Normal Limits

"Chance is the very guide of life"

"In practical medicine the facts are far too few for them to enter into the calculus of probabilities... in applied medicine we are always concerned with the individual" -- S. D. Poisson

November 13, 2005

NYT - For City Kept Sleepless by Colic, No End to Cures in Melting Pot

NYT's Nina Bernstein:
...in this city where 6 of 10 babies have at least one foreign-born parent and pediatricians come from every corner of the world, a cornucopia of colic cures serves as a kind of Rorschach test of child-rearing culture in migration.

The most recent review of infantile colic I could locate, in an article in The Journal of Pediatrics by Michelle Garrison and Dimitri Christakis, concludes:
Four of the interventions studied had data of adequate quality and statistically significant numbers needed to treat (NNT): hypoallergenic diet (NNT = 6), soy formula (NNT = 2), reduced stimulation (NNT = 2), and herbal tea (NNT = 3).

Notably reduced stimulation was found in a 1991 article in the Archives of Disease in Childhood. The full text is NA online but from the review:
In 1 RCT, 93% of infants whose parents were advised to reduce stimulation improved, as opposed to 50% of those in the control group (RR 5 1.87; 95% CI 5 1.04�3.34).

There are several methodological issues that Garrison and Christakis identified:
First, the case definition of colic was highly subjective, which may have led to inclusion of infants with considerably milder symptoms ... Second, parental diaries as a means of assessing treatment benefits are inherently more subjective than the unbiased assessments by study investigators used in some trials. Third, as a behavioral trial, the study was not double-blinded.

This runs contrary to Dr. Karp's suggestion of LOUD SHUSHING to simulate blood flow in the abdominal aorta in utero. I wish someone would perform a RCT on the effectiveness of Dr. Karp's 5 S's.

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