The long crying spasms of colic can be exhausting for parents and babies alike. Because babies with colic have been shown in some studies to have fewer species of beneficial bacteria in their intestines, researchers in Turin, Italy wondered whether giving babies probiotics (beneficial bacteria) might help solve the colic. Ninety breast-fed colicky babies were randomly assigned to get either the probiotic L. reuteri  (0.8 billion cfu per day) or another colic remedy, simethicone (60 mg per day). The breastfeeding moms avoided cow’s milk in their own diets to reduce complicating factors. They recorded the total minutes of crying each day.

At the start, the babies in both groups averaged a parent-exasperating 197 minutes a day of crying spasms.  They were rechecked 7, 14, 21, and 28 days after starting their remedy. By day 7, those who were getting the probiotics were crying and average of 38 minutes less than they were before, about twice the improvement seen with the other remedy. At each check-up, those given the probiotics fared better. The colic had resolved for 95 percent of those receiving probiotics and for only 7 percent of those receiving simethicone.

The results are consistent with what you might expect based on the The Colic Bacteria I discussed yesterday. But other studies showing benefit from probiotics for other conditions, a dose of 5 billion to 10 billion cfu is often used in young children. Perhaps the relatively low dose used in this study is a reason that the benefit was small at first and slow to take hold.

More science in this area is needed to confirm whether this is a good way to relieve colic, and if so, what is the best strain of probiotics and the best dose. But it is clear that the health of the ecosystem in our gut is intimately linked to our own health, in ways we are just beginning to understand.

Savino F, Pelle E, Palumeri E, Oggero R, and 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;e124-e130.

In the modern United Kingdom, about 12 percent of all normal, healthy, full-term babies are hospitalized at least once in their first 8 months of life. Many of these hospitalizations are for pneumonia, bronchiolitis, or other chest infections; many are for diarrhea or other gastroenteritis.  How big a difference might breastfeeding make in preventing these kids from being hospitalized?

The results of a huge study of almost 16,000 babies were published in the April 2007 Pediatrics. Researchers from Oxford and University College London looked at the outcomes of babies who were exclusively breastfed for 8 month, those who were exclusively formula-fed for the same period, and those who received a combination. After accounting for other factors,* the investigators calculated that exclusive breastfeeding could prevent more than 50 percent of all diarrhea and gastroenteritis hospitalizations each month! Even breastfeeding just partially could prevent more than 30 percent of them. Similarly, exclusive breastfeeding could prevent 27 percent of pneumonia and chest infection hospitalizations each month; partial breastfeeding could prevent 25 percent of them. The effect disappeared soon after the child was weaned.

What a gift when babies can breastfeed at least some throughout their entire first year! Even if they can’t, I’m very happy for every month they get.

*The profound effect of breastfeeding held up after researchers accounted for many other variables including birth weight, gestation, mode of delivery, infant’s age in months, infant’s gender, maternal age, whether the infant was firstborn, maternal smoking, maternal socioeconomic class, maternal occupation, maternal education, maternal marital status, and whether the infant lives in a rented accommodation.

How about a fresh approach? What if simply giving probiotics to babies would dramatically reduce the vexing symptoms of colic? What if the crying and distress of colic were related to the mix of bacteria in babies’ guts?

Researchers at Regina Margherita Children Hospital in Turin, Italy decided to find out. They recruited 90 healthy, breastfed babies who had been crying for more than 3 hours a day for more than 3 days a week. Half of the babies were given 5 drops a day of beneficial gut bacteria (the probiotic L. reuteri) for 28 days; the other half got 15 drops twice a day of simethicone, one of the most commonly used colic treatments. All of the moms were asked to  follow a cow’s milk free diet.

The dramatic results appear in the January 2007 Pediatrics. An impressive 95 percent of the probiotic  babies responded, compared to only 7 percent of the simethicone babies. By the  end of the first week of the study, average daily crying time had decreased 38  minutes for the probiotic group and 20 minutes for the simethicone group. By 28  days, the average daily crying had decreased by 2 hours and 26 minutes in the  probiotic group and by only 52 minutes in the simethicone group.

