Spinal manipulation for infantile colic

TECHNOLOGY NAME: Spinal manipulation for infant colic DISEASE/CONDITION: Colic in infants is characterized by excessive and inconsolable crying that appears between the second and sixth weeks of life. Despite being a common occurrence, colic remains a medical enigma. The causes are unknown and despite significant research, a “cure” has not been found. There is no “gold standard” for treating infant colic. TECHNOLOGY DESCRIPTION: Spinal manipulation involves quick, controlled techniques that are adapted for different ages and conditions. The force is applied by hand, suddenly rather than strongly, and moves the joint over a small range. In infants, the forces delivered are smaller than in adults and often only entail specific fingertip pressure. Spinal manipulation of infants is performed in an out-patient setting without the use of special equipment. Treatment usually involves more than one visit. THE ISSUE: Up to 17% of families seek advice regarding their infant’s crying, contributing related costs to the health care system. Frequent episodes of infant colic can cause anxiety for parents and in some cases, excessive crying may trigger physical abuse such as that seen in “shaken baby syndrome.” A number of remedies for colic have been tried, including spinal manipulation. The use of spinal manipulation in children is controversial. ASSESSMENT OBJECTIVES: The objectives of this review are to determine: whether manipulating the spine, by itself, can reduce the signs and symptoms of infantile colic if spinal manipulation is safe. METHODS: CCOHTA performed a systematic literature review to identify relevant clinical trials. Titles and abstracts were screened and eligibility criteria were applied. The criteria for inclusion focused on study design, participants, interventions, safety and measured outcomes. We evaluated the potential exaggeration of results from trial reports by applying Jadad’s scale and assessing if the randomization sequence was adequately concealed from investigators. An intention-to-treat analysis also helped in understanding the strength of findings. CONCLUSIONS: There is no convincing evidence that spinal manipulation alone can affect the duration of infantile colic symptoms. The effect of spinal manipulation on sleep time, parental anxiety, quality of life and number of colic diagnoses could not be determined using available evidence. The potential harm from the spinal manipulation of infants with colic could not be determined using the evidence available from controlled trials.