A probiotic shown to reduce colic symptoms

Compared with colicky babies who received placebo, a far larger proportion of colicky babies who were given a strain of

Lactobacillus reuteri

exhibited at least a 50% reduction in daily average crying time, according to the results of a trial conducted in Poland. In addition,

L reuteri

significantly reduced median crying times compared with placebo.   The 80 colicky infants in the study, all of whom were aged younger than 5 months and were either exclusively or mostly (>50%) breastfed, were assigned to receive either the DSM 17938 strain of

L reuteri

or placebo. Both the probiotic, which was administered at a dose of 108 colony-forming units, and the placebo were taken orally in the form of 5 drops once a day for 21 days.   At the first scheduled visit 7 days after administration of the study products began, crying time had been significantly reduced in the probiotic group compared with the placebo group, according to parental report. This effect continued not only at the scheduled visits at day 14 and 21 but also at day 28, a week after treatment had ended.

   In addition, throughout the study period, parents of infants in the probiotic group were more likely than parents of infants in the placebo group to report reduced colic severity and improved parental and family quality of life. Finally, no adverse events were associated with probiotic treatment (Szajewska H, et al.

J Pediatr

. 2013;162[2]:257-262).
  

Commentary

This is not the first study suggesting a role for probiotics in treating colic; however, this double-blind, randomized, placebo-controlled study offers the strongest evidence yet for this practice. Results on day 14 were impressive: 30 of 40 in the treatment group versus 7 of 40 controls had a 50% or more reduction in daily duration of crying. With a day 14 number needed to treat of 2, 1 baby will have this much of an improvement for every 2 who are treated.-Michael Burke, MD  

Cognitive behavioral therapy eases functional abdominal pain



Cognitive behavioral therapy is more effective than education and support in reducing pain in children with functional abdominal pain (FAP) and in coping with the pain when it occurs, a study in children with persistent FAP and their parents showed.

   The 200 children-parent dyads were divided between 2 treatment groups, each of which received 3 1-hour sessions with a trained therapist. The children, who were recruited from 2 pediatric gastrointestinal (GI) clinics, ranged from 7 to 17 years.   
In the social learning and cognitive behavioral therapy (SLCBT) group, parents and children were taught how to think about and cope with pain in ways that encouraged wellness-through relaxation and maintenance of regular activities-rather than to engage in illness behavior. In the education and support (ES) group, information on the GI system and nutrition was emphasized. In both groups, therapists covered most of the material with children and their parents jointly but also allowed time for independent consultations. Both groups received homework assignments.   A year after the interventions, investigators assessed child symptoms and pain coping via mailed-in written responses (for parents) and by phone (for children), using standard instruments such as the Children’s Somatization Inventory and Functional Disability Inventory. (These assessments also were made 1 week and 3 and 6 months after treatment.)   Compared with children in the ES group, children in the SLCBT group reported larger 12-month follow-up decreases in GI symptom severity and greater improvements in pain-coping responses. Parental responses also supported the efficacy of SLCBT over ES: Parents in the SLCBT group reported greater decreases in solicitous responses (reacting to child’s pain behaviors with sympathy, attention, discouragement of activity, and relief from responsibility) and greater decreases in maladaptive beliefs about their child’s pain seriousness and coping ability (Levy RL, et al.

JAMA Pediatr

. 2013:167[2]:178-184).  

Commentary

You can find the full text of this article and a helpful patient handout in

JAMA Pediatrics

, the recently renamed

Archives of Pediatrics and Adolescent Medicine

. The crux of the training described is teaching patients and their parents how to manage pain while teaching parents how to respond to their children’s complaints. The approach is simple and often effective. -Michael Burke, MD

How accurate is POC ultrasonography for diagnosing pneumonia? 

A study in 200 children from 2 urban emergency departments undergoing chest radiography for suspected community-acquired pneumonia demonstrated that point-of-care (POC) ultrasonography also can diagnose pneumonia-rapidly and with high sensitivity and even higher specificity.   Enrolled patients (median age, 3 years) had a routine clinical examination, with pediatric emergency physicians documenting their overall clinical impression and pretest probability for pneumonia. The same physicians then performed POC ultrasonography-in a mean time of 7 minutes. Patients were classified as positive or negative for pneumonia on the basis of the presence or absence of lung consolidation with sonographic air bronchograms. These results were compared with the reference standard for pneumonia, the attending pediatric radiologist’s reading of the initial chest radiograph (posteroanterior and lateral views).   Almost one-quarter (24.5%) of patients were identified as having pneumonia by ultrasonography, yielding an overall sensitivity of 86% and specificity of 89%. When patients with ultrasound evidence of consolidation of less than 1 cm in diameter were excluded from analysis, ultrasound had a sensitivity of 86% and specificity of 97%. Data also indicated that ultrasonography is more accurate for diagnosing pneumonia than overall clinical impression, auscultation, and presence of tachypnea  (Shah VP, et al.

JAMA Pediatr

. 2013;167[2]:119-125).  

Commentary

Watch for more use of POC ultrasound in emergency departments and other settings in which an expanding group of nonradiologists are using the technology for a wide variety of diagnostic maneuvers. -Michael Burke, MD