Baby colic

This page is about Baby colic. For other types of colic, see Colic.

"Cholic" redirects here. For cholic acid, see Cholic acid.

Colic
Classification and external resources
Crying newborn
ICD-10	R10.4
ICD-9	789.7
MedlinePlus	000978
eMedicine	ped/434
MeSH	D003085

Colic (also known as infantile colic) is a condition in which an otherwise healthy baby cries or displays symptoms of distress (cramping, moaning, etc) frequently and for extended periods, without any discernible reason. The condition typically appears within the first month of life and often disappears rather suddenly, before the baby is three to four months old, but can last upto 12 months of life.^[1] One study concludes that the chances of having colic is lower in breastfed babies.^[2]

The crying often increases during a specific period of the day, particularly the early evening. Symptoms may worsen soon after feeding, especially in babies that do not belch easily.

The strict medical definition of colic is a condition of a healthy baby in which it shows periods of intense, unexplained fussing/crying lasting more than 3 hours a day, more than 3 days a week for more than 3 weeks.^[3] However, many doctors consider that definition, first described by Morris Wessel, to be overly narrow and would consider babies with sudden, severe, unexplained crying lasting less than 3 hours/day as having "colic" (so-called "non-Wessel's" colic).^[4] In reality, this extreme version of colic is more likely to be the final stage of a condition that has worsened for a few weeks.

Persistent infant crying is much more than a parenting nuisance. Crying and the exhaustion associated with it can trigger serious problems, such as relationship stress,^[5] breastfeeding failure,^[6][6] shaken baby syndrome (also known as abusive head trauma - the leading cause of child abuse fatalities),^{[7][8][9][10]} postpartum depression (affecting 10-15% of new mothers and many new dads),^{[11][12][13][14][15][16][17][18]} excess visits to the doctor/emergency room (1 in 6 children are brought to the doctor/emergency rooms for evaluation of persistent crying),^[19] unnecessary treatment for acid reflux^{[20][21][22][22][23][24][25]} and maternal smoking.^[26] Crying and exhaustion may also contribute to Sudden Infant Death Syndrome (SIDS) and suffocation (from agitated babies flipping onto their stomachs, concerned parents placing fussy babies on the stomach to sleep, tired parents falling asleep with their baby in unsafe places, like couches or beds with bulky covers),^[27][28][29] infant obesity,^[30] maternal obesity^[31] and even automobile accidents.^[32]

Causes

For thousands of years, the number one belief of worried parents, grandparents and doctors has been that colicky crying was a sign of abdominal pain (e.g. intestinal spasm, overfeeding, trapped gas).^[33] In fact, even the word "colic" is derived from the ancient Greek word for intestine (sharing the same root as the word "colon"). Today, it is fairly well established that there are a variety of causes of colic symptoms, the most common of which include: stomach gas (due to poor burping or milk flow issues), intestinal gas (pocketed in the intestinal tract), neurological overload (the overwhelmed and overstimulated baby that becomes exhausted) and even a muscular type of colic (perhaps due to muscle spasm and birth trauma). A gastrointestinal (GI) theory of colic seems logical because fussy babies often: grunt/pass gas/double-up/cry after eating; have noisy stomachs; improve with tummy pressure, warmth or massage; may improve with pain medication (e.g. paregoric, also dangerously referred to by its synonym camphorated tincture of opium containing 0.4 mg/mL of morphine which at times can be confused with a opium tincture which contains 10 mg/mL of morphine resulting in a mistake causing babies and adults alike with diarrhea to be wrongly prescribed 25 times the normal amount of morphine found in a regular dose of paregoric^[34])^[35] or sips of herbal teas used for stomach upset (e.g. mint, fennel).^[36] However, 85-90% of colicky babies have no evidence of serious GI abnormality.^[37]

Some have said that babies cry because they sense their mother's anxiety,^[38] but this is highly unlikely. They simply do not have the ability to distinguish a mother's anxiety from depression, frustration, etc. In fact, even though parental anxiety is markedly reduced with successive children, it has been shown that a couple's later children are as likely to be colicky as their first.^[39] It is plausible, however, that anxiety may have some relationship to crying through a more circuitous route. Anxious parents are often so unsure of themselves that they jump from one calming intervention to another without doing any technique long enough for it to be effective.

