Local Practices of Infantile Colic Management and Health Outcomes in Children: A Scoping Review

Abstract

Infantile colic is a self-limiting condition that occurs in infants. It is a common disturbance occurring in the first three months of life but is generally harmless. The exact aetiology is unknown, but it is associated with a vicious cycle of the infant crying and swallowing of air. Mothers use a number of methods to relieve their infants from this condition. However, there is limited evidence that support the use of complementary and alternative treatments (such as herbal supplements, and a manipulative approach) or behavioural interventions. The impetus of this paper is thus to explore local or alternative methods of the management of infantile colic. A scoping review of existing literature was done to assess all research on local practices of infantile colic management by nurses and doctors in developed countries and work carried out in Africa. This was done to identify what has been done and to identify any gaps in research. The majority of the studies reviewed revealed positive effects of unorthodox or local methods in managing infantile colic although some cause complications for the infants. There are very few published articles on this subject and methods used. The researchers, therefore, recommend more controlled trials to test the effectiveness of the different local substances used to manage infantile colic.

Full text

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ARTICLE
https://doi.org/10.25159/2520-5293/2165
ISSN 2520-5293 (Online), ISSN 1682-5055 (Print)
© Unisa Press 2018
Africa Journal of Nursing and Midwifery
https://upjournals.co.za/index.php/AJNM/index
Volume 19 | Number 3 | 2017 | #2165 | 10 pages
LOCAL PRACTICES OF INFANTILE COLIC
MANAGEMENT AND HEALTH OUTCOMES IN
CHILDREN: A SCOPING REVIEW
T. D. Odetola, RN, PhD
http://orcid.org/0000-0002-3363-8073
University of Ibadan, Nigeria
odetolatitilayo@yahoo.com
M. O. Abiona, BNSc
http://orcid.org/0000-0002-0047-2652
Ondo State School of Nursing, Nigeria
dcnsabiona@gmail.com
ABSTRACT
Infantile colic is a self-limiting condition that occurs in infants. It is a common disturbance
occurring in the rst three months of life but is generally harmless. The exact aetiology is
unknown, but it is associated with a vicious cycle of the infant crying and swallowing of
air. Mothers use a number of methods to relieve their infants from this condition. However,
there is limited evidence that support the use of complementary and alternative treatments
(such as herbal supplements, and a manipulative approach) or behavioural interventions.
The impetus of this paper is thus to explore local or alternative methods of the management
of infantile colic. A scoping review of existing literature was done to assess all research on
local practices of infantile colic management by nurses and doctors in developed countries
and work carried out in Africa. This was done to identify what has been done and to identify
any gaps in research. The majority of the studies reviewed revealed positive effects of
unorthodox or local methods in managing infantile colic although some cause complications
for the infants. There are very few published articles on this subject and methods used. The
researchers, therefore, recommend more controlled trials to test the effectiveness of the
different local substances used to manage infantile colic.
Keywords: infantile colic; local practice; management; health outcome

