A study to determine if the prevalence of spinal joint dysfunctions are influenced by whether or not infants suffer from infantile colic

Abstract

Wessel et al. (1954) described the most accepted definition of infantile colic as, “Unexplainable and uncontrolled crying in babies from 0 to 3 months old”. The authors qualify their definition further by stating that the crying occurs for more than 3 hours a day, more than 3 days a week, for 3 weeks or more, usually in the afternoon and evening hours. Although this definition is old, it is the most widely recognized definition to date and is still used by authors (Canivet et al. 1996; Lindberg 1999; Wiberg et al. 1999; Lindberg 2000 and Sondergaard et al. 2000).

Infantile colic is an idiopathic condition, with much debate about its aetiology and treatment (Pineyard 1992). It presents as excessive crying in an otherwise healthy infant who has a normal weight gain (Wiberg et al. 1999; Olafsdottir et al. 2001) and is one of the most frequent problems presented to paediatricians by new parents (Barr 1998). Furthermore, it is a self-limiting and benign condition with approximately 47% of cases resolving at 3 months, a further 41% resolving between 3 and 6 months, and the remaining 12% resolving between 6 and 12 months (Hide and Guyer 1982). Approximately 10 to 20% of infants under the age of three months suffer from infantile colic (Becker et al. 1998) and less than 5% of colicky infants suffer from organic diseases (Barr 1998).

The diagnosis of infantile colic is arrived at by the method of exclusion, completing a thorough history and physical examination to rule out any possible serious illness or infection that may be present (Balon 1997). Lissauer and Clayden (1997: 126) noted that there is no firm evidence that the causative mechanism of infantile colic may be attributed to intestinal, biliary or renal causes. The authors further stipulated that cow’s milk intolerance and gasto-oesphageal reflux are seldom responsible. Effective treatment and management of infantile colic is necessary as the difficulties associated with inconsolable crying may persist and although infantile colic is not detrimental to an infant's health, it places tremendous stress on the family (Balon 1997). Moderate to severe cases of infantile colic, as stated by Lund et al. (1998), may involve uncontrollable crying for many hours during day and night, every day. The authors noted that it is destructive to infant and family, as there is a risk that the condition may negatively affect the mother-child bond after three months (Becker et al. 1998) and result in the infant sustaining non-accidental injury (Lissauer and Clayden 1997: 126). In view of the fact that infantile colic responded favourably to spinal manipulation, Wiberg et al. (1999) suggested that the discomfort and colicky symptoms of infantile colic might have a musculoskeletal origin rather than the assumed yet unproven gastrointestinal origin. This hypothesis is supported by the effective treatment response observed in spinal manipulative studies on infantile colic (Wiberg et al. 1999). It leads to the suggestion that either spinal manipulation may be useful in treating visceral disorders, as spinal manipulation has been postulated to cause somatovisceral spinal reflexes (Gatterman 1990: 204), or that infantile colic may be a musculoskeletal disorder, which may explain why spinal manipulation is effective in treating infantile colic.

The motion palpation of infants’ spines remains controversial (Volkening 2000). Extensive literature searches have not revealed studies that have ascertained if spinal joint dysfunctions are responsible for the colicky symptoms. The observed clinical improvement (which was noted as a decrease in crying time of the infants) of the treatment groups has lead to the conclusion that removal of spinal joint dysfunctions may play a large part in the alleviation of symptoms of infantile colic (Klougart et al. 1989; Mercer 1999: 39; Wiberg et al. 1999).

In studies by Klougart et al. (1989), Mercer (1999:15), Wiberg et al. (1999), only infants suffering from infantile colic were included, therefore it is yet to be determined whether symptoms seen in infants suffering from infantile colic, possibly as a result of spinal joint dysfunction, also occur in healthy infants with no symptoms of infantile colic.

As mentioned by Gottlieb (1993), manual assessment of spinal joint dysfunctions in infants is well within the means of current practice in spinal manipulation and will be beneficial, as it may help to determine if there is a correlation between spinal joint dysfunctions and the prevalence of infantile colic. This study may result in more effective diagnosis and management of this benign, yet distressing condition.

The purpose of the study is to determine if the prevalence of spinal joint dysfunctions is influenced by whether or not infants suffer from infantile colic.