Clearly, more  research is needed into this approach to colic treatment, but the preliminary  research is already very exciting. It seems wise to me to nurture healthy  bacteria in babies. Simple steps include, where possible, probiotics for  Mom, vaginal birth, immediate close contact with the mother, exclusive breastfeeding, and avoiding things that can kill the beneficial bacteria (such as unnecessary antibiotics or chlorine).

he medicinal use of cocoa to treat childhood diarrhea and other intestinal problems was common among the Mayans and Aztecs. Europeans began writing about this in the mid 1500s, but the practice is probably far older. Now, 21st century research published in the October 2005 Journal of Nutrition suggests a scientific basis for this ancient traditional remedy. Globally, diarrhea and dehydrationare a huge problem. About 2.5 million children die from diarrhea each year, mostly in the developing world.

In some types of diarrhea (such as some caused by E. coli and cholera), the intestines actively secrete fluids into the loose stools, leading to watery diarrhea with dangerous fluid losses. A protein called CFTR regulates this fluid secretion in the intestines. So far, no drugs are available that target CFTR during diarrhea.

But chocolate can! For over a year, researchers at the Children’s Hospital Oakland Research Institute and at the Institute for Biochemistry and Molecular Biology in Dorf, Germany have investigated the effects of cocoa (and of cocoa-based flavenoids) on CFTR. They found that these flavenoids target CFTR, and can help turn down this fluid-faucet. This discovery could lead to effective, inexpensive, natural medicines with few side effects – but that could have a major impact on children.s health around the world. This would take years. Meanwhile, the ancient dietary treatment of childhood diarrhea has a scientific basis. Normal cocoa consumption, in foods or drinks, has enough of these flavenoids to reduce salt and water losses in diarrhea.

Dr. Greene’s Answer:

You can relax. In the past, Karo syrup did contain botulism spores, but hasn’t for years now. They changed to a new manufacturing process because of just those concerns — even though no botulism cases were ever proven to come from the spores in Karo syrup (unlike honey, which should not be used in babies). A lot of people heard the alerts about *Karo syrup in the 90′s, but never heard the quieter, less flashy, changed recommendations that followed, so the warnings will still circulate around the net for years to come.

I applaud your reading a variety of sources and comparing to find the truth, and am sorry for the worry this caused. All the best to you and to your baby.

*Note: Children under age 1 should not eat honey because of the risk of infant botulism. Today, corn syrups are manufactured under sanitary conditions to prevent this, but the manufacturers do not make any guarantees. Of course, neither can I. The 2009 AAP Report of the Committee on Infectious Diseases states, “Manufacturers of light and dark corn syrups cannot ensure that any given product will be free of botulism spores, but no case of infant botulism has been proven to be attributable to consumption of contaminated corn syrup”.

Pizza, macaroni, breads, crackers, cereals, and spaghetti are among many children’s favorite foods. These foods and many others can be sources of gluten (protein found in wheat, rye, and barley). When some children eat gluten-containing foods, their bodies mistake the grain protein for a foreign invader and launch an attack on the protein, damaging the lining of the intestines in the process. This condition is called celiac disease.

Although only about 1 in 2000 or 2500 people have been diagnosed with celiac disease, a study published in the June 19, 2003 issue of the New England Journal of Medicine suggests that the condition is far more common than previously thought. In this study, apparently healthy children were tested for celiac disease. How common was undiagnosed celiac? Shockingly, 1 in 99 children tested positive for celiac disease, making it quite a common condition.

Some children with celiac have severe symptoms, such as failure to thrive, vomiting, diarrhea, and muscle wasting. Many children, however, have only subtle symptoms, such as clinginess, tiredness, or irritability. Some have only skin rashes.

Because celiac disease is now known to be so common, I am in favor of testing children who have unexplained tummy or intestinal troubles, skin rashes, slow growth, or behavioral problems. Often children who have celiac disease (and their parents) have been miserable for years before the child is tested.

When the test becomes inexpensive enough, it might be wise to routinely test children for celiac disease to prevent long stretches of time before starting the celiac diet and letting the child know what it feels like to feel comfortable, healthy, and strong.

Dr. Greene’s Answer:

The peak age for gas discomfort for children is 3 to 6 weeks. The extra gas usually comes from swallowing air, which may lead to crying, which may lead to swallowing more air. In some kids it may come from something in mom’s diet (if they are nursing) or from difficulty with the formula, if they take formula.

