A HOLISTIC APPROACH
TO COLIC
Kamyar M. Hedayat, MD
President, Founder, Aroma MD™
Attending, Pediatric Critical Care
Center for Integrative Medicine
Advocate Lutheran Children’s Hospital
Holism and CAM
Holistic Pediatrics is an
approach to child care which
takes into account:
the child
physical disposition
personality of child
relationship to:
family
culture
society
Spirituality
Holistic pediatrics is treatment
Holism and CAM
Complementary treatments to allopathic
modalities of synthetic drugs include:
Herbalism:
Phytotherapy: whole plants or their extracts
Aromatherapy: essential oils distilled from plants
Homeopathy
Nutritional supplementation and diet
Manipulations
Massage, Craniosacral, etc.
State of Incoherence
Physicians show skepticism about CAM.[A,B]
Those who have some knowledge feel they
cannot or will not recommend to patients
CAM discussions initiated by families
Families use CAM more than we realize
Pediatricians should have familiarity with CAM,
know how and when to ask about its use
A) Wahner-Roedler DL, Vincent A, Elkin PL, Loehrer LL, Cha SS, Bauer BA. Physicians' attitudes toward complementary and alternative medicine and their knowledge of specific therapies: a survey at an academic medical center. Evid Based Complement Alternate Med. Dec 2006;3(4):495-501. B) Jean D, Cyr C. Use of complementary and alternative medicine in a general pediatric clinic. Pediatrics. Jul 2007;120(1):e138-141.
Defining Colic
DEFINTION: 3 hours per day, 3 times
a week for more than 3 weeks. [1]
INCIDENCE: 25% of all infants
experience colic; more in bottle fed
infants, less in breast fed [2]
AGE: 3 weeks and 6 months of age,
and often at the same time of day.
EXAM: legs drawn up, tense
abdomen, red face
1. Lucassen PLB, Assendelf WJJ, Gubbels JW, Van Eijk JTM, Van Geldrop WJ, Knuistingh Neven A.
Effectiveness of treatments for infantile colic: a systematic review. BMJ 1998;316:1563-9.
2. Lucas A, St James-Roberts I. Crying, fussing and colic behaviour in breast and bottle-fed infants. Early
Human Development 1998;53:9-19.
Bowel Spasm: Essential Oils
Individual EO effective
for causes of colic:
Peppermint [3]
Caraway [3]
Fennel [4]
Cardamom [5]
Chamomile [6]
Internal use of essential
oils was shown to be
safe in a clinical trial in
infants [*]
3. Micklefield G, Jung O, Greving I, May B. Effects of intraduodenal application of peppermint oil (WS(R) 1340) and caraway oil (WS(R) 1520) on gastroduodenal motility in healthy volunteers. Phototherapy Res. 2003 Feb;17(2):135-40. 4. Lis-Balchin M, Hart S. A preliminary study of the effect of essential oils on skeletal and smooth muscle in vitro. J Ethnopharmacol. 1997 Nov;58(3):183-7. 5. al-Zuhair H, el-Sayeh B, Ameen HA, al-Shoora H. Pharmacological studies of cardamom oil in animals. Pharmacol Res. 1996 Jul-Aug;34(1-2):79-82. 6. Becker B, Kuhn U, Hardewig-Budny B. Double-blind, randomized evaluation of clinical efficacy and tolerability of an apple pectin-chamomile extract in children with unspecific diarrhea. Arzneimittelforschung. 2006;56(6):387-93. *Alexandrovich I, Rakovitskaya O, Kolmo E, Sidorova T, Shushunov S. The effect of fennel (Foeniculum Vulgare) seed oil emulsion in infantile colic: a randomized, placebo-controlled study. Altern Ther Health Med. Jul-Aug
Bowel Spasm: Herbals
Herbal teas containing Roman chamomile,
fennel, and mint have improved colicky behavior
in clinical trials [7,8]
Gripe water is a type of herbal formulation, often
as an alcoholic tincture, but may be alcohol-free.
Homeopathic preparations of the same plants
are recommended. No published studies on their
efficacy or lack thereof.
7. Weizman Z, Alkrinawi S, Goldfarb D, Bitran C. Herbal teas for infantile colic. J Pediatr. 1993;123:670–671.
8. Parkin PC, Schwartz CJ,Manuel BA. Randomised controlled trial of three interventions in the management of persistent crying of infancy. Pediatrics1993;92;197-201.
Bowel Spasm: Pharma
Anti-Cholinergics: Merbentyl
effective in
relieving bowel spasm.[9]
Can have mild to life-threatening side effects:
drowsiness, diarrhea, seizures.[10]
Essential oil of cardamom has anti-cholinergic activity in
bowel [5] with no known cases of seizures or other
harmful side effects.