What is clear is that there are various causes of colicky babies other than the obvious gassy causes:

• Fussiness peaks at about 6 weeks and reliably ends by 3–4 months, yet infants continue to experience plenty of burps, flatus, bowel movements, etc. well beyond 4 months of age ^[40]
• Premature babies—with very immature intestines—have no more colic than full term-ers (despite the fact that their intestines are much more immature). And, when they do get colic it doesn't start until they reach their due date. (In other words, a baby born three months early has the same 10-15% chance of developing colic as a full term baby. Despite eating, defecation, burping and flatulating every day, he/she will have almost no fussing during the first three months.^[41]
• Contrary to the belief that babies cry from swallowed air, X-ray studies reveal that when babies start wailing, they have much less air trapped in their stomachs than they do after the colic is over and they are calm and relaxed.^[42] (Babies gulp air while crying. So they have more air in the stomach after crying, but it is totally innocuous.)
• "Burp" drops (simethicone) are no better at reducing crying than drops of distilled water.^[43][44]
• Car rides and vacuum cleaner sounds may calm fussing, yet have no power to lessen GI pain (just as adults never use a car ride or vacuum to sooth a stomachache).
• In 90% of cases, colic is unrelated to a baby's diet.^[45][46] However, in 10% of cases colic is triggered by stomach discomfort from food allergy and requires altering the diet of a breastfeeding mom or switching a baby to a hypoallergenic formula (e.g. Pregestimil).^[47][47] The most problematic foods for fussy babies seem to be cow's milk based formula and, for breastfeeding babies, dairy products in the mother's diet. Other, less common allergens are wheat, soy and nuts. Breastfed babies may also become fussy from stimulants in the mother's diet (see section on treatment).^[48][49][50] Parents and doctors commonly switch fussy babies to a soy formula; however, it is not clear that soy reduces colic.^[51]

Also, unlike older children and adults who have GI discomfort from lactose intolerance, there is little evidence that this causes crying among infants.^[52][53][54]

Some reports have associated colic to changes in the bacterial balance in a baby's intestine. They suggest treating the crying with daily doses of probiotics, or "good bacteria" (such as Lactobacillus acidophilus or Lactobacillus reuteri). In a 2007 study,^[55] 83 colicky babies given the probiotic Lactobacillus reuteri had reduced crying time. After one week, treated babies had 19% less crying time (159 min/day vs. 197 min/day). By 4 weeks, treated babies had 74% less crying (51 min/day vs. 197 min/day). In a 2010 study conducted with the same probiotic strain, similar benefits were seen in colicky infants.^[56] However, another study found no reduced colic in over 1000 babies who were given a mixture of four other probiotic strains from birth.^[57]

In 2009, a University of Texas study observed that colicky babies had a higher incidence of mild intestinal inflammation and a specific intestinal bacteria, Klebsiella.^[58] But, a commentary in the same journal, noted that the inflammation and bacteria were most likely just an exaggerated variation of normal.^[59]

Over the past 15 years, many thousands of fussy babies have been given medicine in the belief that their colic was caused by painful acid reflux, so-called gastro-esophageal reflux disease (GERD). From 1999-2004, the use of a popular class of liquid antacid (proton pump inhibitor, or PPI) in young children increased 16 fold.^[60] And, from 2000-2003 there was a 400% increase in the number of babies treated with anti-reflux medicines. By all accounts this rate of increase has continued—or accelerated—from 2003 to the present.

In truth, most babies have mild reflux, but we simply call it "spitting up." Over the past 5 years, several studies have proven that GERD rarely causes infant crying. Even crying during feeding and crying accompanied by writhing and back arching is rarely related to acid reflux, unless the baby also has:

• 1) poor weight gain (less than ½ ounce/day)
• 2) vomiting more than 5 times/day; or
• 3) other significant feeding problems.

