Lactobacillus reuteri for Colic — Not So Fast!

Probiotics have been studied for both prevention and treatment of colic. In a recent systematic review, Lactobacillus reuteri significantly reduced crying after 3 weeks in breast-fed infants (age, <3 months) with colic (NEJM JW Pediatr Adolesc Med Oct 18 2013). Notably, mothers in two of the three treatment studies analyzed were on dairy-free diets. Now, the same researchers in Australia performed a double-blind, placebo-controlled, randomized trial with the same probiotic species (L. reuteri, 10⁸ cfu/day) in 167 infants with colic (mean age, 7 weeks; 40% exclusively breast-fed).

After 1 month, 76% of participants had twice-weekly diary information necessary for analysis. Mean crying time decreased similarly in the probiotic and placebo groups (from ~170 to 80 minutes/day), but fussing time (defined as behavior that is not crying but not awake and content) remained unchanged (~150 minutes/day) in the probiotic group and decreased by ~50 minutes/day in the placebo group (a statistically significant difference in adjusted analysis). Crying time was similar between probiotic and placebo groups in both breast-fed and formula-fed infants. Measures of maternal mental health, quality of life, infant fecal microbial diversity, Escherichia coli load, and calprotectin levels also were similar in the probiotic and placebo groups. Results were similar at 6 months and no adverse effects were reported.