Several things may help. The more babies are carried throughout the day, the less gas discomfort they have, especially in the evening. The gentle jostling seems to help the gas find its way out. Tummy time also helps many babies. The gentle pressure on the abdomen moves gas along when the gas has built up. Laying the baby on his back and bicycling the legs can help, as can sitting in a little warm water. Try getting caffeine and caffeine-like products (including chocolate) out of your diet if you breastfeed; this helps for most babies. And for some babies, getting nuts or dairy out of your diet would help.

Simethicone drops are safe and gentle. The studies about their effectiveness are plus/minus, but many moms report that they work great for their babies. Scientific evidence supporting it’s use is unconvincing.

Dr. Greene’s Answer:

GERD stands for Gastroesophageal Reflux Disease. Normally, when we eat, food passes from our mouths to our stomachs through a tube called the esophagus. When food or acid in the stomach travels back up the esophagus, the process is called gastroesphageal reflux.

Many people have some degree of reflux. You may have experienced the feeling of heartburn after a large meal. When reflux occurs on occasion, it typically does not cause any problems. However, when it occurs frequently, it can cause damage and inflammation to the esophagus. Gastroesphageal reflux disease describes reflux that is abnormally frequent or damaging.

All newborns have a small amount of reflux. Spit up, is by definition, a reflux event. However, if the spit up is frequent or causes pain, poor feeding, poor growth, breathing problems, or damage to the esophagus, treatment is usually prescribed.

For babies with a mild degree of reflux, pediatricians may recommend nonmedical treatments such as thickened feeds or sitting the baby up at a 45-degree angle during and after feeds. Giving smaller, more frequent feedings makes good sense and is reported by many doctors and parents to have made a difference. An AR formula is an easy thing to try. Enfamil AR adds some rice without changing the number of calories kids get. It goes down thin then thickens in the stomach. Carnation Good Start, with its partially hydrolyzed proteins, has been able to show that the formula goes through the stomach quicker, but studies proving its effects n reflux are lacking.

Many children outgrow mild GERD as their stomach muscles mature. In more severe cases, babies often need medications to help control symptoms. Very rarely, surgery may be needed.

Pyloric stenosis, is far less common than GERD. It occurs when, the valve at the bottom of the stomach grows so tight, that liquid in the stomach comes shooting back up. The classic thing with pyloric stenosis is projectile vomiting, where the vomit shoots out forcefully away from the body. However, not all kids with pyloric stenosis have this (or vice versa). But the one thing most of these kids have in common is that the vomiting is progressive. It occurs more and more often over time, usually immediately after a feeding, but not necessarily after all feedings. It usually starts after 3 weeks of age, but can begin anywhere up to 5 months. It is most common in firstborns, especially firstborn boys. While nonmedical treatments have been explored in other countries, in the United States, the primary mode of treatment is surgery. When done by an experienced pediatric surgeon, the surgery is rather simple and the recovery time can be quick. Many babies are eating and feeling well enough to go home within 24 to 48 hours after surgery.

Introduction to vomiting:

It tugs at our hearts to hear our children retch, to watch them vomit, and to feel helpless to make it go away. Vomiting is intense. It grabs our attention, and it’s intended to! Vomiting is a signal that something going on in the body needs to be addressed.

What is vomiting?

Your child’s body has a relatively small number of symptoms with which to respond to an ever-changing, wide variety of invaders and irritants. Sneezing ejects the intruders from the nose, coughing from the lungs and throat, diarrhea from the intestines, and vomiting from the stomach.
Vomiting is a forceful action accomplished by a fierce downward contraction of the diaphragm along with a sudden tightening of the abdominal muscles against a relaxed upper stomach with an open sphincter, propelling the contents up and out.
Vomiting is a complex, coordinated, automatic reflex. An increase in saliva production may occur just before vomiting. Retching signals the beginning of the vomiting event.
Vomiting is orchestrated by the vomiting center of the brain. It responds to signals coming from the gastrointestinal tract (the mouth, stomach, and intestines), the bloodstream (and medicines or infections it contains), from the balancing systems in the ear (think motion sickness), and from the brain itself (including unsettling sights, smells, or even thoughts).
An amazing variety of stimuli can trigger vomiting, from migraines to kidney stones.

Who gets vomiting?