A multicenter study, organized by researchers at Pittsburgh Children's Hospital, concluded that GERD medicine is no better than plain water at reducing infant crying. Surprisingly, 50% of fussy babies improved on medicine, but so did 50% of fussy babies given the placebo. In the meantime, research has shown that proton pump inhibitors can cause decreased bone density in adults.^[61] No research has been done on bone density or growth in children given PPIs and this use is not approved by the FDA and should be considered experimental.According to Dr Arsalan Khattak Menicol drops are advised from 2 to 3 times.

Red Flags

Babies who continue crying may simply be hungry, uncomfortable or ill. Parents who are unable to soothe their baby's crying must call their healthcare provider to make sure the baby is not sick. Fortunately, only 5% of colic cases are caused by illness (most commonly by intestinal allergy, described above).^[62]

Parents should be especially suspicious of illness or pain as the cause of their baby's fussing if the cry is accompanied by at least one of the following ten "red flag" symptoms:^[63]

• Persistent moaning or weak crying
• High-pitched, shrill cry (sharp and more dramatic than usual)
• Vomiting (vomit that is green or yellow, bloody or occurring more than 5/day)
• Change in stool (constipation or diarrhea, especially with blood or mucous)
• Fussing during eating (twisting, arching, or crying that begins during or just after a feed)
• Abnormal temperature (a rectal temperature less than 97.0 DEGF or over 100.2 DEGF)
• Irritability (crying all day with few calm periods in between)
• Lethargy (excess sleepiness, lack of smiles or interested gaze, weak sucking lasting over 6 hours)
• Bulging soft spot on the head (even when the baby is sitting up)
• Poor weight gain (gaining less than 1/2 ounce a day)

Babies with persistent crying or any "red flag" symptoms should be checked by a healthcare professional to rule out illness. The top ten medical problems to consider in irritable babies with "red flag" symptoms are:^[63]

• Infections (e.g. ear infection, urine infection, meningitis, appendicitis)
• Intestinal pain (e.g. food allergy, acid reflux, constipation, intestinal blockage)
• Trouble breathing (e.g. from a cold, excessive dust, congenital nasal blockage, oversized tongue)
• Increased brain pressure (e.g., hematoma, hydrocephalus)
• Skin pain (e.g. a loose diaper pin, irritated rash, a hair wrapped around a toe)
• Mouth pain (e.g. yeast infection)
• Kidney pain (e.g. blockage of the urinary system)
• Eye pain (e.g. scratched cornea, glaucoma)
• Overdose (e.g. excessive Vitamin D, excessive sodium)
• Others (e.g. migraine headache, heart failure, hyperthyroidism)

Effect on the family

Infant crying can have a prominent effect on the stability of the family. Crying and the fatigue that typically accompanies it can inflict enormous emotional strain causing parents to feel they are providing inadequate care, triggering anxiety, stress, resentment and low self-esteem.^[64]

Persistent infant crying has been associated with severe marital discord, postpartum depression, Shaken Baby Syndrome, SIDS/suffocation, early termination of breastfeeding, frequent visits to doctors, maternal smoking and over a quadrupling of excessive laboratory tests and prescription of medication for acid reflux.

Parents are at especially high risk of experiencing a serious reaction to their infant's crying; at-risk parents include teens, drug addicts, military families, foster parents, parents of premies and parents of multiples. Families living in dense housing projects, such as apartment blocks, may also suffer strained relationships with neighbors and landlords if their babies cry loudly for extended periods of time each day.

Treatment

Currently, the first approach most commonly recommended in healthy babies (without any "red flag" symptoms) is to use non-medicinal, noninvasive treatments like burping, stomach massage and gas release techniques as well as symptomatic and emotional support^[65][66].

Some reports have associated colic to changes in the bacterial balance in a baby's intestine. They suggest treating the crying with daily doses of probiotics, or "good bacteria" (such as Lactobacillus acidophilus or Lactobacillus reuteri). In one study,^[67] 83 colicky babies given Lactobacillus reuteri had reduced crying time. After one week, treated babies had close to 20% less crying time (159 min/day vs. 197 min/day). By 4 weeks, treated babies had 74% less crying (51 min/day vs. 197 min/day). Overall, there was a 95% positive response to the Lactobacillus reuteri probiotic drops in colicky infants.

