Long-Term Effects of Infant Colic:
A Survey Comparison of Chiropractic
Treatment and Nontreatment Groups

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

FROM:   J Manipulative Physiol Ther 2009 (Oct); 32 (8): 635–638 ~ FULL TEXT

Joyce E. Miller, DC; Holly Lane Phillips, MChiro

Advanced Professional Practice Chiropractic Paediatrics,
Bournemouth University,
Bournemouth, UK.
jmiller@aecc.ac.uk

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OBJECTIVE:   Investigation into the alleviation of long-term effects of infant colic on the toddler is a neglected area of research. The aim of this study was to document any behavioral or sleep disturbances experienced by post-colicky toddlers who were previously treated with chiropractic care vs those who had not experienced this treatment as an infant.

METHODS:   Two groups of children were sampled from clinic records from a chiropractic clinic and from a child care center in similar regions of England. Patients were classified in the treatment group if they had been treated for infant colic with routine low-force chiropractic manual therapy. The nontreatment group consisted of post-colicky children in the same age group who had received no chiropractic care for their diagnosed colic as infants. A survey of parents of 117 post-colicky toddlers in a treatment group and 111 toddlers in the nontreatment group was performed.

RESULTS:   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.

CONCLUSION:   Untreated post-colicky infants demonstrated negative behavioral patterns at 2 to 3 years of age. In this study, parents of infants treated with chiropractic care for excessive crying did not report as many difficult behavioral and sleep patterns of their toddlers. These findings suggest that chiropractic care for infants with colic may have an effect on long-term sequelae.

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From the Full-Text Article:

Discussion

There is a bewildering array of interventions proposed as panaceas for persistent crying of infancy. Few of these have withstood the rigors of scientific testing. However, chiropractic care has been reported to be effective in infants with functional disturbances of the vertebral column associated with excessive crying. [14, 12, 13] Chiropractic manual therapy was the treatment in this study and was evaluated for its long-term effects rather than its short-term effects on persistent crying, which have been previously established.

Long-term behavioral effects in post-colic children have been investigated. [4-12] These are considered disorders of behavioral and emotional regulation and having had colic as an infant increases the risk of these disorders. [4-12] This was corroborated in our study where children in the nontreatment group had more temper tantrums than children in the treatment group. This reflects the previous research in this area, demonstrating that ex-colicky infants tend to have more temper tantrums as toddlers. [7, 9, 11, 12] The low number of temper tantrums in the treatment group has not previously been demonstrated.

Difficulty in falling asleep and staying asleep is fodder for angst in many parents of toddlers. [15] Poor sleep is not only a hallmark of infant colic but also of post-colicky children. [12, 15, 16] In our sample, this previous research was corroborated as the children in the nontreatment group had more sleep difficulties than those in the treatment group. The literature suggests that toddlers should take 20 minutes or less to fall asleep in the evening [15] and this was the case with 78% of the treated group. Our study further suggests that toddlers treated for infant colic by chiropractic intervention take a shorter period to fall asleep at night compared to the nontreatment group and waken less frequently. The results of our study also corroborate previous research showing that post-colicky children tend to wake during the night, especially between midnight and 5:00 am. [9, 10] Children in the nontreatment group were more than twice as likely to awaken during the night compared to children in the treatment group. Infants with infant colic expose the entire family to stress and strain, which may disrupt the parents which in turn can disrupt the infant's normal behavioral and sleep patterns. [16] Some research studies have shown these traits affect the child until he is 8 to 10 years of age. [17] Further rigorous research is required to determine whether chiropractic treatment of infant colic can reduce the long-term effects on other behavior problems for a larger sample as well as for older age groups.

Limitations

There are many limitations of this study. It was a convenience sample with no attempt at randomization and, thus, may suffer from selection bias. It serves only as a real-world sampling of post-colic toddlers and their behaviors as reported by their parents. It is a small study and, therefore, has little power to exclude with confidence any confounding variables that are not evident. We gave the parents only 2 weeks to respond to the survey; there may be a difference between quick responders, slow responders and, of course, nonresponders; and this was not taken into account. However, both groups were given the same response times. Identification of baseline characteristics between the 2 groups was relatively limited. There is a possibility that the groups were not similar and that other issues would be differentially distributed between groups. No adjustments were made for possible confounders of maternal age, parity, or feeding methods, although it can be noted that none of these variable have previously been found to be significant in colic or post-colic syndromes. We did not measure a wide enough array of variables to address confounders. The geographic areas of study were similar areas in the UK. However, by the reason that some children presented to a chiropractic clinic for colic treatment may mean there is a difference in the populations. Furthermore, there was no investigation of other interventions that might have been used by the families of these subjects. We know that mothers are likely to search for a well-known set of interventions, and it may be reasonably assumed that these may be equally distributed between both groups; however, this cannot be known with any certainty. The only variable under study was whether post-colic children had received chiropractic care as an infant. Many other variables may have been involved, which were not uncovered in this study. We found these data of interest and hoped that it might serve as a catalyst to develop well-designed long-term outcome studies.

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Conclusion

In this study, chiropractic treatment of infant colic was the variable tested relative to long-term behavior problems in children. The children who had received chiropractic intervention for infant colic had fewer temper tantrums, fell asleep more quickly, and stayed asleep longer than the untreated control subjects. This study corroborated the research that shows post-colicky infants seem to have stressful behavioral and sleep patterns at least up to 2 to 3 years of age. It further demonstrated that a group of children treated by chiropractic manual therapy for infant colic seems to have averted these particular negative behavioral and sleep patterns during toddlerhood compared to those children who did not receive chiropractic care.

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Practical Application

• This study shows some evidence that late effects of colic are fewer in toddlers who had been treated with chiropractic care as infants than in a control group.

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