The Irritable Baby
Infantile colic is a term that has been used by various healthcare professions to describe the persistent, often violent crying which sometimes characterizes an otherwise healthy and thriving baby. There has never been agreement about how to diagnose colic with the result that the term colic is applied to many different clinical presentations. Colic also carries an inference that the cause of the symptoms is in some way due to abdominal or intestinal problems: no link with the intestines as a cause of the symptoms has been found and the cause of the symptoms remains unknown. In view of these difficulties we prefer to use the diagnosis "Irritable Baby Syndrome" (IBS). Numerous non chiropractic treatments have been proposed but most have been shown to be without effect and most drug preparations have serious side effects. A common drug treatment still used is dimethicone and several good controlled studies have shown that this treatment is no better than placebo.
The first significant study looking at chiropractic treatment of IBS was published in 1989 in the Journal of Manipulative and Physiological Therapeutics.(1) This study of 316 cases undergoing chiropractic revealed a reduction of 66% in the hours of IBS by day 12. A recent study by Wiberg et al (2) in 1999 confirmed the results of the 1989 study with a 67% reduction on day 12 in the group receiving chiropractic treatment. It is interesting to note that the study by Wiberg involved chiropractors in general practice with no special training in paediatrics.
A study in 2010 looked at whether natural improvement in babies crying time could explain the response to chiropractic care. In the 276 babies studied they found that slightly older age was found to be linked to excessively crying infants who experienced clinical improvement. However, a natural decline in crying was not found to explain the improvement in cry time for this group of infants.(3) A 2012 study of 104 infants found that chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.(4)
There are a number of conditions that can complicate IBS. It is important that the baby has a full examination by someone trained in paediatrics to rule out the possibility of other underlying disorders such as cow’s milk protein or soy protein sensitivity, infection, gastroesophageal reflux, pyloric stenosis, intussusception or a bowel obstruction. In the absence of any of other causative conditions the baby is regarded as having “uncomplicated colic”.
Cow’s milk protein sensitivity:
The clinical diagnosis of cow’s milk protein intolerance is made based on the presence of the “triad” of symptoms, which include gastrointestinal disturbance, skin rash and respiratory ‘wet’ sounds. (5) Cow’s milk protein allergy/intolerance is the main cause of lactose intolerance in infants. Common symptoms associated with cow’s milk protein intolerance are:
Gastrointestinal: Bloating, frequent passage of flatus and intractable crying/distress with pulling up of the legs. Chronic diarrhea, constipation or an alternating pattern of both.
Skin: Maculopapular rash which may occur anywhere on the body but is most commonly found on the face neck trunk buttocks and upper arms. Eczema.
Respiratory: Crackles/wet sounds without obvious dyspnea. Wheezing and rhinitis (snuffly breather).
Neurological: Disturbed sleep pattern with frequent waking and crying at night.
Chiropractic - gentle with an exemplary safety record.
A commonly held apprehension about chiropractic care of the paediatric patient is the matter of safety and the degree to which the baby or child will experience discomfort. This is a very reasonable concern and one that deserves a direct and definitive answer. The maximum force used in these procedures has been measured at around 2 Newtons, a pressure that can be comfortably tolerated on your eyeball.
A team effort – always the best.
As children only chiropractors, we do not see ourselves as “alternative” to anyone or any method, but rather, as an integral part of the health care delivery system. It is our experience of 20 plus years of working with other health care providers in caring for children that chiropractic has a discreet and vital role to play in the well being of children of all ages. When the subluxation is the cause of a child’s distress, only a chiropractor can adequately address the situation and correct it. In working with others in caring for children, we believe it is essential for all concerned to be kept informed. For that reason, we send detailed letters to health care providers involved in the care of the children we see and try to support and encourage parents to follow the advice given by those professionals. Children who are referred to us are carefully screened using standard, orthodox methods of clinical history, physical and developmental assessment and when necessary, diagnostic investigation such as x-ray examination. Only after it is clear to us that a child fits into the chiropractic paradigm do we recommend to the parents that their child receive chiropractic care.
At Chiropractic Children’s Healthcare, safety and specificity are our top priorities. Our treatment of children is extremely gentle with an exemplary safety record.
1. Klougart N, Nilsson N, Joacobsen J. Infantile colic treated by chiropractors: a prospective study of 316 cases. JMPT 1989;12(4):281-8.
2. Wiberg JMM, Nordsteen J, Nilsson N. The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic; A Randomised Controlled Clinical trial with a Blinded Observer. JMPT 1999;22(8):517-522.
3. Wiberg KR and Jesper MM. A retrospective study of chiropractic treatment of 276 Danish infants with infantile colic. J Manipulative Physiol Ther 2010;33:536-541
4. Miller JE, Newell D, Bolton JE. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single blind, randomized controlled trial. J Manipulative Physiol Ther 2012;35:600-607
5. Davies NJ. Chiropractic Pediatrics: A Clinical Handbook. Churchill-Livingstone. 2000