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bottle-feeding pairs (33%), the hypoallergenic diet was a hypoallergenic infant formula the control diet was a cow milk-containing infant formula.14

In 2012, Lacovou, et al, conducted a systematic review and concluded that in formula-fed infants, colic may improve after changing from a standard cow’s milk formula to either a hydrolysed protein formula or a soy- based formula.15

is some scientic evidence to support the use of a casein hydrolysate formula in formula-fed infants or a low- allergen maternal diet in breastfed infants with infantile colic but that further research of good methodological quality on low-allergenic formulas and maternal diets is indicated. Based on the previously mentioned studies it is important to explore the knowledge and practice patterns of digestive conditions have been surveyed. In 2012, Martinez, et al, conducted a survey questionnaire completed by 43 fellowship training directors of 62 active programs afliated to the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition including sites in the United States, Canada and Mexico. The study concluded that program directors cited a lack of faculty interested in nutrition and a high workload as common obstacles for teaching.

Furthermore, the methodology of nutrition education during gastroenterology fellowship training is for the most part, unstructured and inconsistent among the different programs. The minimum Level 1 requirements are not consistently covered.16

conducted a survey to 272 members of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition and found that pediatric gastroenterologists identied gaps in their nutrition knowledge base that may be attributed to the present nutrition education training during fellowship.17

The practice patterns for chiropractors regarding digestive conditions has been surveyed. In 2009, a multidisciplinary panel of 37 was made up primarily of doctors of chiropractic with a mean of 18 years in practice, many with post-graduate training in pediatrics.

TABLE 1 Year

Dobson, et al, 2012 (20) Low risk of selection bias (Random sequence generation)

Dobson, et al, 2012 (20) Low risk of selection bias (Allocation concealment)

Dobson, et al, 2012 (20) Low risk of performance bias (parental blinding)

Dobson, et al, 2012 (20) Low risk of attrition bias (selective reporting)

THE ORIGINAL INTERNIST JUNE 2016 In 2013, Lin, et al, also Also in 2012, Hall, et al, found that there

The panel represented 5 countries and 17 states there were members of the American Chiropractic Association, the International Chiropractors Association, and the International Chiropractic Pediatric Association. A broad- based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specic aspects of the chiropractic approach to clinical evaluation, management, and manual treatment for pediatric patients, based on both scientic evidence and clinical experience.18

In 2010, Alcantara, et al, conducted a survey of 548 chiropractors, the majority of whom are practicing in the United States, Canada, and Europe. This survey found that digestive conditions were the third most common treated condition by the Chiropractors participating in the survey.19

The safety of chiropractic treatment in the pediatric population has been evaluated. In 2009, Alcantara, et al, conducted a survey of chiropractors and parents in a practice-based research network and found that Chiropractor responders indicated three adverse events per 5,438 ofce visits from the treatment of 577 children. The parent responders indicated two adverse events from 1,735 ofce visits involving the care of 239 children. Both sets of responders indicated a high rate of improvement with respect to the children’s presenting complaints, in addition to salutary effects unrelated to the children’s initial clinical presentations.20


The inclusion of spinal manipulative therapy as part of the protocol for the treatment of infantile colic is promising. Based on the lack of efcacy and safety of certain drugs and the lack of evidence for overall treatment options, physicians may want to consider chiropractic treatment as part of the management of infantile colic. A possible treatment protocol could be the combination of chiropractic and probiotics (L. reuteri ATCC 55730 and L. reuteri DSM 17938) which were both shown to reduce crying time in this study. Further studies conrming these ndings are warranted.



Randomized controlled trials

Randomized controlled trials

Randomized controlled trials

Randomized controlled trials

Number of Studies 5

4 2 1

Number of Patients

30 205 124 40

Mean Difference

1.20 1.24 0.57 1.95

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