Infantile Colic and Chiropractic

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

Hold your horses! Before you wade into the Colic Section, please read Dr. Nansel & Szlazak's fascinating JMPT article (see below), as it clarifies WHY chiropractic gets such dramatic results with a spectrum of purported diseases and disorders. You'll be glad you did!    Somatic Dysfunction and the Phenomenon of Visceral Disease Simulation: A Probable Explanation for the Apparent Effectiveness of Somatic Therapy in Patients Presumed to be Suffering from True Visceral Disease J Manipulative Physiol Ther 1995 (Jul);   18 (6):   379–397 ~ FULL TEXT The proper differential diagnosis of somatic vs. visceral dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, need to be appreciated by all portal-of-entry health care providers, to insure timely referral of patients to the health specialist appropriate to their condition. Furthermore, it is not unreasonable that this somatic visceral-disease mimicry could very well account for the “cures” of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to “holistic” health care claims on the part of such clinical disciplines.

	The Effect of Chiropractic Care on Infantile Colic: Results From a Single-blind Randomised Controlled Trial  NCT02595515 Chiropractic & Manual Therapies 2021 (Apr 19);   29:   15 ~ FULL TEXT In conclusion, we found that excessive crying was reduced by half an hour in favor of the group receiving chiropractic care compared with the control group, but not at a statistically significant level after adjustments. From a clinical perspective, the mean difference between the groups was small, but there were large individual differences, which emphasizes the need to investigate if subgroups of children, e.g. those with musculoskeletal problems, benefit more than others from chiropractic care.
	Identifying Potential Treatment Effect Modifiers of the Effectiveness of Chiropractic Care to Infants with Colic Through Prespecified Secondary Analyses of a Randomized Controlled Trial  NCT02595515 Chiropractic & Manual Therapies 2021 (Apr 19);   29:   16 ~ FULL TEXT None of the preselected items or predefined indices were valuable for identification of infants with potentially larger gain from manual therapy than others. However, more hours of crying at baseline, short duration of symptoms and young age were all associated with an increased effect of chiropractic care; hours of crying at a statistically significant level. This may be a clinically relevant finding, suggesting that the most severely affected infants have the greatest potential for an advantage from manual therapy. This finding requires validation by further studies.
	An Overview of Systematic Reviews of Complementary and Alternative Therapies for Infantile Colic Systematic Reviews 2019 (Nov 11);   8 (1):   271 ~ FULL TEXT Sixteen systematic reviews were identified. Probiotics, fennel extract and spinal manipulation show promise to alleviate symptoms of colic, although some concerns remain. Acupuncture and soy are currently not recommended. The majority of the reviews were assessed as having high or unclear risk of bias and low confidence in the findings.
	The Effect of Chiropractic Treatment on Infantile Colic: Study Protocol for a Single-blind Randomized Controlled Trial   NCT02595515 Chiropractic & Manual Therapies 2018 (Jun 7);   26:   17 ~ FULL TEXT In a single-blind randomized controlled design we will evaluate the effectiveness of chiropractic treatment on infantile colic. The study will contribute to determine the effect of chiropractic treatment on infantile colic in an area where limited evidence exists. Furthermore, the study aims to explore if subgroups of children with suspected musculoskeletal problems will benefit more from the intervention than others. If they obtain better results, this could imply the need for stratified care.
	Management of Musculoskeletal Dysfunction in Infants Experimental and Therapeutic Medicine 2016 (Jun);   11 (6):  2079–2082 ~ FULL TEXT In conclusion, based on the above literature, it can be concluded that manual chiropractic therapy is the most successful option for the management of paediatric musculoskeletal health of infants. In addition, few adverse effects have been reported, and these are negligible in comparison to the beneficial accounts of manual therapy. However, additional investigations need to be performed to elucidate the core mechanisms responsible for existing results of manual therapy.
	Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial J Manipulative Physiol Ther. 2012 (Oct);   35 (8):   600–607 ~ FULL TEXT In this study, chiropractic manual therapy improved crying behavior in infants with colic (50% reduction). 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.

Joyce E. Miller, BS, DC, DABCO also wrote a follow-up study, a cost comparison of the medical and chiropractic care provided in her earlier RTC study, titled: Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT For This Condition J Clinical Chiropractic Pediatrics 2013 (Jun);   14 (1):   1063–1069 This RTC cast new and significant insights into previous colic trials: Chiropractic care lowered overall costs more than 400% compared with medical management That study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

	Manipulative Therapies for Infantile Colic Cochrane Database Syst Rev. 2012 (Dec 12);   12:   CD004796 ~ FULL TEXT The studies included in this meta-analysis were generally small and methodologically prone to bias, which makes it impossible to arrive at a definitive conclusion about the effectiveness of manipulative therapies for infantile colic. The majority of the included trials appeared to indicate that the parents of infants receiving manipulative therapies reported fewer hours crying per day than parents whose infants did not, based on contemporaneous crying diaries, and this difference was statistically significant. The trials also indicate that a greater proportion of those parents reported improvements that were clinically significant. However, most studies had a high risk of performance bias due to the fact that the assessors (parents) were not blind to who had received the intervention. When combining only those trials with a low risk of such performance bias, the results did not reach statistical significance. Further research is required where those assessing the treatment outcomes do not know whether or not the infant has received a manipulative therapy.There are inadequate data to reach any definitive conclusions about the safety of these interventions.
	The Use of Spinal Manipulative Therapy For Pediatric Health Conditions: A Systematic Review of the Literature J Can Chiropr Assoc. 2012 (Jun);   56 (2):   128–141 ~ FULL TEXT Six clinical trials investigated the effectiveness of SMT on colic, two each on asthma and enuresis, and one each on hip extension, otitis media, suboptimal breastfeeding, autism, idiopathic scoliosis and jet lag. Studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma.
	Prognostic Significance of Subgroup Classification for Infant Patients with Crying Disorders: A Prospective Cohort Study J Can Chiropr Assoc. 2012 (Mar);   56 (1):   40–48 ~ FULL TEXT An observational cohort design was employed. All infants presenting with excessive infant crying between July 2007 and March 2008 were categorized into three subgroups, (A) infant colic, (B) irritable infant syndrome of musculoskeletal origin (IISMO) and (C) inefficient feeding crying infants with disordered sleep (IFCIDS) based on history and physical findings. Mothers completed questionnaires which rated their own and their child's characteristics prior to and at the end, of a course of manual therapy. Independent associations between infant subgroups and changes in continuous outcomes (crying, stress, sleep, and consolability) were assessed. Multivariable analysis of covariance was used to identify and control for potential confounders.
	The Chiropractic Care of Infants With Colic: A Systematic Review of the Literature Explore (NY). 2011 (May);   7 (3):   168–174 Our systematic review of the literature revealed 26 articles meeting our inclusion criteria. These consisted of three clinical trials, two survey studies, six case reports, two case series, four cohort studies, five commentaries, and four reviews of the literature. Our findings reveal that chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events.
	A Retrospective Study of Chiropractic Treatment of 276 Danish Infants With Infantile Colic J Manipulative Physiol Ther. 2010 (Sep);   33 (7):   536–541 ~ FULL TEXT Data matched the clinical experience of good treatment effect independent of the infant's age. Slightly older age and longer duration of treatment were found to explain covariables linked to crying infants with improvement. No apparent link between the natural development of crying pattern and a positive outcome of chiropractic treatment was found. The findings of this study do not support the assumption that possible effect of chiropractic treatment of infantile colic is simply a reflection of the normal cessation of this disorder.
