Reference
Landgren K, Kvorning N, Hallstrom I. Acupuncture reduces crying in infants with infantile colic: a randomized, controlled, blind clinical study. Acupunct Med. 2010;28:174-179.
Design
Ninety otherwise healthy infants aged 2 to 8 weeks with infantile colic were randomized to receive acupuncture or no treatment. Infants underwent a structured regimen of 6 visits over 3 weeks to an acupuncture clinic in Sweden. Parents met with a blinded nurse. The infant was then given to another nurse in a separate room. That nurse handled infants similarly except that the infants allocated to acupuncture received treatment at LI4 bilaterally for 2 seconds at each visit. No sham acupuncture was administered.
Key Findings
Minimal intervention with acupuncture was effective in reducing the duration and intensity of crying in infants with colic. Infants in the acupuncture group had a shorter duration of fussing over the 1st (74 versus 129 minutes; P=0.029) and 2nd week (71 versus 102 minutes; P=0.047), as well as a shorter duration of colicky crying in the 2nd week (9 versus 13 minutes; P=0.046). The total duration of fussing, crying, and colicky crying was significantly lower in the acupuncture group than the control in both the 1st (193 vs 225 minutes; P=0.025) and 2nd week (164 vs 188 minutes; P=0.028). Overall, there was a significant difference between the acupuncture group and the control group (P=0.034), favoring the acupuncture group.
Practice Implications
About 10% of children in the Western world experience colic.1 No clear etiology has been identified, but many theories have been proposed, including that colic is a normal gastro-colic reflex in response to food, increasing peristalsis to make room for incoming food.2 It has also been theorized that colic is the result of a gastrointestinal (GI) abnormality such as gastroesophageal reflux disease (GERD), gas, or muscular spasm in the colon, all which are very plausible contributors. It is interesting to note, however, that 85-90% of colicky babies have no evidence of GI abnormality.3
Although it has little direct medical consequence, infantile colic does pose many significant concerns for both the child and her parents. Several studies have identified infantile colic and prolonged crying as risk factors for maternal and paternal postpartum depression.4,5 Furthermore, research has demonstrated that mothers of colicky infants are at risk for a shortened duration of breastfeeding6 and have twice the rates of insecure attachment to their infants,7 both of which may impact the child's long-term physical and mental health.
Colicky babies are more likely to be victims of shaken baby syndrome and may be at an increased risk of sudden infant death syndrome.
Colicky babies are more likely to be victims of shaken baby syndrome8 and may be at an increased risk of sudden infant death syndrome (SIDS).9 They have also been more likely to be treated with prescription medications, including sedative medications (eg, phenobarbital, valium, ethanol), analgesics (eg, opium),10 and antispasm drugs (eg, scopolamine, dicyclomine) historically,11 and more recently, proton pump inhibitors (PPIs) for GERD, despite recent evidence out of University of Pittsburg that concluded that PPIs were no more effective than water at reducing infant crying.12
Infant crying can have a prominent effect on the stability of the family. Crying, frustration, and fatigue can inflict enormous emotional strain on new parents, leading to anxiety, stress, marital discord, and low self-esteem as a parent.13 When we combine these social effects with the increased risks to affected infants and their parents, we see the serious concern that colic poses. It is important to implement safe and effective strategies to calm colicky infants. It appears as though along with teaching soothing techniques to parents,2 optimizing digestion through avoidance of food allergens,14 and supplementation of probiotics,15 acupuncture may be an effective tool to calm babies with colic.
Several studies have investigated acupuncture and infantile colic and found beneficial results, including this reported study. A 2008 study by Reinthal showed that in 40 infants who received light needling at LI4 for 20 seconds on 4 occasions, parents reported significant improvement in colic symptoms.16 A 2011 study by the same author demonstrated that in 913 infants needled at the same point, LI4, for 10-20 seconds daily, 76% of parents reported amelioration of symptoms after 1 week.17 A third study, published in Journal of Traditional Chinese Medicine in 2002 by Zhao, demonstrated a similar effect on infants' night crying with acupuncture at point PC9 in 100 cases.18
In Reinthal's 2008 study, the effect was attributed to the motor and autonomic nervous system and its potential reduction of intestinal peristaltic movements. The most interesting theory of colic, in my opinion, is the serotonin-melatonin circadian rhythms and their effect on intestinal peristalsis. Peak serotonin concentration causes intestinal cramps associated with colic because serotonin increases intestinal smooth muscle contraction. Melatonin has the opposite effect of relaxing intestinal smooth muscles. Both serotonin and melatonin exhibit a circadian rhythm with peak concentrations at night.<19 However, serotonin intestinal contractions are unopposed in the first 3 months of life because only serotonin circadian rhythms exist at birth. Melatonin circadian rhythms are not developed in the infant pineal gland until age 3 months, the time when colic generally subsides.20 Acupuncture has been previously demonstrated to increase endogenous melatonin secretion in adults.21 This may be a mechanism by which acupuncture relieves infantile colic symptoms, in addition to directly impacting peristalsis and smooth muscle contraction.
The far-reaching impact of infantile colic on infants as well as their parents and their family structure provide adequate reason to further explore means to relieve colic symptoms. Acupuncture appears to be a viable consideration when devising a treatment plan to manage infantile colic.
Limitations
There are significant limitations to this study. First is the dependence on parental measurement of crying, fussiness, and colicky crying as primary outcome measures. As a parent myself, I understand the challenge of accurately evaluating how long your own child has been crying, especially under the stress of lack of sleep, a new child, and other normal aspects of daily life. Even if minutes of crying are accurately counted, you cannot distinguish the cause of the crying and whether it was due to colic symptoms. Another limitation of the study is that the overall P value (P=0.034) is fairly low considering the study had 90 subjects.
It certainly appears, as demonstrated in the studies mentioned, that there may be merit to acupuncture to manage infantile colic. It would be valuable to see follow-up studies involving larger patient groups and using a more accepted placebo. Although not without its drawbacks, sham acupuncture is the current standard. In addition, more objective measures of outcome would add value and validity to the study. Identification and evaluation of physiologic measures of infant distress or markers of colic would also strengthen the conclusions of the researchers.
