A Not So Silent Night

[originally published in KCN, January 2000]

colic-crying-baby-1The Christmas season has come and gone once again.  Memories have been made.  Good times have been shared.  And families have come together.  But alas, it’s time to pack away the decorations and lights.  Put away the Christmas CD’s, and eat that last Christmas cookie.  And as you hum the tunes of popular carols, and “Silent Night” comes to the forefront,  it might be surprising for you to realize that on average the parents of nearly 25% of our newborn population aren’t experiencing such a “silent night.”  Not during Christmas; not during anytime of the year for that matter.  Their babies are suffering from a frustrating condition of persistent crying many parents are well aware of — a condition known as colic.

And it is just as frustrating for our doctors:  the condition is poorly understood, and the treatments available when we turn to the medicine chest have been shown in studies to be no better than placebos or to have serious side-effects.  And while the condition is usually described as “self-limiting,” spontaneously disappearing on its own in about 3 months, one study found that only half of all cases followed such a course.  The rest lasted up to 6 months, with 12% persisting even longer into the 6-12 month range.  And even, if we do shrug it off as a “phase,” it is an extremely difficult one for parents to cope with.  Studies conclude that these troublesome and screaming infants are in a high-risk group for development of negative mother-child relationships, and even worse, damage to the central nervous system and possibly death from Shaken Infant Syndrome.

Well, we can all breathe a sigh of relief and maybe some of the parents out there can begin to get some rest, for our Danish friends have given us one last Christmas gift to open up this year — and the exciting part is that you can be bearer of this vital information for the parents that are probably too tired to read this article.

colic-jmptDanish researchers were able to scientifically show what numerous preliminary studies and parents of infants who have undergone chiropractic care have testified all along:  chiropractic care can soothe a colicky baby.  Or more precisely, in the words of this Danish study [recently  published in the Journal of Manipulative and Physiological Therapeutics (22:8) entitled “The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic:  A Randomized Controlled Trial with a Blinded Observer,”] “Spinal manipulation has a positive short-term effect on infantile colic.” What this study had that the others lacked in the past was a control group.  With this key aspect, the researchers were able to assess whether or not chiropractic treatments for infantile colic were significantly better than a placebo.

colic-chiro-vs-placeboThe Danish National Health Service recruited 50 infants meeting the criteria for colic.  Twenty-five were given a course of chiropractic manipulations (adjustments), while the other 25 were given a medication still prescribed for colic, dimethicone — a drug, which despite its use for this condition, has been shown in several well-designed studies to be no better than placebo treatment.  So, in other words, the study was Chiropractic vs. Placebo for the treatment of colic.

Over the two-week treatment period, the chiropractic group received three to five manipulations (adjustments) of light, finger-tip pressure to restricted vertebral segments in the infants’ spines, while the placebo/drug group was administered dimethicone daily per the Danish PDR.  To help track the results, parents were required to keep a colic diary recording, among other things, the number of crying hours.  In addition, nurses visited the families weekly to administer an “infantile colic behavior profile.”

colic-sleeping-baby-2The results, needless to say, were very promising.  As  early as the first three days into the trial, the group treated with chiropractic adjustments had reduced their average number of daily crying hours from 3.9 to 2.3!  By day seven, the number of crying hours was down to 1.5, and reduced even further on the last day of measurement, day 11,  to only 1.2 hours of crying per day.  A total reduction of 2.7 hours per day!

The drug/placebo group, in contrast, was only able to reduce the total number of crying hours per day by 1 hour — a number that is gcolic-crying-baby-2enerous at best.  For if one closely examines the data, he will note that while 100% of the chiropractic group followed through with the trial, 28%  of the drug/placebo group dropped out because their child’s condition had genuinely “worsened” or “greatly worsened” after taking the drugs and therefore were not able to be included in the final results.  In the discussion portion of the study, the authors addressed this:  “By excluding data from the dropouts, we are excluding more severe cases from the dimethicone group, and this has the effect of making that group appear better than it actually was….despite this [bias that was introduced] the manipulation group did significantly better.”

colic-calendarThe findings of this study are awesome!  As one editorialist so aptly challenged his readers, “Show me one parent who wouldn’t be thrilled to reduce their child’s daily crying by 2.7 hours per day!”  I agree!  The results and the caliber of this study are very validating to what we chiropractors have been seeing in our practices for the past 100 years.  And while more research needs to be done to tack down the exact physiology behind infantile colic, it appears we finally have a treatment that has passed the rigors of the scientific method.  The same editorialist smugly pointed out that this study “gives [chiropractic’s] honest critics something to chew on and the others something to choke on.”

“But why did the chiropractic treatments only show a short term effect?” you may be asking.  The honest answer to this question is that the study only looked at a short term treatment period.  The authors explained that they would have liked a longer trial, but keeping the participants in the study who still had colic, would have been very difficult and would have resulted in an “unacceptably high number of dropouts.”

Another question you may be wondering is “if the drug they used is supposedly no better than a placebo, how come it was able to reduce daily crying by one hour?”  Good question.  A couple of different issues probably play into this result.  Number one, placebos have a tendency sometimes to show small improvements.  Also recall, that the improvement of one hour was artificially inflated, because 28% of the drug group pulled out of the study due to genuine worsening in their children’s condition.  A second factor to consider, is that both groups, in addition to their assigned treatments, received counseling and advice from the nurses on breast-feeding and burping techniques, mother’s diet, and air swallowing, etc.  This advice alone could have accounted for an hour of improvement in not only the drug group, but the chiropractic group as well.

So there you have it.  Sorry you didn’t hear about it on the evening news or read about it in the headlines of the Times or PI.  This study wasn’t about the latest “wonder drug” backed by a drug company with a billion dollar advertising budget.  No, it simply was about chiropractic.  I hope you take this information and run with it.  Share it with everyone you know — including your doctors — but more importantly, share it with the parents you know that are being affected by a colicky baby RIGHT NOW.

So how is Denmark dealing with all of this?  Well, apparently, it was big news over there.  They had media coverage which brougcolic-sleeping-babyht significant numbers of infants into the offices of their doctors of chiropractic — including infants of unbiased medical doctors who, as parents, care about what works, not about the politics involved.

So as you haul your holiday boxes up to the attic, continue to hum those Christmas carols , but remember to deliver this final Christmas present, courtesy of the Danes, to a young family on your list, so that they too can truly have a “silent night.”

____________

Sources used for this article:
Chiropractic found effective for infantile colic.  Dynamic Chiropractic. 17(26). 1999.
Sportelli.  Mixed messages:  are we getting them or sending them?  Dynamic Chiropractic. 17(26). 1999.
Petersen.  Take that Murray Katz!  Dynamic Chiropractic. 17(26). 1999.
Wiberg, Nordsteen, and Nilsson.  The short-term effect of spinal manipulation in the treatment of infantile colic:  a  randomized controlled clinical trial with a blinded observer.  JMPT. 22(8). pp 517-522. 1999.
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