Simethicone
has not
been shown to be effective
for colic.[11]
9. Gruinseit F. Evaluation of the efficacy of dicyclomine hydrochloride (“Merbentyl”) syrup in the treatment of infantile colic. Curr Med Res Opin1977;5:258-61; 10. Williams J, Watkin Jones R. Dicyclomine: worrying symptoms associated with its use in some small babies. BMJ1984;288:901; 11. Metcalf TJ, Irons TG, Sher LD, Young PC. Simethicone in the treatment of infantile colic: a randomized, placebo-controlled, multicenter trial. Pediatrics1994; 94: 29-34.
Bowel Gas
Probiotics:
Lactobacillus reuteri
reduces irritability and
crying within 1 week in
over 95 % of infants
starting on probiotics.
[13]
13. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection Strain 55730) Versus Simethicone in the Treatment of Infantile Colic: A Prospective Randomized Study. Pediatrics 2007; 119(1):e124-130.
Cow’s Milk Insensitivity
Formula Change:
Cow’s milk either in
formula (i.e. Similac, Enfamil),
or
maternal dairy consumption by breast
feeding mothers, play role in colic.[12]
Hydrolyzed whey (i.e. Carnation Good Start)
Soy (i.e. ProSobee)
Pre-digested formulas (i.e. Nutramigen) help
relieve symptoms of colic.
12. Lothe L, Lindberg T, Jakobsson I. Cow's milk formula as a cause of infantile colic: a double-blind study. Pediatrics. 1982 Jul;70(1):7-10.
Hands on Approach
Some pediatricians encourage parents to ignore
their crying, colicky infant.[14]
Teach parents to interpret signs of happy vs.
disturbed infant
Facial and physical cues
Causes of distress: temperature, hunger, soiled diaper.
Counseling reduced duration of colic by 65% in
one study, but is only supportive. [15]
14. McKenzie S. Troublesome crying in infants: effect of advice to reduce stimulation. Arch Dis Child 1991;66:1416-20. 15. Dihigo SK. New strategies for the treatment of colic: modifying the parent/infant interaction. J Ped Health Care. 1998;-12(5):-256-62.
Reducing Irritability
Hold me, baby, one more time:
Kangaroo
care reduces salivary cortisol levels in infants, an
indication of relieving stress
Massage:
reduces stress levels [16-19]
Infant tummy massage can be learned in less than 5
minutes
Parental Counseling
: Nervous or angry
parents have nervous and angry children
16. Field T, Morrow C, Valdeon C, et al. Massage reduces anxiety in child and adolescent psychiatric patients. Am Acad Child Adolesc Psychiatry1992; 31:125-31; 17. Field T, Henteleff T, Hernandez-Reif M, Martinez E, Mavunda K, Kuhn C, Schanberg S. Children with asthma have improved pulmonary functions after massage therapy. J Pediatr.1998; 132(5):854-8; 18. Hernandez-Reif M, Field T, Krasnegor J, Martinez E, Schwartzman M, Mavunda K. Children with cystic fibrosis benefit from massage therapy. J Pediatr Psychol. 1999; 24(2):175-81; 19. Scafidi F, Field T, Schanberg S, et al. Massage stimulates growth in preterm infants: a replication. Infant Behav Dev
Infant Tummy Massage
Massage an
outward spiral
from umbilicus.
Repeat twice.
Massage up
from distal
hepatic flexure
to costal
margin.
Repeat twice.
Massage across
hepatic and
transverse flexure
of colon
Repeat in
succession twice.
Massage from
hepatic flexure to
sigmoid colon in
a “U”-shaped
motion.
Repeat in
succession twice.
The circle is the abdomen, middle of cross hairs umbilicus
Using Aromatherapy
Organic essential oils preferred
Can be purchased online or health store
Look for reputable brands or distributors
Physician-formulated best to use to ensure
adequate understanding of pediatric
pharmacokinetics, pharmacodynamics and
disease processes
MUST be diluted for infants, 1-3%.
Avoid peppermint in children under 2 years
of age due to dermal irritation from ketone
content (menthone)
Using Aromatherapy (cont.)
Inhalation
1-2 drops undiluted essential oil on cotton ball
Hold 3-6 inches from nose
Topical:
1-3 % dilution
1-3 drops of essential oil(s) per teaspoon of
carrier oil (jojoba, olive, almond)
Mix, apply to abdomen and chest
Medical aromatherapy blend by physician
Making Teas at Home
Bring water to near boil
Add plant material
Dry: 1 tsp
Fresh: 1 tbsp
Add 4 ounces water
Add desired sweetener
Honey
Stevia
Making Teas at Home
Steep 5-10 minutes
Cool
Ice cubes
Ice bath
Refrigerator
½-1 oz q 2 hrs prn
Store in Refrigerator
Discard after 24 hrs
infusing science with nature™
Aroma MD™ is a physician-founded medical
aromatherapy company specializing in
science-based product formulation
Aroma MD™ uses only medical-grade essential
oils, organic whenever possible
Visit us at
aromamd.net
/education for more
information on medical aromatherapy
Dr. Hedayat, founder of Aroma MD™, is available
for Aromatherapy Seminars for healthcare
providers:
askthedoc@aromamd.net