In past decades, doctors recommended treating colicky babies with sedative medications (e.g. Phenobarbital, Valium, ethanol), analgesics (e.g. opium) or anti-spasm drugs (e.g. scopolamine, Donnatal, dicyclomine), but all of these have been stopped because of potential serious side-effects, including death.

There is a broad body of evidence showing that symptoms can be eased through soothing measures, such as pacifiers,^[68][69] strong white noise^{[70][71][72][73][74]} and jiggly rocking^{[75][76][77][78]} are effective in calming babies during crying bouts. These techniques form the core of the "5 S's" approach:

1. - Swaddling^{[79][80][81][82][83][84]}(safe swaddling carefully avoiding overheating, covering the head, using bulky or loose blankets,^[85] and allowing the hips to be flexed^[86][87][88]);
2. - Side or stomach (holding a baby on the back is the only safe position for sleep, but it is the worst position for calming a fussy baby);
3. - Shhh sound (making a strong shush sound near the baby's ear or using a CD of womb sound/white noise);^{[89][84][90][91][92]}
4. - Swinging the baby with tiny jiggly movements (no more than 1" back and forth) always supporting the head and neck;^{[93][84][94][75][95][76][96][78][97][98]}
5. - Sucking (Letting the baby suckle on the breast, your clean finger or a pacifier)

The most common medical causes of colic are food related. In a breastfed baby, the doctor may suggest eliminating all stimulant foods (e.g. coffee, tea, cola, chocolate, decongestants, diet supplements, etc.) from a mother's diet for a few days to evaluate for improvements in the baby's condition. If food allergy is suspected, the doctor may suggest a hypoallergenic formula for a formula fed infant or, if the mother is breastfeeding, a period of elimination of allergenic foods (e.g. dairy, nuts, soy, citrus, etc.) from her diet in order to observe changes in the baby's condition.^[48][49] If the crying is related to a cow's milk allergy benefits are usually seen within 2–7 days. Mothers can then choose to add back small amounts of the suspected offending food a little bit at a time as long as persistent crying does not reappear. If crying reappears, the offending foods may need to be avoided for many months.^[99][50]

Persistently fussy babies with poor weight gain, vomiting more than 5 times a day, or other significant feeding problems should be evaluated by a healthcare professional for other illnesses (e.g. urinary infection, intestinal obstruction, acid reflux).^[23]

Claims are sometimes made as to the effect of chiropractic intervention to relieve their infants' colic. One explanatory theory behind such treatment is that the pain infants appear to be experiencing may be spinal in origin (perhaps acquired in the birth process), rather than gastro-intestinal. A single study by chiropractors^[100] in 1999 used dimethicone drops as a placebo, comparing them to spinal manipulation; this suggested a similar level of effectiveness but no independently administered randomised control trial evidence supports such claims.