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Odetola and Abiona Infantile Colic Management
BACKGROUND OF THE STUDY
Infantile colic is a syndrome characterised by excessive, unexplained paroxysmal crying
in an otherwise healthy baby (Savino 2007). The crying typically starts in the rst
few weeks of life and spontaneously resolves within three to ve months (Landgren,
Lundqvist, and Hallström 2012). Excessive crying is dened as crying that lasts for
more than three hours per day and more than three days per week for at least three weeks
(Leung and Lemay 2004). The crying has been typically described as a high-pitched
scream, occurring mainly in the late afternoon or evening, but may occur at any time.
Characteristically, the infants’ knees are drawn up to the abdomen, the face is ushed
and “pained”, the sts are clenched, the atus is expelled, and there is minimal response
to attempts at soothing the infant (Balon 1997).
Various studies have attributed colic to painful intestinal contractions, lactose
intolerance, the presence of gas in the gut, and parental misinterpretation of normal
crying. However, in recent times, it was hypothesised from various studies that
infantile colic might have a medical or behavioural cause (Savino 2007). The medical
hypotheses include food hypersensitivity or allergies and immaturity of gut function
or gut dysmotility. The behavioural hypotheses include inadequate maternal-infant
interaction (Lucassen et al. 1998), maternal anxiety and difcult infant temperament
(Leung and Lemay 2004). Other recent hypotheses that are being investigated are
hormone alterations and maternal smoking (Savino 2007). The role of gut microora
in the aetiopathogenesis of colic has also been reported. The linking of colic to organic
causes has changed its management interventions which include the use of a wider
range of pharmacological agents such as antispasmodic, defoaming agents, gut hormone
antagonists (Savino 2007), and herbal medicines (Oshikoya, Senbanjo, and Njokanma
2009).
Both behavioural and pharmacological interventions have been studied over the
years in the management of colic and have demonstrated a signicant improvement in
the symptoms (Arikan et al. 2008). However, only a few of these interventions have
been conrmed by randomised clinical trials. Infantile colic usually has a favourable
course and outcome, even without treatment. Most infants are free of the symptoms
by the age of four to ve months (Savino 2007). However, most parents are faced with
tremendous stress and are unlikely to tolerate the stress until the symptoms completely
disappear without medical intervention; therefore either medical help is sought or
self-medication practised by the parents (Arikan et al. 2008; Oshikoya, Senbanjo, and
Njokanma 2009). The majority of Nigerians are known to use and consult traditional
healers for healthcare because of poverty and poor enlightenment. Based on this, herbal
medicines are commonly used in childhood illnesses and even in managing colic
(Chinawa et al. 2013).
When a baby constantly cries despite the parents’ attempts at consolation, the balance
within the family is disturbed as all of the members of a family are mutually dependent in
a complex system. Colic disturbs mother-child and father-child relationships (Landgren,

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Lundqvist and Hallström 2012), creates chaos and disrupts family life (Landgren and
Hallström 2011). Both mothers and fathers often feel powerless and frustrated and search
desperately and creatively for treatments for colic to soothe their babies’ crying. Parents
become very frustrated when they nd that no intervention seems to help. Therefore
they try various means to soothe the baby (Landgren and Hallström 2011).
STATEMENT OF THE RESEARCH PROBLEM
Infantile colic is one of the major challenges of parenthood. It is the most common
paediatric problem in the rst year (Oshikoya, Senbanjo, and Njokanma 2009). It is also
one of the common reasons why parents seek medical advice during their child’s rst
three months of life. Sleepless nights and the inability to console a newly arrived baby
cause a great deal of stress, especially among rst-time parents.
Because of the lack of consensus in the literature about the aetiology and
management of colic, healthcare providers do not have a consistent explanation or
approach to management to share with distressed parents. This lack of consistency leads
to confusion for the parents because they are unsure of whom to turn to or what advice
to follow. In a bid to resolve the stress and anxiety posed by the condition in their
infants, most mothers receive advice from friends and family which may conict with
the regimen prescribed by healthcare providers. These mothers also try various local
and unorthodox regimens to help and relieve their babies of the colic.
PURPOSE OF THE STUDY
The purpose of the study was to review existing literature on researches conducted
especially by medical doctors and nurses in local practices of infantile colic management
both in developed countries and in Africa. This review is done to identify local methods
that mothers or caregivers follow to manage their infants with colic.
This study will help in identifying gaps in existing literature on infantile colic
management and will add to the body of knowledge on effective methods of managing
infantile colic.
OBJECTIVES OF THE STUDY
• To investigate local methods of managing infantile colic.
• To explore the effectiveness of local or unorthodox methods of managing infantile
colic.
• To identify gaps in existing literature on infantile colic management.

