An infant’s persistent excessive crying is one of the most upsetting problems for new parents. Absent of other symptoms, infantile colic is a diagnosis of exclusion using Wesley’s “rule of three” criteria, meaning an infant who is well-fed and otherwise healthy cries for more than three hours per day, for more than three days per week, and for longer than three weeks. Typically, colic resolves within three months with no lasting effects. However, having an infant cry for this amount of time is extremely distressing to the parents, who fear there is something seriously wrong with their child.
Parents with colicky babies are likely to seek treatment; however, few successful treatments are available. Dietary changes, medications, and parental behavior changes are effective for some, but are not proven to be effective for all. Therefore, some parents turn toward complementary care such as massage therapy, and research on massage therapy for colic is helping them justify that decision.
Massage Versus Rocking
In one recent study, the efficacy of infant massage therapy compared to infant rocking was tested in reducing colic symptoms.1 This institutional review board (IRB)-approved study included 100 infants who met Wesley’s criteria for colic. Other subject enrollment criteria included being less than 12 weeks old and a full-term birth, as well as having no known diseases, medical treatments for colic, allergy to lactose, skin problems, limitations on receiving massage, maternal smoking, or mothers with severe anxiety.
Subjects were randomized to either the massage intervention or the rocking control group. Mothers with infants in the massage group were taught to massage their infants and were asked to complete the massage for 15–20 minutes twice a day for one week. Mothers in the control group were asked to gently rock their infants for 5–25 minutes when the symptoms of colic appeared.
In both groups, several outcomes were measured each day, including the duration of infant crying in minutes, the severity of crying using a visual analog scale, and the number of crying sessions. All mothers in both groups successfully completed the study interventions and documentation.
The baseline demographic characteristics of the infants did not differ between groups in terms of infant weight, gender, breastfeeding, or type of delivery. However, there were significant baseline differences in terms of symptoms that favored the rocking group. For example, the pre-treatment measures on the day before the start of treatment showed a difference in cry duration (4.96 hours in massage and 3 hours in rocking group), sleep duration (9.29 hours in massage and 12.24 hours in rocking group), and colic severity (more severe symptoms in massage group).
The results of this study demonstrated that there was a statistically significant difference in pre- to post-treatment outcomes in the massage group, including the change in the duration of cries (reduction of 2.8 hours of crying), duration of sleep (increase of 2.9 hours per day), number of cries (reduction of 4.08 cries per day), and colic severity (improvement of 2.41 points on a visual analog scale). The only statistically significant pre- to post-treatment difference in the rocking group was for colic severity (reduction of 0.59 points on a visual analog scale).
Between-group comparisons in this study demonstrated a greater improvement in all outcomes, favoring the rocking group, but this was interpreted with caution due to the statistically significant group difference at baseline. Baseline differences can greatly affect post-treatment outcomes due to an unfair advantage from the start of the study. These differences in baseline characteristics were considered a serious limitation in this study and the between-group outcomes were not considered valid.
Another limitation of this study was that the mothers performed the massage or rocking without assessment as to whether the treatments were consistently performed correctly. To overcome this, the authors observed the mothers’ massages three times during the week and were regularly in contact with the mothers to be sure that all questions were answered. The massage was not defined in the methods of this study, so we do not know how it was performed. However, with the regular checks by the investigators, we can assume there was a regular protocol and that consistency was encouraged.
Further limitations of this study include the lack of blinding to treatment group by the mothers. Knowing which treatment group their infants were in could have potentially affected the way the mothers reported the outcomes. Also, consistency with documentation of outcomes in a potentially busy household should be questioned. The subjective nature of treatments and outcomes in this study may have affected the final results of this study.
Massage and Lavender Oil
A similar IRB-approved study on colicky infants compared massage using lavender oil with no treatment.2 Lavender oil used due to its possible sedative, antispasmodic, and anticolic properties. This study included 40 infants with colic between 2 and 6 weeks of age and of normal birth, development, and growth. There were no differences in baseline characteristics between the groups in this study.
Treatments were again administered by the mothers of the infants. The mothers randomized to the massage group were trained to do aromatherapy massage at home. They used 1 drop of lavender oil mixed with 20 milliliters of almond oil as the lubricant, which was mixed by the researchers. At the start of a colic attack, the mothers delivered abdominal massage for 5–15 minutes. The infants in the control group did not receive any form of care.
A total of five weekly in-house visits were completed by the investigators to measure the level of colic symptoms. In addition, mothers recorded any crying that lasted for more than 15 minutes during each week. In the massage group, the number of hours of crying significantly changed from 13.28 hours per week to 6.27 hours, whereas the number of crying hours did not change in the control group, measured as 13.25 hours per week to 13.37 hours per week. This demonstrated a statistically significant difference between groups, favoring the massage group.
Again, as in the previous study, the limitations include the fact that we do not know the specific protocol for the massage intervention, although we do know that massage was specific to the infants’ abdomens and that the investigators assessed the massage treatment on a weekly basis. Another limitation similar to the previous study is that the mothers were the ones to record the crying times of their infants, but were unblinded to the treatment group, which might have led to bias in their assessments.
Overall, there seems to be a trend in positive outcomes for infantile colic massage, with some significant outcomes in the time of infant crying. This may be a viable option for parents whose infants suffer from colic. However, more studies with fewer limitations are needed before definitive results can be concluded. When treating infants in your practice, be sure to work with the infant’s physician to determine if massage would be a safe option.
Notes
1. A. Sheidaei et al., “The Effectiveness of Massage Therapy in the Treatment of Infantile Colic Symptoms: A Randomized Controlled Trial,” Medical Journal of the Islamic Republic of Iran 30 (April 9, 2016): 351.
2. B. Çetinkaya and Z. Basbakkal, “The Effectiveness of Aromatherapy Massage Using Lavender Oil as a Treatment for Infantile Colic,” International Journal of Nursing Practice 18, no. 2 (April 2012): 164–9. doi: 10.1111/j.1440-172X.2012.02015.x.
Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at jcambron@nuhs.edu.