See also

• Antispasmodic

References

1. ^ Barr RG. Changing our understanding of infant colic. Arch Pediatr Adolesc Med. 2002; 156 (12):1172-74. [PubMed]
2. ^ Saavedra, MA; Saavedra MA, da Costa JS, Garcias G, Horta BL, Tomasi E, Mendonça R. (Mar-Apr 2003). "Infantile colic incidence and associated risk factors: a cohort study". J Pediatr (Rio J). :101-2. 79 (2): 115–22. PMID 14502331. 
3. ^ Wessel MA, et al. Paroxismal fussing in infancy, sometimes called "colic." Pediatrics. 1954; 14:421-435
4. ^ Barr RG, Rotman A, et al, The Crying of Infants With Colic: A Controlled Empirical Description. Pediatrics 1992; 90:14-21 [Abstract/Free Full Text]
5. ^ Levitzky S, Cooper R. Infant colic syndrome: maternal fantasies of aggression and infanticide. Clin Pediatr 2000;39:395 -400[Abstract/Free Full Text]
6. ^ ^{a b} Li, R, et al, Why Mothers Stop Breastfeeding: Mothers' Self-reported Reasons for Stopping During the 1st Year, Pediatrics 2008; 122:s69-76
7. ^ Catherine N, Ko J, Barr RG. Should we do more to get the word out? Causes of, responses to and consequences of crying and colic in popular parenting magazines. J Dev Behav Pediatrics 2005;26:14-23
8. ^ Barr RG, Trent RB, Cross J, Age-related incidence curve of hospitalized Shaken Baby Syndrome cases: Convergent evidence for crying as a trigger to shaking, Child Abuse & Neglect 2006;30:7-16
9. ^ van der Wal, MF, et al. Mothers' reports of infant crying and soothing in a multicultural population. Arch Dis Child. 1998;79:312-317 [Abstract/Free Full Text]
10. ^ Theodore AD, et al. Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas. Pediatrics 2005;115:331-7 www.pediatrics.org/cgi/content/full/115/3/e33
11. ^ Murray L, Cooper P. The impact of irritable infant behavior on maternal mental state: a longitudinal study and a treatment trial. In: Barr R, St James-Roberts I, Keefe M, eds. New Evidence on Unexplained Early Infant Crying: Its Origins, Nature and Management. Skillman, NJ: Johnson & Johnson Pediatric Institute; 2001:149 -164
12. ^ Maxted AE, et al. Infant colic and maternal depression. Infant Ment Health J. 2005;26:56-68 [CrossRef][Web of Science
13. ^ Corwin EJ, et al. The impact of fatigue on the development of postpartum depression. J Obstet Gynecol Neonatal Nurs. 2005;34:577-586 [CrossRef][Web of Science][Medline]
14. ^ Howell EA, et al. Correlates of early postpartum depressive symptoms. Matern Child Health J 2006;10:149-157[Web of Science][Medline]
15. ^ Areias ME, et al. Correlates of postnatal depression in mothers and fathers. Br J Psychiatry 1996;169:36-41.
16. ^ Ramchandani P, et al. Paternal depression in the postnatal period and child development: a prospective population study. Lancet 2005;365:2201-5.
17. ^ Matthey S, et al. Paternal and maternal depressed mood during the transition to parenthood. J Affect Dis 2000;60:75-85
18. ^ Prenatal and Postpartum Depression in Fathers and Its Association With Maternal Depression A Meta-analysis James F. Paulson, PhD; Sharnail D. Bazemore, MS JAMA. 2010;303(19):1961-1969
19. ^ St James-Roberts I, Halil T. Infant crying patterns in the first year: normal community and clinical findings. J Child Psychol Psychiat 1991;32:951-968[Medline].
20. ^ Heine R et al.The role of gastro-oesophageal reflux in infant irritability, Arch Dis Ch 1995; 73:12
21. ^ Moore DJ, et al. Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. J Pediatrics 2003;143:219-23 CrossRef
22. ^ ^{a b} Jordan B, et al. Effect of antireflux medication, placebo and infant mental health intervention on persistent crying: a randomized clinical trial. J Paed Ch Health 2006;42:49-58
23. ^ ^{a b} Heine RG, et al: Clinical predictors of pathological gastro-esophageal reflux in infants with persistent distress. J Paed Ch Health 2006; 42: 134-9