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METHODS
Study Design
The researchers conducted a scoping review of existing literature to assess all research
conducted in Africa, West Africa and globally on local practices of infantile colic
management from 2005 to 2015. The researchers wanted to identify what research has
been done, which ones were adjudged effective, where they have been done, and to
identify any gaps in infantile colic management research.
Search Strategy
Systematic searches of literature on local practices of infantile colic management among
mothers published in peer-reviewed journals from 1 January 2005 to 31 December 2015
were performed in PubMed, Web of Science, CINHAL, and Science Direct. Studies
were identied using keyword searches of electronic databases.
Inclusion and Exclusion Criteria
• Research was included if it was conducted by doctors and nurses.
• The study had to contain original research excluding reviews and letters to the
editors.
• Articles had to be published globally in any peer-reviewed journal with an abstract
in English, and had to include patient outcomes.
• Articles had to be published from 2005–2015.
Procedure for Article Selection
The procedure for selecting articles was sequential consisting of the identication of
relevant literature, screening of the articles, assessing the eligibility of full texts, and
nal inclusion of articles. Studies were retrieved from the initial search, and full articles
were downloaded. This process resulted in seven articles that met the criteria being
selected and used for the study.
Data Extraction
Data were extracted from studies that met the inclusion criteria using the researcher-
developed extraction sheet created for the study. The data included the names of the
authors, the title of the study, year of publication, countries of publication and study,
and study type and design.

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Odetola and Abiona Infantile Colic Management
RESULTS
Different studies have shown the effectiveness of unorthodox techniques and methods of
managing babies with colic. The studies ranged from descriptive studies to interventional
studies. The different methods of the management of infantile colic are discussed below.
Herbal Extracts
A study was carried out by Savino et al. (2005) to test the effectiveness of a standardised
extract of Matricaria recutita (chamomile), Foeniculum vulgare (fennel) and Melissa
ofcinalis (lemon balm) (Colimil) in the treatment of breastfed colicky infants. Ninety-
three breastfed colicky infants were enrolled in the study; the diagnosis of infantile
colic was made according to Wessel’s criteria. After a three-day observation period,
the infants were randomly divided into two groups, one treated with a phytotherapeutic
agent (PA) and the other with placebo twice a day for one week. Crying time, and side
effects were recorded. The study shows that colic in breastfed infants improves within
one week of treatment with an extract based on Matricaria recutita, Foeniculum vulgare
and Melissa ofcinalis.
Chashti (2008) also recommended giving the infants extracts from Trachyspermum
copticum, and Foeniculum vulgare (fennel) mixed in the milk for the infant, which
are also effective. Another effective possibility is mixing the extract from Foeniculum
vulgare and Acorus calamus in the milk and giving it to the infant. Similar effects
have been reported for Pimpinella anisum (aniseed) and mastic. In cases in which the
aetiology is related to the warm nature of the food, the modication of the mother’s diet
and consequently the milk consumed by the infant are of importance. In such cases, it
is recommended to give medications of “cold nature” to the infant. Giving the infant
a massage with cold oils such as Viola odorata (sweet violet) (Feyzabadi et al. 2014),
Rosa damascena (damask rose) or even giving the infant some drops of almond oil can
also be effective (Chashti 2008).
Sucrose Solution, Herbal Tea or Hydrolysed Formulas
The effectiveness of massage, sucrose solution, herbal tea or a hydrolysed formula,
each used individually in the treatment of infantile colic was evaluated by Arikan
et al. (2008) using a randomised controlled trial. The study revealed that there was
a signicant reduction in the crying hours per day in all intervention groups. The
difference between the mean duration of the total crying (hours/day) before and after
the intervention in the infants in the hydrolysed formula group was higher than that of
the massage, sucrose and herbal tea group. Similarly, the difference between the mean
duration of the total crying (hours/day) before and after the intervention in the infants in
the massage group was lower than that of the other intervention groups. Therefore, the
study ndings demonstrated that varied interventions such as administering a massage,

