Cry Babies: A Framework For Chiropractic Care

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   Clinical Chiropractic 2007 (Dec); 10 (3): 139–146 ~ FULL TEXT

Joyce Miller

Anglo-European College of Chiropractic,
University of Bournemouth,
13-15 Parkwood Road, Bournemouth, Dorset BH5 1JL,
United Kingdom

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With 21% of parents taking their excessively crying infant to a healthcare professional, chiropractors are often selected to treat these infants. The personal, family and social costs of this crying syndrome are high, yet there is no agreed treatment protocol. A large number of studies have been aimed at providing useful interventions, but no ‘‘cure’’ has been demonstrated. With some evidential backing, chiropractors are well-placed to provide therapy for this syndrome. A seven-step process of thorough history (including ante-natal and natal factors), administration of depression index to the mother, examination of the infant to rule out illness, differential diagnosis, specific treatment plan for specific disorders, therapeutic trial and reassurance to the parents provides a rational framework for appropriate chiropractic care of this enigmatic and problematic condition.

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From the FULL TEXT Article

Introduction

A remarkable number of infants suffering from excessive and unexplained crying are brought to healthcare professionals. It is the most common presentation to paediatricians in the first 16 weeks of life and a recent prospective study of 483 infants shows that 19.1% are afflicted with a crying syndrome. [1] Despite the most conscientious efforts to console the child, concerns that the child is experiencing pain drive the parents to seek help. Many parents choose alternative/complementary approaches including chiropractic care after initial presentation to their GP or paediatrician. [2, 3] It is the inexplicable nature and persistence of the crying that makes everyone uncomfortable, even the doctor who is asked to ‘‘cure’’ the child of his/her ailments. Morris reported in 2001 that the annual medical costs to the National Health Service (NHS) in the UK for treating crying babies are substantial (£65 million) [4] and that this cost does not account for additional expenditures linked to over-the-counter medication and multiple alternative therapies sought by parents for their child. Further, costs of lost work and lost sleep additionally create a huge social burden. The excessively crying baby is an enigmatic problem, driving 21% of families in the UK to seek care. [4] However, the evidence-base concerning possible interventions (Table 1) offers little help for the condition. [5–8]

Not only is this condition stressful for the parent and linked to post-natal depression, [9, 10, 20, 21] but also potentially puts the child at risk, being the leading cause of Shaken Baby Syndrome. [11–13] A number of other risks for the irritable infant have been identified (Table 2). [14, 15] Clinicians are trained to help and support patients and are expected to ‘‘do something’’ to offer relief. At a minimum, realistic reassurance must be given; at best, clinicians are called upon to provide interventions or management plans that result in elimination or at least reduction of symptomatology. In this context, it is frustrating for all concerned when clear answers and reassurance supported by robust evidence are not available. At the Anglo-European College of Chiropractic, a majority (63%) of children who presented at the teaching clinic (out of approximately 5000 infant paediatric visits annually) suffer from unexplained crying (Fig. 1). To address this common presentation, a framework of conservative care was developed in the college teaching clinic (Table 3) and is described as possible aid to the clinician who cares for infants with this problem.

Defining the problem

Traditionally, the persistently crying infant has been diagnosed with ‘‘infant colic.’’ Wessel, in 1954, defined infant colic as ‘‘bouts of crying amounting to more than 3 h a day for more than 3 days a week for more than 3 weeks.’’ [16] Although useful for research purposes, this is not a very practical definition when faced with a distressed parent. Few parents will actually wait three weeks before consulting a clinician. Further, the diagnosis of colic implies a gastro-intestinal (GI) disorder; however, these infants seldom have signs of any specific clinical condition pertaining to GI dysfunction that could cause ‘‘colic.’’ Given the relative absence of any gut spasm, it is possible that the diagnosis of colic remains only a category within which the crying infant may be conveniently, though incorrectly, placed. [17, 18] Perhaps this term should be abandoned. To more accurately describe this syndrome, we have labelled it Infant Fuss-Cry-Irritability with Sleep Disorder Syndrome (IFCIDS). Table 4 describes the common characteristics of the irritable infant syndrome. This term (IFCIDS) is merely descriptive at this point as we are not able to say conclusively why it occurs, nor can we predict when it will occur. A complaint of excessive crying is accepted by the clinician if the parent experiences it as such. This is clinically appropriate because it has been found that when parents say their child cries excessively, in fact, they do. [19] Parents spend considerable time and energy trying to soothe their baby. Parents who cannot console their child may feel inadequate and/or may become depressed over time, [9, 10, 20, 21] possibly exacerbating the problem for both the child and parent. The clinician should strive to understand and validate both child and parent and work to alleviate fear and distress in the family as deterioration of the family situation is common with persistent crying, even as long as two years later. [1] In this context, administration of the Edinburgh postnatal depression survey (EPDS) is recommended for use by all clinicians who encounter distressed mothers of paediatric patients. [22]

Role of the chiropractor

The chiropractor is well-placed to assist the parent and infant in identifying contributing factors and controlling the problem. Although the evidence is inconclusive that chiropractic care is beneficial in the treatment of infant colic, several studies document less crying time for infants treated by a chiropractor. [23–28] Listening to the parents’ concerns and reassurance that the child is healthy and thriving may also be useful, although not curative. Generally, the most effective help for the parents is from a supportive healthcare professional [29] and the chiropractor is in a position to provide that support.

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