24. ^ Putnam P. Stop the PPI Express: They Don't Keep Babies Quiet! J Pediatrics 2009:154: 475-6
25. ^ Orenstein SR, et al Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor Lansprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatrics 2009; 154: 514-20
26. ^ Gaffney KF, Henry LL. Identifying risk factors for postpartum tobacco use. J Nurs Scholarsh. 2007;39:126-132[CrossRef][Web of Science][Medline]
27. ^ Willinger M, et al. Factors Associated With Caregivers' Choice of Infant Sleep Position, 1994-1998. The National Infant Sleep Position Study. JAMA. 2000;283:2135-42
28. ^ Colson ER, et al. Trends and Factors Associated With Infant Sleeping Position, The National Infant Sleep Position Study, 1993-2007. Arch Pediatr Adolesc Med. 2009;163:1122-8
29. ^ Ponsonby AL, et al. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med. 1993;329:377-382 [Abstract/Free Full Text]
30. ^ Paul IM, Birch L. Pediatric Ambulatory Society (PAS) Meeting The Relationship between Infant Feeding, Sleeping, and Weight Gain Baltimore, MD May 4, 2009
31. ^ Taheri S, et al. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index (BMI). Sleep. 2004;27:A146-7.
32. ^ 2004 Sleep in America Poll Final Report, National Sleep Foundation, March 2004, p 165 http://www.sleepfoundation.org/sites/default/files/2004SleepPollFinalReport.pdf
33. ^ Cirgin Ellett ML. What is known about infant colic? Gastroenterol Nurs. 2003;26:60-5.
34. ^ Sanghavi D. "Recurring Confusion Between Opium Tincture and Paregoric" Published Online: Sunday, June 1st, 2003 Kate Kelly, PharmD, Editor, ISMP Medication Safety Alert! Community/Ambulatory Care Edition, and Allen J. Vaida, PharmD, FASHP, Executive Director, Institute for Safe Medication Practices http://www.pharmacytimes.com/publications/issue/2003/2003-06/2003-06-7241
35. ^ Sanghavi D. "Bleary parents crave colic cure." Boston Globe, Mar 29, 2005 http://www.darshaksanghavi.com/columns/colic.htm
36. ^ Weizman Z, et al. Efficacy of herbal tea preparation in infantile colic. J Pediatr 1993;122:650-652[Medline].
37. ^ Lucassen P, et al, Effectiveness of treatments for infantile colic: systematic review. BMJ 1998;16:1563-69
38. ^ Infant crying: Theoretical and research perspectives BM Lester and CFZ Boudykis eds, NY Plenum Press 1985, pp.334
39. ^ Hubbard FOA, van IJzendoorn MH. Maternal unresponsiveness and infant crying across the first 9 months: A longitudinal study. Infant Behav and Dev 1991. 14:299-312
40. ^ Brazelton TB, Crying in infancy. Pediatrics. 1962; 29:579-588
41. ^ Barr RG, et al. Crying Patterns in Preterm infants. Dev Med and Child Neuro 1996; 38: 345-355
42. ^ Illingworth RS. Three months colic. Arch Dis Child. 1954;29:165-74. MEDLINE | CrossRef
43. ^ Danielsson B, Hwang CP. Treatment of infantile colic with surface active substance (simethicone), ACTA Ped Scan 1985 74:446-450
44. ^ Metcalf T, et al. Simethicone in the treatment of infantile colic, Pediatrics, 1994 94:29-34
45. ^ Taubman B. Parental counseling compared with elimination of cow's milk or soy milk protein for the treatment of infant colic syndrome: a randomized trail. Pediatrics 1988;81:756-761
46. ^ Thomas DW, et al. Infantile colic and type of milk feeding. Am J Dis Child. 1987;141:451-453
47. ^ ^{a b} Lothe L, Lindberg T, Jakobsson I. Cow's milk formula as a cause of infantile colic: A double-blind study. Pediatrics. 1982;70:7-10
48. ^ ^{a b} Jakobsson I, Lindberg T. Cow's milk proteins cause infantile colic in breast-fed infants: a double-blind crossover study. Pediatrics 1983;71:268-271[Abstract/Free Full Text].
49. ^ ^{a b} Evans RW, et al. Maternal diet and infantile colic in breast-fed infants. Lancet. 1981;1:1340-2.
