50 Years Ago in The Journal of Pediatrics:

Article Outline

• Copyright

Breslow L. J Pediatr 1957;50:196-206

In one of the early studies of infantile colic, Breslow evaluated 90 infants with the typical features of colic, who were seen in his private practice. The goal was to evaluate the role played by hunger, feeding technique, and other factors in the cause of colic. He developed a strict protocol that involved instructions regarding feeding techniques, increasing amounts of formula, and then changes in the components of the formula to detect possible intolerance. Although one third of infants appeared to have some intolerance of carbohydrate or fat, the cause of colic could not be identified for more than 40% of the infants.

For those infants who did not respond to the changes in feedings, Breslow advocated small doses of barbiturates or atropine, drugs we now avoid because of their high likelihood of side effects. Over the past 50 years, the pediatric literature is replete with studies trying to find an effective treatment for colic. Even after several systematic reviews, no clear treatment has been identified.

In the absence of formula intolerance, Breslow had the hypothesis that “marked evidence of emotional instability on the part of the parents” may be causal in the development of infantile colic, particularly for those in the group who did not respond to formula changes. Another author, cited by Breslow, noted that colic frequently improved “by substituting a calm nurse for an agitated mother.” Of course, these comments reflect a time when it was thought that a number of unexplained conditions, such as autism, could somehow be caused by parental factors.

Fifty years after Breslow’s study, the cause and treatment of infantile colic remains elusive. However, it seems clear that parental stress is a result of their infant’s colicky behavior and not the cause of it. Given that only a small number of infants will respond to hypoallergenic formula, we now recognize the need to pay as much, if not more, attention to the emotional reactions of the parents and to provide support during these challenging early weeks of an infant’s life.