Vomiting is extremely common. Almost all children will vomit several times during their childhood. The most common situation is a child with a viral gastrointestinal infection, such as rotavirus.
Infections elsewhere in the body can also cause vomiting. Other classic situations are kids with pneumonia, ear infections, urinary tract infections, hepatitis, meningitis, or appendicitis.
Children with inborn errors of metabolism, such as PKU or galactosemia, will start vomiting at an early age.
Children with obstructions in the gastrointestinal tract often vomit. An obstruction could occur almost anywhere along the tract, but a common one in babies is pyloric stenosis.
Children with food poisoning, perhaps from E coli, staphylococcus, or Norwalk virus, are another important group who vomit.
Children with brain tumors, hydrocephalus, or other causes of increased pressure in the skull will vomit. Any child with headaches that awaken him from sleep and early morning vomiting should be evaluated.

What are the symptoms of vomiting?

Vomiting itself is the symptom. Children with persistent vomiting need to be evaluated.
Signs that a vomiting child needs to be seen right away include vomiting that lasts longer than 24 hours, changes in level of alertness, signs of dehydration, blood or bile in the vomit, or severe abdominal pain.
“Spitting up,” the gentle sloshing of stomach contents up and out of the mouth, sometimes with a burp, is an entirely different process. Some spitting up is normal for babies, and usually gets gradually better over time. Worsening spit up might be GE reflux disease, and should be discussed with your doctor.

Is vomiting contagious?

Hearing, seeing, or smelling someone else vomit will often stimulate your own vomiting center.
Some of the important causes of vomiting are contagious, but many are not.

How long does vomiting last?

Vomiting with most minor illnesses will end within 24 hours. When children vomit for longer than that it is important for them to be seen, both to assess their hydration and to diagnose the cause of the vomiting.

How is vomiting diagnosed?

The evaluation begins with a history and physical examination. Often no other tests are necessary. The work-up might involve a wide variety of tests, including blood tests, urine tests, or x-rays, depending on what problems are suspected.

How is vomiting treated?

Keeping kids hydrated is one of the initial concerns. Offer steady, small amounts of clear liquids, such as electrolyte solutions. Giving solid foods, or more than a few ounces of liquid at a time, will likely stimulate further vomiting. A child who isn’t able to keep liquid down, or appears to be getting dehydrated, needs to be seen.
The other initial concern with vomiting is to get a general idea of the cause. Most vomiting comes from mild viral illnesses. Nevertheless, if the vomiting might come from a toxic ingestion or Reye syndrome (a liver disease usually arising from children taking aspirin), or some other medical emergency, the child needs to be seen immediately.

How can vomiting be prevented?

A number of medicines are effective at preventing vomiting. Your doctor is unlikely to prescribe these because in most situations the vomiting is an important part of getting well. In some situations, however, preventing the vomiting makes life much better.

Related A-to-Z Information:

Appendicitis, Celiac Disease, Dehydration, Diarrhea, E. Coli, Ear Infection, Encephalitis, Food Poisoning, Galactosemia, Gastroesophageal Reflux, Headache, Hepatitis A, Hepatitis B, Hernia (Inguinal hernia), Hydrocephalus, Intussusception, Meningitis, Motion sickness, Norwalk Virus, Pertussis (Whooping cough), Phenylketonuria (PKU), Pneumonia, Pyelonephritis, Pyloric Stenosis, Reye Syndrome, Rotavirus, Staph (Staphylococcus aureus), Urinary Tract Infection (Cystitis)

Related concepts:

Food hypersensitivity, Oral allergy syndrome, Allergic proctocolitis

Introduction to food allergies:

Many parents of infants and toddlers are told that food allergies don’t happen that young, or that they are very rare. We’ve learned that food allergies certainly do happen and that they are common – affecting about 1 in 18 children before the 3rd birthday.

What are food allergies?

Food allergy is the name given to a variety of situations in which specific foods provoke some type of over-zealous immune response, which produces symptoms.
Because the developing immune system is quite complex and has mechanisms to protect us from what we swallow, food allergies are also complex, and can result from a variety of different mechanisms and cause a variety of symptoms.
Celiac disease is an immune response to gluten – proteins found in wheat and other grains.
Lactose intolerance is not a food allergy. A missing enzyme makes milk difficult to digest, creating gas and loose stools. And the flushed cheeks that some children get when eating citrus or tomatoes are not usually an allergy.

Who gets food allergies?

