A low allergen diet is a significant intervention in infantile colic: Results of a community-based study,☆☆,,★★

https://doi.org/10.1016/S0091-6749(95)70224-5Get rights and content

Abstract

Background: The effect of diet change in 38 bottle-fed and 77 breast-fed “colicky” infants, referred from community-based pediatric facilities was studied over a 1-week period in a double-blind (within each feeding mode), randomized, placebo-controlled trial. Methods: Bottle-fed infants were assigned to either casein hydrolysate or cow's milk formula. All mothers of breast-fed infants were started on an artificial color-free, preservative-free, additive-free diet and also randomized to an active low allergen diet (milk-, egg-, wheat-, nut-free) or a control diet. Results: The response to diet was assessed on day 1 and day 8 with the use of a previously validated infant distress chart on which parents recorded distress levels. If successful outcome was defined as a reduction in distress of 25% or more, after adjusting for age and feeding mode, infants on active diet had a significantly higher rate of improvement than those on the control diet (odds ratio, 2.32; 95% confidence interval, 1.07-5.0; p = 0.03). Analysis of the day 8 to day 1 distress ratio, again adjusted for age and feeding mode, showed that infants on the active diet had distress reduced by 39% (95% confidence interval, 26-50) compared with 16% (95% confidence interval, 0-30) for those on the control diet (p = 0.012). Conclusion: The results suggest a period of dietary modification with a low allergen diet and appropriate nutritional support should be considered in healthy infants with colic. (J ALLERGY CLIN IMMUNOL 1995;96:886-92.)

Section snippets

Patients

Information regarding the study was distributed to pediatricians and community-based Maternal and Child Health nurses in the Melbourne metropolitan area. Infants with colic, who were otherwise healthy, were included if they were between the ages of 4 and 16 weeks, were the result of an uncomplicated pregnancy of more than 37 weeks' duration, and had an uneventful perinatal period.

Colic was defined as unexplained bouts of irritable and distressed behavior present for more than 3 hours per day,

RESULTS


At the outset, the study was expected to be completed within 12 months, but as it progressed, many sources of referral commenced implementation of the diet modification being tested by this research study, and patient referral ceased. Therefore after 3 years, the study was terminated, although the proposed number of bottle-fed infants had not reached the sample size sought. Thirty-six infants did not complete the second assessment, and after exclusion of this group, 122 infants remained.

DISCUSSION

According to the results of this study, diet is one factor that contributes to infant distress in the colic syndrome. This study was designed to investigate the effect of diet change on distressed behavior in infants in a community setting while minimizing the potentially confounding effects of counseling and support. The lack of supportive contact between the research team and patients may have contributed to the high dropout rate. Because the patients were receiving anticolic medication and

Acknowledgements

The secretarial assistance of Mrs. J. Sedmak is gratefully acknowledged. The clinical studies were conducted by Sisters A. Duke, SRN, and J. Brown, SRN. The diet programs were developed with the help of Mrs. B. Lynch, Dip.Inst.Man., Certif.Dietetics, MDAA, AO, formerly Chief Dietitian, RCH, Melbourne. Mr. Hok Pan Yuen of the Statistical Consulting Centre, University of Melbourne, assisted with data management.

References (36)

  • TB Brazelton

    Crying in infancy

    Pediatrics

    (1960)
  • I Jacobsson et al.

    Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study

    Pediatrics

    (1983)
  • WB Carey

    Cow's milk formula and colic

    Pediatrics

    (1984)
  • L Lothe et al.

    Cow's milk formula as a cause of infantile colic: a double-blind study

    Pediatrics

    (1982)
  • L Lothe et al.

    Cow's milk whey protein elicits symptoms of infantile colic in colicky formula-fed infants: a double-blind crossover study

    Pediatrics

    (1989)
  • RG Barr et al.

    Parental diary of infants cry and fuss behaviour

    Arch Dis Child

    (1988)
  • MA Wessel et al.

    Paroxysmal fussing in infancy: sometimes called “colic”

    Pediatrics

    (1954)
  • DJ Hill et al.

    Clinical manifestations of cow's milk allergy in childhood. I. Association with in vitro cellular immune responses

    Clin Allergy

    (1988)
  • Cited by (124)

    • Evaluation of Food Allergy

      2016, Pediatric Allergy: Principles and Practice: Third Edition
    • Parent training programmes for managing infantile colic

      2019, Cochrane Database of Systematic Reviews
    • Probiotics to prevent infantile colic

      2019, Cochrane Database of Systematic Reviews
    View all citing articles on Scopus

    From aRoyal Children’s Hospital, Melbourne; b Department of Statistics, University of Melbourne; and cMurdoch Institute for Research into Birth Defects, Melbourne.

    ☆☆

    Supported by a grant from Mead Johnson Nutritionals, International Division of Bristol-Myers Squibb Company, USA.

    Reprint requests: David J. Hill, FRACP, Director, Department of Allergy, Royal Children's Hospital, Parkville 3052, Melbourne, Australia.

    ★★

    1/1/64147

    View full text