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Thanks Dr. Kumar,

By the way I realized I mislead the list serve. It was Wessel that codified
colic with the rule of three's. 

Mea culpa,

------------------------------------
Pediatric Emergency Specialists, P.C.
Martin Herman, M.D.,FAAP,FACEP
President
[log in to unmask]
PO box 637
Ellendale TN 38029
tel: 901 405 1407
fax: 901 405 1524
mobile: 901 219 9202 
------------------------------------

-----Original Message-----
From: Rajiv Kumar [mailto:[log in to unmask]] 
Sent: Friday, February 22, 2008 10:00 AM
To: [log in to unmask]; [log in to unmask]
Subject: Re: Colic

I agree with Dr. Herman; there is no single intervention that will help with
colic.  Once one is sure that the diagnosis is colic, the goal is to educate
and empower the parents so you don't see that child again with shaken baby.
A crying baby sometimes won't stop, and the parents need to know it is okay
to lay the child supine in their crib (or other safe place away from choking
hazards) and walk away to regroup.  They need to maintain close
communication with their PMD, and it is also good to give numbers for local
support groups (available in almost all major cities/counties) so parents
can be re-assured by other parents that it does get better.  

Rajiv Kumar
Peds Resident
Loyola University Chicago


>>> Martin Herman <[log in to unmask]> 02/22/08 8:12 AM >>>
I suggest everyone on this list look up;
The Period of P.U.R.P.L.E. Crying. 
It is a culmination of the work of Ron G Barr and I thin it says a lot about
infant crying. 

Basically when you review the work of Brazelton ( normal crying in health
babies)  , Illingsworth ( probably the first to describe colic) and his
contemporary Decker ( who codified the rule of threes) you will learn that
all babies cry. 

Poole et al looked whether or not the crying infant in the ED had some
disease, and only 5% did. Typically those that did could be detected by
simple methods ( H& E, with minimal labs) . I am ware of another study
coming out soon that has verified that work. 

As for treatment, well you could tell the parents to "bay at the moon" and
probably get the same results as you do with bundling, placing on a dryer,
placing in a swing, Mylanta, donnatol, probiotics, levsin, changing
formulas, etc. Some will improve, some will not. If one techniques fails,
try another. Remember at the end of the night, the crying stops and by age
12 weeks it typically does not recur. 

Marty

------------------------------------
Pediatric Emergency Specialists, P.C.
Martin Herman, M.D.,FAAP,FACEP
President
[log in to unmask]
PO box 637
Ellendale TN 38029
tel: 901 405 1407
fax: 901 405 1524
mobile: 901 219 9202 
------------------------------------

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of John Lee
Sent: Friday, February 22, 2008 5:43 AM
To: [log in to unmask]
Subject: Re: Colic

Here is a summary from *Pediatr Clin North Am* - 01-DEC-2007:

 Savino and colleagues
[47]<http://www.mdconsult.com/das/article/body/88570744-3/jorg=journal&sourc
e=MI&sp=20186640&sid=676644115/N/620173/1.html?issn=0031-3955#r07001423047>h
ave
evaluated the effect of
*probiotics* and prebiotics on *colic*. In one trial, they compared a *
probiotic* (*Lactobacillus reuteri*) with simethicone in a randomized
controlled trial in 90 exclusively breastfed colicky infants. Simethicone, a
conventional nonprescription medication, has been previously shown to be
ineffective for *colic* treatment
[19]<http://www.mdconsult.com/das/article/body/88570744-3/jorg=journal&sourc
e=MI&sp=20186640&sid=676644115/N/620173/1.html?issn=0031-3955#r07001423019>.
After the 1-month trial, 95% of the *probiotic* treatment group responded
(no longer met Wessel criteria for *colic*) versus only 7% of the
simethicone group. The second study randomized 267 formula-fed infants to
one of two arms
[48]<http://www.mdconsult.com/das/article/body/88570744-3/jorg=journal&sourc
e=MI&sp=20186640&sid=676644115/N/620173/1.html?issn=0031-3955#r07001423048>.
The treatment group was fed a novel partially hydrolyzed whey protein
formula supplemented with prebiotic oligosaccharides and the control group
received the standard formula (without prebiotics) and simethicone. The
treatment group, after both 1 and 2 weeks, had a significant reduction in
crying episodes when compared with the control group.

With regard to the immune compromised patients, how do the European
reports define "immune compromised?"  Certainly any neonate/young infant can
be technically be defined as "immune compromised" or "immunologically
immature" but I would think giving probiotics to a healthy 6 month old is
different than a 16 year old with ALL undergoing chemotherapy and an ANC of
300.

I have never personally recommended probiotics or yogurt to parents in the
ED, but find the possibility of giving this advice intriguing, especially
when I have little else to advice these understandably beleaguered parents.

John Lee, MD

On 2/20/08, Michael Gorn <[log in to unmask]> wrote:

> Check out this recent study in Pediatrics.  There is
> some helpful info there as well.
>
>
> Francesco Savino, MD, Emanuela Pelle, MD, Elisabetta
> Palumeri, MD, Roberto Oggero, MD and Roberto Miniero,
> MD Lactobacillus reuteri (American Type Culture
> Collection Strain 55730) Versus Simethicone in the
> Treatment of Infantile Colic: A Prospective Study
> PEDIATRICS Vol. 119 No. 1 January 2007, pp. e124-e130
>
> Michael
>
>
>
>
> --- "D. Scott Moore, DO, MS" <[log in to unmask]>
> wrote:
>
> > A follow up....
> >
> >
> http://www.parenting.com/article/Pregnancy/Health/A-Natural-Colic-Cure
> >
> > Has anyone actually looked at this?  I know not
> > exactly an emergency
> > medicine topic, but I have fielded many questions at
> > night about this.  I
> > wonder how good this work is?
> >
> > Scott
> >
> > On Tue, Feb 19, 2008 at 9:54 PM, D. Scott Moore, DO,
> > MS <[log in to unmask]>
> > wrote:
> >
> > > I have a friend who has a colicky baby and was
> > trying to counsel him.
> > > Have any of you heard of research using probiotics
> > (Yogurt or Acidophilis)
> > > for treatment of colic?  He had asked me what I
> > thought about it.  Can
> > > anyone anticipate any problems giving a 6 week old
> > baby with colic a
> > > probiotic?  I wonder if a pacifier or nipple with
> > a tiny bit of yogurt on it
> > > would facilitate gut colonization with good
> > bacteria.
> > >
> > > What do all of you tell frustrated fatigued
> > parents?
> > >
> > > Scott
> > >
> > > D. Scott Moore, D.O., M.S., F.A.A.E.M.
> >
> >
> >
> >
> > --
> > D. Scott Moore, D.O., M.S., F.A.A.E.M.
> >
> > For more information, send mail to
> > [log in to unmask] with the message: info
> > PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> >
> >
> http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
> >
>
>
>
>
>
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> The URL for the PED-EM-L Web Page is:
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>



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