	A Description of Children and Adolescents in Danish Chiropractic Practice: Results from a Nationwide Survey J Manipulative Physiol Ther. 2009 (Oct);   32 (8):   607–615 ~ FULL TEXT For the older children, musculoskeletal problems were the most dominant complaint, ranging from 33% among the preschool children to 75% among the teenagers. These complaints were often chronic and about a third of the children older than 2 years had experienced symptoms for more than 1 year before seeing the chiropractor. Among the older children and the adolescents, musculoskeletal complaints were most common and mostly of a chronic nature. The large number of pediatric patients in chiropractic practices and the paucity of evidence of treatment effectiveness indicate the need for further research in these age groups.
	Long-Term Effects of Infant Colic: A Survey Comparison of Chiropractic Treatment and Nontreatment Groups J Manipulative Physiol Ther 2009 (Oct);   32 (8):   635–638 ~ FULL TEXT Toddlers who were treated with chiropractic care for colic were twice as likely to not experience long-term sequelae of infant colic, such as temper tantrums (relative risk, 2.0; 95% confidence interval, 1.3–3.0) and frequent nocturnal waking (relative risk, 2.0; 95% confidence interval, 1.5–2.8) than those who were not treated with chiropractic care as colicky infants.
	Comparison of the Short-term Effects of Chiropractic Spinal Manipulation and Occipito-sacral Decompression in the Treatment of Infant Colic: A Single-blinded, Randomised, Comparison Trial Clinical Chiropractic 2008 (Sep);   11 (3):   122–129 Both treatments appear to offer significant benefits to infants with colic. Infants treated by SMT or OSD cried less and slept more after 2 weeks of treatment. There were no differences in outcomes between the two treatment approaches. Although the participants completed the trial of therapy prior to the usual age of remission for infant colic, the natural course cannot be ruled out.
	Chiropractic Care for Nonmusculoskeletal Conditions: A Systematic Review With Implications For Whole Systems Research J Altern Complement Med. 2007 (Jun);   13 (5):   491–512 ~ FULL TEXT (1) Adverse effects should be routinely reported. For the few studies that did report, adverse effects of spinal manipulation for all ages and conditions were rare, transient, and not severe.   (2) Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic.   Evidence was promising for potential benefit of manual procedures for children with otitis media and elderly patients with pneumonia.
	Chiropractic Management of Infantile Colic Clinical Chiropractic 2004 (Dec);   7 (4):   180–186 These cases suggest a possible association between birth trauma; the development of cranial and spinal segmental dysfunction and consequential manifestation of symptoms of infantile colic. Secondly, they demonstrate chiropractic treatment successfully restoring correct spinal and cranial motion, with an associated resolution of symptoms.
	Vertebral Subluxation Correlated with Somatic,Visceral and Immune Complaints: An Analysis of 650 Children Under Chiropractic Care Journal of Vertebral Subluxation Research 2004 (Oct 18):   1–23 The process of neurological learning or programming of the central nervous system with respect to locomotion, posture, proprioception, and body kinetics begins within a few short months after birth. Our study revealed a pattern of pelvic dysfunction correlated with numerous somatic, visceral and immune complaints. These dysfunctions should be discovered as early as possible in a child’s development to effect a correction and the relationship between these dysfunctions and ill health should be further studied.
	Differential Compliance Instrument in the Treatment of Infantile Colic: A Report of Two Cases J Manipulative Physiol Ther 2002 (Jan);   25 (1):   58–62 ~ FULL TEXT A PulStar Function Recording and Analysis System (PulStar FRAS, Sense Technology, Inc, Pittsburgh, Penn) device was used to administer light impulses (approximately 1.7 joules, which produced a 3 to 4 lb force) at each segmental level throughout the dorsal spine, with probe tips spaced 2 cm apart straddling the spinous processes. Crying was reduced by 50% after a single session of instrumental adjusting in a 6–week old girl and after 4 sessions in a 9–week old boy, according to colic diaries kept by the mothers. Average hours of uninterrupted daily sleep increased from 3.5 to 6.5 hours after a single session.