50. ^ ^{a b} Forsythe BW, Colic and the effect of changing formulas: A double-blind, multiple-crossover study . J Pediatrics 1989; 115:521-6
51. ^ Bhatia J, et al. Use of Soy Protein-Based Formulas in Infant Feeding. Pediatrics, 2008;121:1062-8
52. ^ Barr RG, et al. Carbohydrate change has no effect on infant crying behavior: A randomized controlled study. Am J Dis Child 1987; 141:391
53. ^ Liebman WM. Infantile colic association with lactose and milk intolerance. JAMA 1981; 245: 732-3
54. ^ Heyman, MB, et al. Lactose Intolerance in Infants, Children, and Adolescents. Pediatrics, 2006;118:1279-86
55. ^ Pelle SF, et al. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: A prospective randomized study. Pediatrics 2007:119; e124-30
56. ^ Savino, F., Cordisco, L., Tarasco, V., Palumeri, E., Calabrese, R., Oggero, R., Roos, S. and Matteuzzi, D. (2010) Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics, 126, e526-33
57. ^ Kukkonen K, et al. Long-Term Safety and Impact on Infection Rates of Postnatal Probiotic and Prebiotic (Synbiotic) Treatment: Randomized, Double-Blind, Placebo-Controlled Trial. Pediatrics 2008;122;8-12
58. ^ Rhoads, MJ, et al. Altered Fecal Microflora and Increased Fecal Calprotectin in Infants with Colic. J Pediatrics 2009;155: 823-8
59. ^ Moore DJ, Inflaming the Debate Infant Colic. J Pediatrics 2009;155:772-3
60. ^ Barron JJ, et al. Proton pump inhibitor utilization patterns in infants. J Pediatr Gastroenterol Nutr. 2007;45:421-7 CrossRef
61. ^ Am J Gastroenterol. 2009 Mar;104 Suppl 2:S2-4. The effect of proton pump-inhibiting drugs on mineral metabolism. Insogna KL.
62. ^ Barr RG, Management of Clinical Problems and Emotional Care: Colic and crying syndromes in infants. Pediatrics 1998:102 (5) Supplement;1282-6
63. ^ ^{a b} Karp HN, The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer, New York, NY: Bantam Dell, 2002
64. ^ Kirkland J. CrySOS, Cry Research Letter, 5:9-14, 1983
65. ^ Wolke D, et al. Excessive Infant Crying: A Controlled Study of Mothers Helping Mothers.. Pediatrics 1994; 94:322-32
66. ^ MR, et al. Effectiveness of an Intervention for Colic. Clinical Pediatrics 2006;45:123-33
67. ^ Savino & Pelle SF, et al. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: A prospective randomized study. Pediatrics 2007:119; e124-30
68. ^ Woodson R, et al. Effects of non-nutritive sucking on state and activity: Term-preterm comparisons. Infant Behav and Dev 1985; 8:435-41
69. ^ Campos RG. Soothing pain-elicited distress in infants with swaddling and pacifiers. Child Dev. 1989; 60: 781-792 [CrossRef][Web of Science][Medline]
70. ^ Brackbill Y, et al. Arousal level in neonates and preschool children under continuous auditory stimulation. J Exp Child Psychol 1966;4:178-88[Medline].
71. ^ Brackbill Y, Continuous Stimulation And Arousal Levels in Infancy: Effects of Stimulus Intensity and Stress. Child Dev 1975; 46: 364-9
72. ^ Birns B, et al. Behavioral inhibition in neonates produced by auditory stimulation. Child Dev 1965; 36: 639-645
73. ^ Smith C, Steinschneider A. Differential effects of prenatal rhythmic stimulation on neonatal arousal states. Child Dev 1975; 46:574-8
74. ^ Spencer JAD, et al. White noise and sleep induction. Arch Dis Child 1990, 65:135-7
75. ^ ^{a b} Koner A, et al. The relative efficacy of contact and vestibulo-proprioceptive stimulation in soothing neonates. Ch Dev 1972; 43:443-53
76. ^ ^{a b} Pederson DR. The soothing effect of rocking as determined by direction and frequency of movement. CanJBehav Sci 1975;7:237-43
77. ^ Hunziker U, Barr R. Increased carrying reduces infant crying: A randomized controlled trial. Pediatrics 1986; 77:641-8 http://pediatrics.aappublications.org/cgi/content/abstract/77/5/641?ijkey=718ecc3ab3b25018bca2d0b4aacca3cc97259b80&keytype2=tf_ipsecsha