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Odetola and Abiona Infantile Colic Management
sucrose solution, herbal tea and hydrolysed formula are effective in the treatment of
colic. However, the hydrolysed formula was the most effective in reducing the duration
of crying (hours/day) when compared with the other intervention groups.
Massage or Chiropractic Interventions
Massage is another unorthodox method or local way of managing the colic condition.
According to a study by Sheidaei et al. (2016), massage signicantly improved colic
symptoms during a one-week intervention for all outcomes. In addition, signicant
differences were found between the intervention and control groups for massaging.
Therefore, massage therapy is more effective than rocking for treating infantile colic
symptoms. This study also supports the ndings of a study conducted by Javan,
Feyzabadi, and Kiani (2015), which discovered that one of the most effective treatment
methods for colic in infants is abdomen massage. Based on the study, Trachyspermum
copticum (Ajowan caraway, bishop’s weed or carom) mixed with yolk in diluted form
(Tela) proved very helpful when massaging the infant abdomen. Oils from herbs such
as mastic and olives also yielded positive results when used to massage infants. Another
useful method explored by this interventional study is putting the infant on its mother’s
lap facing downwards and then massaging its spinal cord and back, using oil from Rosa
damascena.
This chiropractic intervention was also discovered in Nigeria according to a study
by Oshikoya, Senbanjo, and Njokanma (2009,), in which infantile colic was managed
by massaging the infants’ abdomens with anointing oils or herbal mixtures. Mothers
placing their hands on the abdomens of their colicky infants or laying the infants on
their abdomens (56.4%) and applying a hot water bottle to the colicky abdomen (21.8%)
were the other chiropractic interventions practised by the mothers. They also stipulated
that applying a hot water bottle to the abdomen of the infant has been reported to relieve
rectal spasm to aid easier passage of atus. Parents must, however, be cautioned about
the use of this method as they stand the risk of causing burn to the infants’ abdomens.
Arikan et al. (2008) also conducted a study to test the effectiveness of massage as
an intervention with other unorthodox substances in the management of infants with
colic. The massage intervention yielded the least symptomatic improvement among all
other interventions tested, but it was effective in soothing the irritable babies.
Herbal Concoctions
In Nigeria, herbal medicines are usually used to manage babies with colic. The use of
herbal concoctions in the management of childhood illnesses has been reported both in
developed and developing countries. According to a study by Chinawa et al. (2013), the
most commonly used herbal concoction by caregivers is “Gbomoro”. This is a herbal
medication which contains mainly chloroquine, lactose and ascorbic acid (Oshikoya et
al. 2007). It has been hypothesised that when given to infants with colic, it relieves them

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Odetola and Abiona Infantile Colic Management
of pain. Pharmacological and toxicological studies are necessary to determine the safety
of this herbal medication in infants.
Gripe water has been in use for over a century to treat colic with little or no response.
This may explain the 4.6 per cent of mothers who used it as self-medication. It has
been determined that the alcohol content of gripe water provides a soothing effect, the
bicarbonate provides a neutralising effect on the gastric acid, and the carminative in the
plant extract causes the soothing of the infant in the presence of excess gas in the lumen
that may cause pain. This treatment is, however, not entirely harmless. Therefore the
proper dosage has to be scientically determined (Chinawa et al. 2013).
Although the majority of mothers did not attribute the colic to any disease, they
were willing to use herbal concoctions to treat the abdominal colic, as no caregiver is
comfortable watching a child in pain and discomfort. The use of native concoctions for
infants with colic may be viewed as a common practice among mothers of different
cultures and tribes in Nigeria, but the types of herbal medicine used may likely differ.
For instance, “Ororo Ogiri” was the most used herbal medicine in a particular study
(Oshikoya, Senbanjo, and Njokanma 2009). It is derived from putreed Cucumeropsis
mannii (melon) seeds, and is used as a local food seasoning among the Yoruba tribe
in Nigeria. When dissolved in water and taken by adults, it relieves indigestion by
causing excessive atulence. Its use in the treatment of infantile colic was based on the
hypothesis that it removes the excess intraluminal gas in the infant by causing atulence.
The majority of the mothers (87.7%) studied by Chinawa et al. (2013) apply various
substances or medications for colic which range from paracetamol (33.1%), Gbomoro
(16.2%), teething powder (15.4%), salt water (13.2%), Buscopan (7.7%) and gripe water
(4.6%). Mothers usually attribute symptoms of most childhood illnesses to abdominal
colic. This may have led to unnecessary and sometimes harmful management. The
study by Oshikoya, Senbanjo, and Njokanma (2009) revealed various herbal substances
used to manage babies with this condition of which 48 (26.2%) were “Ororo Ogiri”.
Nospamin (49.5%) and gripe water (43.0%) were the two frequently prescribed and
self-medicated medicines for infants with colic. However, the efcacy of these herbal
drugs is yet to be evaluated.
However, various complications can arise from the use or excessive use of herbal
concoctions. Hepatic encephalopathy and death from the use of herbal preparations
(such as preparations from Allium sativum L. (garlic) and Allium ascalonicum L
(shallots)) that contain naphthalene tablets have been reported by some workers. Other
documented harmful effects of these herbal preparations have also been reported
(Chinawa et al. 2013).
Acupuncture
Some studies have shown that the practice of acupuncture had different effects on the
treatment of infantile colic (Ernst 2009; Landgren, Lundqvist, and Hallström 2011).

