by Anne Eglash MD, IBCLC, FABM
Does the probiotic Lactobacillus reuteri (L. reuteri) have the same beneficial effect for colic in breastfed vs formula fed infants? In CQW #85 we highlighted a December 2015 systematic review on interventions that are likely to be helpful for colic. L. reuteri DSM 17938 had the strongest evidence for reducing crying time. Many other interventions such as simethicone (gas drops) and changes in the maternal diet were not shown to be effective.
What’s colic again? Colic is typically defined by the Wessel rule of ‘3’s, occurring in infants who are growing well, healthy, but have episodes of irritability and who cry inconsolably for at least 3 hours a day, at least 3 days a week, for a period of 3 weeks or longer. Evidence has shown that colic starts before or at 3 weeks of age, peaks at 6-8 weeks of age, and diminishes by 3-4 months of age. The underlying cause of colic is not well understood but several studies have shown a different in gut microbiota between infants with and without colic.
I am raising this topic again because of a recent meta-analysis on the effectiveness of L. reuteri, and whether the effectiveness depends on feeding type, e.g. breastfeeding vs formula feeding. Also, the response to L. reuteri is variable, and there are questions whether other interventions for colic, such as medications for infant GE reflux alter the response to L. reuteri as a treatment.
The meta-analysis included 4 double-blind randomized controlled trials involving a total of 345 infants, with 174 receiving the Biogaia brand infant probiotic and 171 placebo. The studies all measured duration of crying time.
According to the authors of this meta-analysis, which statements do you think are accurate? (choose 1 or more):
- Infants treated with L. reuteri had twice the reduction in crying time as compared to the infants who received a placebo.
- Breastfed infants treated with L. reuteri had a significantly greater reduction in crying time as compared to formula-fed infants treated with L. reuteri.
- The formula fed infants treated with L. reuteri had a significant reduction in crying compared to formula fed infants given a placebo.
- Infants in the study who were taking acid-reducing medication and antibiotics were less likely to gain benefit from L. reuteri.
Sally Hammerman
Excellent information for families with colicky babies!
Barbara Robertson
Dear Anne,
Thank you for doing these! I am always intrigued! I am confused by the results however. If you read below it says that overall the probiotic group had success but how can this be if only the breastfed babies did well? Did they do so well that they balanced out the non-successful formula fed babies? Can you explain? Thank you again!
“The probiotic group averaged less crying and/or fussing time than the placebo group at all time points…The probiotic group was almost twice as likely as the placebo group to experience treatment success at all time points.”
MilkMob
Yes, you are correct. The effect on the breastfeeding infants was great enough to still make the effect significant despite the fact that the formula fed infants did not respond to the probiotic.
Barbara Robertson
Wow! That is some powerful stuff! Too bad this wasn’t really pointed out in the results. Thank you for confirming my guess!
Rebecca Harris, RN, IBCLC
Thank you for this helpful information! Is there a brand of infant probiotics with Lactobacillus Reuteri, that you recommend?
MilkMob
The brand used in the meta-analysis is Biogaia. IABLE does not have any financial interest in this brand, nor does IABLE specifically endorse this product.
Muriel W BOETTE, IBCLC
Glad to see this type of work going on. Even more glad for the outcome. Colic is fairly common with the babies I see. I have suggested mom and dad use probiotics and smaller portions for the baby. Mom’s were some times addressing thrush issues as well.
Chris Sheppard
This is very interesting research. More often, I would look at consertive breastfeeding management first with infants and babies with what may be labeled as colic eg. mum has overefficient MER resulting in excess air accumulating in gut particularly at the end of the day. Getting a good history is so important. If a baby/child has been affected by a significant bacterial or fungal infection the probiotics could work well. I tend to trust mothers milk to have the best healing properties, given time.
The formula companies have certainly done their homework claiming to produce a range of products for every condition,usually caused by the formula in the first place. Having said that they owe these kids to do the research and produce the best most protective product possible.
Noriko
I am curious if there is any study linking colic and compromised healthy microbione related to current labour practice(maternal abx use in labour, C-section, infant abx use for suspected sepsis etc).