Approach to infantile colic in primary care

The role of breast milk beta-endorphin and relaxin-2 on infant colic

BACKGROUND

The relationship between infant colic and breast milk beta-endorphin (BE) and relaxin-2 (RLX-2) has not been studied before.

METHODS

Thirty colic infants and their mothers constituted the study group, and the same sex, similar age and healthy infants and their mothers formed the control group. Maternal predisposing factors were analysed with questionnaires.

RESULTS

The frequency of headache and myalgia in the mothers was significantly higher in the study group compared to the control group. Sleep quality of mothers in the study group was worse than in the control group (p = 0.028). While breast milk RLX-2 level in the study group was not different from the control group, breast milk BE level in the study group was significantly higher than the control group (p = 0.039). A positive correlation was found between breast milk BE levels and crying times, and between sleep quality scores and crying times. Headache, myalgia, sleep quality and breast milk BE levels were found to have a significant effect on infant colic.

CONCLUSIONS

Breast milk RLX-2 has no role on infant colic. Breast milk BE may act as a biological mediator in transmitting of maternal predisposing factors such as poor sleep quality, headache and myalgia from mother to infant.

IMPACT

The relationship between infant colic and breast milk beta-endorphin (BE) and elaxin-2 (RLX-2) has not been studied before. Maternal sleep quality, headache, and myalgia are predisposing factors associated with infant colic. Breast milk RLX-2 has no effect on infant colic. Breast milk BE may play a role as a biological mediator in transmitting the effects of predisposing factors from mother to infant. Breast milk BE may be a mediator in biological communication between mother and infant.

The five "S's" and the "SNOO" Smart Sleeper-non-pharmacological interventions (NPI) to promote sleep and reduce crying of infants: a scoping review

Background

Sleeping and crying are normal activities of infants. Infant crying and night wakings can be both distressing and exhausting for parents. At its worse it may be associated with an increased risk of maternal depression and psychosocial stress for both parents. Strategies for reducing crying and improving sleep include the five "S's"-swaddling, side/stomach position, sucking, swinging and shushing sounds simulating "womb-like" sensations. The "SNOO" Smart Sleeper (SNOO), a "smart" bassinet, incorporates 3 of the five "S's", swaddling, swinging (rocking) and emits soothing sounds while demonstrating safe infant sleep practices. This paper explores the effectiveness of the five "S's" and the SNOO.

Methods

References for the five "S's" were obtained from various sources while a scoping review of publications from PubMed, Embase and Web of Science was undertaken to seek out relevant studies to document the efficacy of the SNOO.

Results

The five "S's" appear to help soothe infants, reduce their crying and improve their sleep. In addition, infant obesity rates fell. Infants also experienced less pain following immunisations. Of the 66 papers gleaned from the database in mid-2021 for the scoping review, only those which provided clear outcomes and conclusions, were complete and related to infants were included. That resulted in only 2 studies that fitted the criteria imposed. They suggested that the SNOO incorporating 3 of the five "S's" had similar beneficial effects.

Conclusions

The five "S's" were effective non-pharmacological strategies to help reduce crying and improve sleep in infants. Confounding factors included normal crying of infants, triggers of hunger or tiredness, or recognised causes of crying. The 2 studies reviewed suggested that the SNOO was helpful in reducing crying and improving the sleep duration of normal infants. Further studies have suggested it may be used therapeutically for distressed or ill infants.

Incidence and Associated Factors of Infantile Colic in Thai Infants

Purpose

Infantile colic, a common functional gastrointestinal condition, causes distress and frustration in families. Its prevalence and incidence vary from community to community. The purpose of our study was to demonstrate the incidence of and factors associated with infantile colic in Thai infants.

Methods

We conducted a prospective analytic study to explore the incidence and factors associated with infantile colic in 386 Thai infants aged between one month and six months. Caregivers were interviewed using a questionnaire about infants' symptoms of colic based on the definition from the Rome IV criteria. Family background and potential precipitating factors of colic were also evaluated.

Results

The incidence of colic in infants younger than 6 months was 6.5%. All infants' colic started within 12 weeks of life and lasted approximately 6 weeks. Sex, gestational age, birth weight, delivery route, birth order, family factors, and parental factors were not correlated with the occurrence of colic. Infants who were exclusively breastfed for the first 2 months of life had a lower incidence of infantile colic than those who were mixed- or formula-fed (odds ratio=3.0; 95% confidence intervals=1.3 to 7.2).

Conclusion

The incidence of infantile colic in Thai infants in our study was 6.5%, which is similar to that in other reports. Being exclusively breastfed for the first two months was the only risk factor in our cohort.