	Randomised Controlled Trial of Infantile Colic Treated With Chiropractic Spinal Manipulation Arch Dis Child. 2001 (Feb);   84 (2):   138–141 Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic.
	Chiropractic Management of an Infant Experiencing Breastfeeding Difficulties and Colic: A Case Study J Clinical Chiropractic Pediatrics 2000;   4 (1):   245–247 Immediate improvement of infant's symptoms following the first adjustment with complete resolution within five days. A recurrence, with exacerbated presentation, (as reported by the mother) was noted within three hours of the infant receiving his second Hepatitis B vaccine. Immediate remission was not observed nor was the infant able to remain subluxation free during the stress-reaction phase described by Scheibner. However, complete remission of symptoms and the ability of the infant to remain subluxation free occurred once the infant was past that acute reaction phase.
	The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer J Manipulative Physiol Ther 1999 (Oct);   22 (8):   517–522 ~ FULL TEXT By trial days 4 to 7, hours of crying were reduced by 1 hour in the dimethicone group compared with 2.4 hours in the manipulation group (P = .04). On days 8 through 11, crying was reduced by 1 hour for the dimethicone group, whereas crying in the manipulation group was reduced by 2.7 hours (P = .004). From trial day 5 onward the manipulation group did significantly better that the dimethicone group. The authors then conclude: Spinal manipulation is effective in relieving infantile colic. You may also enjoy FCER's review of this article.
	Study Finds Benefits for Colic with Chiropractic Spinal Manipulation FCER: December 7, 1999 The first controlled randomized clinical trial involving the chiropractic management of infantile colic has just been published by a research group in Denmark at Odense University and in private practice. Although previous studies dating back over the last 10 years have been encouraging, this is the first demonstration of the clear clinical advantage conferred upon infants by spinal manipulation as compared to a control group given dimethicone, commonly used in medical treatment of colic.
	Chiropractic Care of Infantile Colic: A Case Study J Clinical Chiropractic Pediatrics 1999;   3 (1):   203–206 This study outlines the chiropractic care of an eleven-month-old male with severe, complicated, late onset infantile colic. The infant had been unable to consume solid foods for a period of four months, and suffered from severe constipation. In addition, this subject demonstrated extreme muscular weakness and lack of coordination The baby was unable to crawl, stand, or walk, and was greatly unresponsive to his surroundings.
	Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases J Manipulative Physiol Ther 1989 (Aug);   12 (4):   281–288 A prospective, uncontrolled study of 316 infants suffering from infantile colic and selected according to well-defined criteria shows a satisfactory result of spinal manipulative therapy in 94% of the cases.
	Infant Colic and Chiropractic Eur J Chiropr 1985;   33 (4):  264–265 In a retrospective uncontrolled questionnaire study of 132 infants colic, 91% of the parents reported an improvement, which occurred after an average of two to three manipulations, and one week after the treatment started.
	Infantile Colic ~ Kids Need Chiropractic Too! Dynamic Chiropractic – December 17, 1993 The following day Sally took her baby to the chiropractor to have his spine evaluated. The doctor evaluated Brendan's spine and found two areas which needed to be corrected. A couple of light, finger-tip adjustments and the job was done. "How could my baby have spinal problems at his young age," Sally asked. "Well," said the chiropractor, "it can often be the trauma from a difficult birth, a long labor or perhaps even the way we burp the baby or pick the baby up from the crib, that produces spinal problems at such a young age." The next day, Brendan was somewhat better. Sally took him to the chiropractor again for a further adjustment, similar to the ones performed the previous day. Three days after Brendan's first spinal adjustment, Sally just couldn't believe how much her son had improved. He now slept like a baby, only cried when he was hungry or wet, and was once again the perfect baby that Sally knew he was. And Bob slept happily ever after.

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Updated 7-17-2021