December 2013

Probiotics to Prevent or Treat Excessive Infant CryingSystematic Review and Meta-analysis

Author Affiliations
  • 1Department of Paediatrics, The University of Melbourne, Parkville, Australia
  • 2Murdoch Childrens Research Institute, Parkville, Australia
  • 3Centre for Community Child Health, Royal Children’s Hospital, Parkville, Australia
  • 4Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  • 5Department of Allergy and Immunology, Royal Children’s Hospital, Parkville, Australia

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JAMA Pediatr. 2013;167(12):1150-1157. doi:10.1001/jamapediatrics.2013.2572

Importance  Excessive infant crying is common, distressing, but without proven effective prevention or management options. Probiotics may be a promising solution.

Objective  To examine whether probiotics are effective in the prevention/management of crying (“colic”) in infants 3 months or younger.

Data Sources  A systematic search of MEDLINE, EMBASE, and the Cochrane Library, supplemented by the metaRegister of Controlled Trials.

Study Selection  Studies that randomized infants 3 months or younger to oral probiotics vs placebo or no or standard treatment with the outcome of infant crying, measured as the duration or number of episodes of infant crying/distress or diagnosis of “infant colic.” Twelve of the 1180 initially identified studies were selected.

Data Extraction and Synthesis  This review/meta-analysis was conducted according to guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data were independently extracted by 3 of us.

Main Outcome(s) and Measure(s)  Infant crying, measured as the duration or number of episodes of infant crying/distress, or diagnosis of “infant colic.”

Results  Of the 12 trials (1825 infants) reviewed, 6 suggested probiotics reduced crying, and 6 did not. Three of the 5 management trials concluded probiotics effectively treat colic in breastfed babies; 1 suggested possible effectiveness in formula-fed babies with colic, and 1 suggested ineffectiveness in breastfed babies with colic. Meta-analysis of 3 small trials of breastfed infants with colic found that Lactobacillus reuteri markedly reduced crying time at 21 days (median difference, −65 minutes/d; 95% CI, −86 to −44). However, all trials had potential biases. Meanwhile, of 7 prevention trials, 2 suggested possible benefits. Considerable variability in the study populations, study type, delivery mode/dose of probiotic supplementation, and outcomes precluded meta-analysis.

Conclusions and Relevance  Although L reuteri may be effective as treatment for crying in exclusively breastfed infants with colic, there is still insufficient evidence to support probiotic use to manage colic, especially in formula-fed infants, or to prevent infant crying. Results from larger rigorously designed studies applicable to all crying infants will help draw more definitive conclusions.