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Odetola and Abiona Infantile Colic Management
Acupuncture is a frequently used alternative treatment modality in Scandinavia and
is also used for infantile colic (Reinthal, Lund, and Lundeberg 2011). Acupuncture is
an original Chinese treatment method using thin steel needles penetrating through the
skin and into connective tissue and muscle bres. The neurophysiologic basis for the
observed effects, especially the pain-inhibiting effects, is relatively well understood.
Acupuncture is a safe procedure when used by trained practitioners, and the risk of
serious adverse effects is low in children (Adams et al. 2011).
Two controlled trials of children with infantile colic treated with acupuncture have
been published (Landgren and Hallström 2011; Reinthal, Lund, and Lundeberg2011).
Both studies concluded that acupuncture signicantly reduced the crying and pain-
related behaviour without noticeable adverse effects. Effect sizes were small, and there
was no blinding validation. General practitioners were educated within the programmes
of the Norwegian Society of Medical Acupuncture and used a standardised bilateral
needling of the point ST36 when treating infantile colic. Acupuncture point ST36 is
located in the proximal part of the anterior tibia muscle and is the acupuncture point
considered for ailments of gastro-intestinal nature in traditional Chinese medicine
(Deadman, Al-Khafaji, and Baker 2008). A postulated neurophysiologic mechanism
explains a benecial effect on gut dysmotility by way of the parasympathetic vagal
reexes, as well as a centrally opioid-mediated pain inhibitory pathway (Takahashi
2006).
When Holgeir et al. (2013) carried out a study with the aim to test the hypothesis
that such acupuncture treatment has an effect above no-treatment control in infantile
colic, it was discovered that the trial of acupuncture treatment for infantile colic showed
no statistically signicant or clinically relevant effect.
CONCLUSION
Infantile colic affects newborns for up to three months. It is a self-limiting condition.
Owing to the stress this condition causes parents or caregivers, the majority of the
parents or caregivers try a variety of treatments ranging from pharmacological to non-
pharmacological methods. These treatments all have an effect on the colicky infant.
Local or herbal treatments had also proven to be effective in managing this condition,
but the majority of these products or substances have yet to be studied to determine
their efcacy and side effects in infants. It is therefore recommended that clinical trials
be carried out on these products and unconventional ways of managing infantile colic.
ACKNOWLEDGEMENTS
The researchers wish to thank Kazeem Oshikoya, Idowu Senbajo and Olisame-
dua Njokanma for going the extra mile in investigating the local methods used by
Nigerian mothers in managing infantile colic. The researchers also wish to thank the

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Odetola and Abiona Infantile Colic Management
mothers who participated in the study, the Medical Librarian, Dr J. U. Igbeka, from
the Latunde Odeku Medical Library, and the College of Medicine at the University of
Ibadan for granting permission to use their library portal.
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