manner, except that the infants assigned to acupuncture received treatment with LI4 bilaterally for two seconds at each visit. No sham acupuncture was performed.

Key findings

Minimal intervention with acupuncture was effective in reducing the duration and intensity of crying in infants with colic. Infants in the acupuncture group had less restlessness in the first month (74 versus 129 minutes).P=0.029) and 2nd week (71 vs. 102 minutes;P=0.047) and a shorter duration of colicky crying in the 2nd week (9 versus 13 minutes;P=0.046). The total duration of excitement, crying, and colicky crying was significantly shorter in the acupuncture group in both the 1st group and the control group (193 vs. 225 minutes).P=0.025) and 2nd week (164 vs. 188 minutes;P=0.028). Overall, there was a significant difference between the acupuncture group and the control group (P=0.034), in favor of the acupuncture group.

Effects on practice

About 10% of children in the Western world suffer from colic.¹No clear etiology has been identified, but many theories have been put forward, including the suggestion that colic is a normal gastric colic reflex in response to food that increases peristalsis to make room for the food being fed.²It has also been theorized that colic is the result of a gastrointestinal (GI) abnormality such as gastroesophageal reflux disease (GERD), bloating, or muscle spasms in the colon, all of which have very plausible causes. However, it is interesting to note that 85-90% of babies with colic have no signs of gastrointestinal abnormality.³

Although infantile colic has few direct medical consequences, it represents major concerns for both the child and its parents. Several studies have identified infantile colic and persistent crying as risk factors for maternal and paternal postpartum depression.^4.5Additionally, research has shown that mothers of colicky infants are at risk of shortening the duration of breastfeeding⁶and have twice as many insecure attachments to their children,⁷Both can have a long-term impact on the child's physical and mental health.

Babies who suffer from colic are more likely to suffer from shaken baby syndrome and may be at increased risk of sudden infant death syndrome.

Babies who suffer from colic are more likely to be victims of shaken baby syndrome⁸and there may be an increased risk of sudden infant death syndrome (SIDS).⁹They were also more likely to be treated with prescription medications, including sedatives (e.g., phenobarbital, Valium, ethanol), analgesics (e.g., opium),¹⁰and anticonvulsant medications (e.g. scopolamine, dicyclomine) in the past,¹¹and more recently, proton pump inhibitors (PPIs) for GERD, although recent findings from the University of Pittsburg concluded that PPIs are no more effective than water in reducing infant crying.¹²

Infant crying can have a significant impact on family stability. Crying, frustration, and fatigue can take a toll on new parents emotionally, leading to anxiety, stress, marital discord, and low self-esteem as parents.¹³When we combine these social impacts with the increased risks to affected infants and their parents, we recognize the serious concern that colic poses. It is important to implement safe and effective strategies to calm colicky infants. It seems as if in addition to teaching calming techniques to parents too²Optimizing digestion by avoiding food allergens,¹⁴and supplementation of probiotics,¹⁵Acupuncture can be an effective way to calm babies with colic.

Several studies have examined acupuncture and infantile colic and found positive results, including this published study. A 2008 study by Reinthal showed that in 40 infants who received light needling at LI4 for 20 seconds four times, parents reported significant improvement in colic symptoms.¹⁶A 2011 study by the same author showed that in 913 infants who were given a needle in the same location, LI4, for 10-20 seconds daily, 76% of parents reported improvement in symptoms after one week.¹⁷A third study published inJournal of Traditional Chinese Medicinein 2002 by Zhao, showed a similar effect on nighttime crying of infants using acupuncture at point PC9 in 100 cases.¹⁸

Reinthal's 2008 study attributed the effect to the motor and autonomic nervous system and its possible reduction in intestinal peristalsis. The most interesting colic theory, in my opinion, is the serotonin-melatonin circadian rhythm and its effect on intestinal motility. The highest concentration of serotonin causes intestinal cramps associated with colic because serotonin increases the contraction of intestinal smooth muscle. Melatonin has the opposite effect of relaxing intestinal smooth muscles. Both serotonin and melatonin exhibit a circadian rhythm with peak concentrations at night.^<19However, intestinal serotonin contractions are unhindered in the first three months of life because only circadian serotonin rhythms exist at birth. The melatonin circadian rhythm is not developed in the infant's pineal gland until 3 months of age, when colic generally subsides.²⁰Acupuncture has previously been shown to increase endogenous melatonin secretion in adults.²¹This may be a mechanism by which acupuncture relieves the symptoms of infantile colic, in addition to directly affecting peristalsis and smooth muscle contraction.

The far-reaching effects of childhood colic on infants as well as on their parents and family structure provide sufficient reason to explore further options for alleviating colic symptoms. Acupuncture appears to be a useful consideration when developing a treatment plan to treat infantile colic.

restrictions

This study has significant limitations. First, reliance on parental measures of crying, fussiness, and colicky crying as primary outcome measures is important. As a parent myself, I understand the challenge of accurately assessing how long your child has been crying, especially under the stress of lack of sleep, a new child, and other normal aspects of daily life. Even if the minutes of crying are counted accurately, you cannot distinguish what the cause of the crying was and whether it was due to colic symptoms. Another limitation of the study is that the overall P value (P=0.034) is quite low considering that the study included 90 subjects.

As the studies mentioned show, it certainly appears that acupuncture can be beneficial in the treatment of childhood colic. It would be valuable to see follow-up studies with larger patient groups and using a more accepted placebo. Although not without drawbacks, sham acupuncture is the current standard. Additionally, more objective outcome measures would increase the value and validity of the study. Identifying and assessing physiological measures of infant discomfort or markers of colic would also support the researchers' conclusions.