Infantile Colic: Nutritional Considerations

Links between diet and infantile colic should be regarded as tentative, pending further research. Nevertheless, some evidence indicates that replacement of cow’s milk and cow’s milk–based formula with hypoallergenic formula, or elimination of cow’s milk products from a breast–feeding mother’s diet, may be helpful to certain patients. Also, in some cases, the maternal diet may influence colic as a result of the transmission of offending proteins or other compounds through breast milk. The key nutritional issues are as follows:

Cow’s milk proteins. The possibility that cow’s milk proteins may elicit colic symptoms is supported by at least 2 kinds of evidence. The first is the observation that colic symptoms often improve in infants who are either given formula free of cow’s milk proteins or who are breast–fed by mothers who avoid cow’s milk.^8,9 The second is the high number of infants who experience colic symptoms when challenged indirectly with breast milk subsequent to maternal ingestion of whey capsules.⁹

In spite of the belief that the maternal intestinal wall provides a barrier to large molecules, it has been shown that cow’s milk proteins are absorbed from the maternal gastrointestinal tract into the circulation and subsequently pass into breast milk. Passing on these proteins when breast–feeding is a suspected cause of colic.¹⁰

Disaccharidase deficiency or galactosemia may also cause colic symptoms.¹¹ A 1–week trial of a hypoallergenic formula may be recommended for colicky infants,^7,12 although this is not a proven strategy for reducing colic symptoms.

Allergy–causing and gas–producing foods. A breast–feeding mother who eats a hypoallergenic diet may improve her infant’s colic.⁵ Breast–feeding mothers with atopy may find that colic symptoms increase on days that dairy products are consumed.¹³ A survey of breast–feeding women revealed that the foods mothers found to be most strongly linked to colic in their infants were cruciferous vegetables (broccoli, cabbage, cauliflower), onions, and chocolate.¹⁴

However, evidence is increasing that many other foods may exacerbate colic. In a randomized controlled trial in which many of these foods (eg, cow's milk, eggs, peanuts, tree nuts, wheat, soy, and fish) were excluded from the diets of breast–feeding women with colicky infants, a reduction in colic symptoms was observed, compared with women who continued eating these foods.¹⁵

Fructose malabsorption. Rarely, patients with colic may have isolated fructose malabsorption and respond to a fructose–free diet.¹⁶

Orders

Parental smoking cessation.

Nutrition consultation: to advise breast–feeding mothers in the use of a dairy–free or hypoallergenic diet, as appropriate, and arrange follow–up.

Social work consultation: to assess home environment, and arrange follow–up to assess the possibility of ill feelings toward the infant, care provider burnout, and maternal depression or anxiety.

What to Tell the Family

In the absence of other medical issues, colic typically resolves within 4 months, and is always self–limited. Reassurance of the family is important. Dietary changes, including a dairy–free or hypoallergenic diet for breast–feeding mothers or the use of a nondairy or hypoallergenic formula, may be given a therapeutic trial. If switching to a soy–based formula, it is essential to use a baby formula, not common soy milk sold in grocery stores.

All household smokers should stop smoking for the present and future health of the baby and other family members.

Caregivers should understand that they may not be able to console the infant on every occasion, and that caring for a colicky baby is very stressful. They should be encouraged to ask for help if anxiety, depression, or feelings of frustration or anger toward the baby arise. Reducing stimulation, including the stimulation of a family’s repeated efforts to console the baby, may result in decreased colic symptoms.