78. ^ ^{a b} Elliott MR, et al. Effects of rocking on the state and respiration of normal and excessive criers. Can J of Psych 1988, 42: 163-172
79. ^ van Sleuwen BE, et al. Swaddling: a systematic review. Pediatrics. 2007;120 (4). Available at: www.pediatrics.org/cgi/content/full/120/4/e1097
80. ^ Gerard CM, et al. Physiologic studies on swaddling: an ancient child care practice, which may promote the supine position for infant sleep. J Pediatrics 2002;141:398-403 [CrossRef][Web of Science][Medline]
81. ^ Gerard CM, et al. Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics 2002;110 (6) Available at: www.pediatrics.org/cgi/content/full /110/6/e70
82. ^ Franco P, et al. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 2005;115:1307-11[Abstract/Free Full Text]
83. ^ Lipton EL, et al. Swaddling, a child care practice: Historical, cultural and experimental observations. Pediatrics 1965;35(suppl):521-567[Abstract/Free Full Text
84. ^ ^{a b c} Brackbill Y, Cumulative effects of continuous stimulation on arousal levels in infants. Child Dev 1971; 42: 17-26
85. ^ Wolff PH: The causes, controls and organization of behavior in the neonate. Psychol Issues 1966;5;1-105
86. ^ Mahan ST, Kasser JR. Does swaddling influence developmental dysplasia of the hip? Pediatrics 2008;121:177-8[Free Full Text]
87. ^ Karp HK Safe Swaddling and Healthy Hips: Don't Toss the Baby out With the Bathwater. Pediatrics 2008; 121: 1075-6. http://pediatrics.aappublications.org/cgi/content/full/121/5/1075-a?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=karp&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
88. ^ Mahan ST, et al, Safe Swaddling and Healthy Hips: Don't Toss the Baby out With the Bathwater: In Reply. Pediatrics, 2008; 121: 1077. http://pediatrics.aappublications.org/cgi/content/full/121/5/1077-a?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=mahan&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
89. ^ Brackbill Y, Adams SG, Crowell DH, et al. Arousal level in neonates and preschool children under continuous auditory stimulation. J of Exp Child Psychol 1966; 4: 178-188
90. ^ Brackbill Y, Continuous Stimulation And Arousal Levels in Infancy: Effects of Stimulus Intensity and Stress. Child Dev 1975; 46: 364-69
91. ^ Birns B, Blank, M, Bridger WH, et al. Behavioral inhibition in neonates produced by auditory stimulation. Child Dev 1965; 36: 639-645
92. ^ Spencer JAD, Moran DJ, Lee A, et al. White noise and sleep induction. Arch Dis Child 1990, 65:135-137
93. ^ van den Daele l. Modification of infant state by treatment in a rockerbox. J of Psychol 1970, 74:161-165
94. ^ Brackbill Y, Continuous Stimulation Reduces Arousal Level: Stability of the Effect over Time. Child Dev 1973; 44: 43-46
95. ^ Pederson DR, et al Ter Vrught D, The influence of amplitude and frequency of vestibular stimulation on the activity of two-month-old infants. Child Dev 1973, 44: 122-128
96. ^ Kramer LI, Pierpont ME. Rocking waterbeds and auditory stimuli to enhance growth of preterm infants. J Peds 1976; 88:297-299
97. ^ Korner, AF, et al. Sleep enhanced and irritability reduced in preterm infants: Differential efficacy of three types of waterbeds. Dev and Behav Peds; 1990; 11:240-246.
98. ^ Gatts JD, Fernbach SA, Wallace DH, et al. Reducing crying and irritability in neonates using a continuously controlled early environment. Journal of Perinatology, 1995; 15:215-221
99. ^ Lucassen PL, et al. Infantile colic: Crying time reduction with a whey hydrolysate: a double-blind, randomized, placebo-controlled trial. Pediatrics 2000;106 :1349-54[Abstract/Free Full Text]
100. ^ J Manipulative Physiol Ther. 1999 Oct;22(8):517-22.The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer.Wiberg JM, Nordsteen J, Nilsson N.