Food allergies are common, especially in the first 3 years of life. They are more common in those with a family history of food allergies, or in those with a broader allergic family history (allergy, eczema, or asthma).
Food allergies are also more common in babies who are exposed to allergic foods at an early age. About 90 percent of food allergies in babies and children are to one of 5 foods: cow’s milk, soy, eggs, peanuts, or wheat.
Most children with food allergies have an allergy to only one food, although multiple allergies are possible. A sizeable minority of those allergic to cow’s milk are also allergic to soy.

What are the symptoms of food allergies?

Food allergy can be so severe that the most trivial contact with the food causes immediate itching, tingling, and/or swelling of the lips, tongue, and throat.
A food allergy can trigger full-blown anaphylactic shock. Most life-threatening food allergies are to peanuts, nuts, shellfish, or fish.
Usually the symptoms of food allergy are much more mild. Still, babies with food allergies may well be fussier than their peers. Colic can be caused by food allergies (either to the formula or to a food in the mother’s diet).
Gastrointestinal symptoms are often the easiest to recognize. A food allergy might cause loose stools, excess gas, diarrhea, nausea, or vomiting. Infants will sometimes have streaks of blood or mucus in the stools, especially with allergies to cow’s milk. Sometimes the amount of blood is too small to see, but still enough to cause anemia. Sometimes food allergies cause constipation.
Symptoms elsewhere in the body are also common. These include hives, ear infections, stuffy noses, runny noses, watery or red eyes, wheezing, asthma flare-ups, and eczema. Sometimes eczema (or fussiness) is the only sign of a food allergy, and the eczema (or fussiness) will disappear if the offending food is eliminated.

Is food allergies contagious?

Food allergies are not traditionally contagious.

How long does food allergies last?

Most young children outgrow their food allergies. Outgrowing milk and soy allergies is common by the 1st birthday. The great majority have outgrown them by the time they are 3. Even those who still have food allergies at 3 will often outgrow them, especially if they are not exposed to the offending foods for a year or two.
Some food allergies, however, are lifelong. Allergies to peanuts, nuts, shellfish, and fish are classic examples.

How is food allergies diagnosed?

Food allergies might be diagnosed when eliminating a food improves symptoms and reintroducing the food causes the symptoms to recur.
Allergy testing can also be helpful. Skin testing and RAST testing can both be used to detect food allergies. In babies, a positive result is usually a sign of a real allergy, but a negative result doesn’t give much information either way.
In preschool kids, the opposite is true. A negative result is a good indication that a child is not allergic to the food. A positive result, however, may or may not represent an allergy.
Also, many people think that having been allergy tested once tells the whole story. Allergy testing is a snapshot in time. Allergies themselves are a moving picture. Repeat allergy testing is very helpful.

How is food allergies treated?

Eliminating the offending food is the core of treatment. This can be difficult because some foods occur as hidden ingredients in many other foods. Usually symptoms will improve greatly within 3 days of eliminating the food that causes them.
Breastfeeding is wonderful for babies with food allergies. Sometimes, however, offending foods are best removed from the mother’s diet. When a baby with a cow’s milk protein allergy is fed formula, it often needs to be a protein hydrolysate formula. Lactose-free formulas and partial hydrolysate formulas do not help with real milk allergies.
If food allergies cause wheezing or other respiratory symptoms, an allergist should be involved in the care. If necessary, parents should have access to emergency medications.

How can food allergies be prevented?

Breastfeeding can prevent many food allergies. This is especially true if the mother forgoes some of the most allergic foods (especially peanuts and perhaps milk or eggs). On a positive note, mothers who eat beneficial bacteria, as in yogurt, while pregnant and nursing may help prevent food allergies.
Delaying the introduction of solid foods until the latter part of the acceptable window may prevent some allergies. Delaying particularly allergic foods even longer can further reduce the risk of allergies.

Related A-to-Z Information:

Allergies (Allergic Rhinitis), Anemia (Low hemoglobin), Asthma, Attention Deficit Hyperactivity Disorder (ADHD), Blocked Tear Duct, Celiac Disease, Colic, Common Cold, Conjunctivitis (Pink eye), Constipation, Cough, Croup, Diaper Rash, Diarrhea, Ear Infection, Enuresis, Food Poisoning, Galactosemia, Gastroenteritis, Gastroesophageal Reflux, Giardia Lamblia, Head Banging, Headache, Hives, Otitis Media with Effusion (OME), Peanut Allergy, Poison Ivy, Oak, and Sumac, Pyloric Stenosis, Reye Syndrome, Rotavirus, Sinusitis, Vomiting, Wheezing