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Probiotics, in particular strains of lactobacillus have been shown to reduce crying time in babies with infant colic. In 2007, Savino, et al, conducted a prospective randomized study and found that Lactobacillus reuteri improved colicky symptoms in breastfed infants within 1 week of treatment, compared with simethicone.8


While the aforementioned studies compared both chiropractic and Lactobacillus to simethicone, they fail to compare chiropractic to lactobacillus in reducing crying time.


The purpose of this study is to compare chiropractic to lactobacillus (after 21 days of treatment) using only data with low risk of selection bias (random sequence generation and allocation concealment), low risk of performance blinding (parental blinding) and low risk of attrition bias (selective reporting).


METHODS


Chiropractic treatment and lactobacillus were compared in mean difference of the reduction in crying time for babies with infantile colic after 21 days of probiotic treatment. A search of literature reviews for the treatment of infantile colic using chiropractic and lactobacillus was made using the Cochrane collaboration software program, Review Manager (RevMan) (RevMan 2008). Literature or systematic reviews and meta-analysis were found by a search of the pubmed and google scholar electronic database.


An inclusion and exclusion criteria was performed. Only data with low risk of selection bias (Random sequence generation and allocation concealment), low risk of performance blinding (parental blinding) and low risk of attrition bias (selective reporting) was included.


RESULTS


One review including 5 studies and 223 patients measuring the efcacy of chiropractic treatment in reducing crying time met the inclusion criteria. Also, one study including 3 studies and 209 patients measuring the efcacy of lactobacillus in reducing crying time was found.


Of the chiropractic studies, 4 were peer reviewed while all 3 studies for lactobacillus had a low risk of selection, attrition and performance bias except Savino, et al, 2007 rated with a high risk of performance bias. Savino, et al, 2010 was rated with an unclear risk of selection bias for allocation concealment. All the ratings were performed by their respective authors.


Chiropractic was more effective than lactobacillus at reducing crying time when considering only studies with low risk of selection bias (random sequence generation and allocation concealment) (1.24 and1.20/56.03) and low risk of attrition bias (selective reporting) (1.95/56.03). Chiropractic was similar to lactobacillus at reducing


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et al, conducted a systematic review and concluded that pharmaceuticals have not proven effective (simethicone, lactase) and some (dicyclomine) can cause potentially serious adverse reactions. Furthermore, the study concluded that the most validated treatment for infantile colic is the substitution of a hydrolysed cow’s milk formula, the use of Lactobacillus reuteri, and of fennel extracts.9


In 2012, Bruyas,


crying time when considering only studies with low risk of performance bias (participant/parental blinding) (0.58/56.03).


DISCUSSION


The available literature providing support for the inclusion of chiropractic care in the treatment of infantile colic was reviewed in the introduction. Another study supporting the treatment of infant colic with chiropractic has to do with the long term effects of chiropractic treatment in babies with infantile colic. In 2009, Miller, et al, conducted a survey of parents of 117 post-colic toddlers in a treatment group and 111 toddlers in the non-treatment group and found that toddlers who were treated with chiropractic care for colic were twice as likely to not experience long-term symptoms of infant colic, such as temper tantrums and frequent nocturnal awakening than those who were not treated with chiropractic care as colicky infants. The study concluded that 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 difcult behavioral and sleep patterns in their toddlers.10


Other treatment modalities not explored or reviewed include treatment with pharmaceuticals. Studies in- dicate that some drugs either lack efcacy or safety in the treatment of infantile colic. In 1994, Metcalf, et al, conducted a randomized placebo controlled study involving eighty-three infants between 2 and 8 weeks of age with infant colic and found that simethicone is no more effective than placebo in the treatment of infantile colic.11 In 1998, Lucassen, et al, conducted a systematic review and concluded that Dicyclomine was effective, but serious side effects had been reported like breathing difculties, seizures, syncope, asphyxia, muscular hypotonia, and coma. No benet was shown for simethicone.12


Hall, et al, conducted a systematic review of 19 studies and found that there is little scientic evidence to support the use of Simethicone, Dicyclomine hydrochloride and cimetropium bromide.13


Hall, et al, also concluded that there is some scientic evidence to support the use of a casein hydrolysate formula in formula-fed infants.


in crying time is similar to both chiropractic treatment and lactobacillus discussed in this study.


Whey hydrolysate formula has shown efcacy in the treatment of infantile colic. In the year 2000, Lucassen, et al, conducted a double blind placebo controlled randomized trial that showed a difference in the decrease of crying duration of 63 minutes per day.13


This reduction


Another topic that wasn’t mentioned in this study was the role of diet in the treatment of infantile colic. In the year 2000, Garrison, et al, conducted a systematic review and suggested there was evidence of efcacy of hypoallergenic diet for the breastfeeding mother to reduce the incidence of infantile colic. In breastfeeding pairs (67%), the hypoallergenic diet was a maternal diet free of milk, egg, wheat, and nut products the control diet was a maternal diet that included all of these products. In


THE ORIGINAL INTERNIST JUNE 2016 (Continued on next page)


In 2012,


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