'Is sticking needles in babies really the best way to ease distress from colic?' the Daily Mail asks.
The question was prompted by a study that looked at whether acupuncture can help with colic in babies.
Colic is a common yet poorly understood condition that causes excessive and prolonged crying in babies. It's not serious, but can be distressing for parents.
Researchers randomly assigned 157 babies aged two to eight weeks to three treatment groups: standard care, minimal acupuncture, and acupuncture based on the principles of traditional Chinese medicine.
They found the total time spent crying was reduced by around 40 minutes a day in babies allocated to the acupuncture groups.
While this is a well-designed trial, the findings should be interpreted with some caution.
The researchers set out to compare two different forms of acupuncture, but had to combine the groups as they did not analyse enough infants to reliably detect differences.
Also, as acupuncture caused crying in more than three-quarters of the babies treated, it's questionable how useful it is as an intervention to stop excessive crying.
A larger trial would be required to confirm whether acupuncture is an effective and acceptable treatment for colic.
More traditional ways to treat colic include holding your baby during a crying episode, sitting or holding them upright during feeding to prevent them swallowing air, and avoiding too much tea, coffee and other caffeinated drinks if you're breastfeeding.
Where did the story come from?
The study was carried out by researchers from Lund University in Sweden and was funded by Ekhagastiftelsen, Family Uddenäs.
This has been covered widely by the UK media.
While the actual reporting of the study has been broadly accurate, as is so often the case some headline writers have overstated the implications of the results.
A case in point is The Daily Telegraph's headline: 'Acupuncture helps young babies stop crying'.
The Daily Mail's headline – 'Scientists split over using acupuncture to treat the condition' – is much more accurate, as it reflects the difference of opinion among independent experts.
Professor George Lewith of the University of Southampton is quoted as saying: 'This looks to me to be a good-sized, fastidious, well-conducted study … which suggests that minimal acupuncture is a reasonable and, as far as we know, safe intervention for infantile colic.'
A contrasting view is provided by Professor David Colquhoun, who is quoted as saying: 'What parent would think that sticking needles into their baby would stop it crying? The idea sounds bizarre. It is.'
What kind of research was this?
This randomised controlled trial aimed to assess two acupuncture protocols against usual care for the treatment of colic in infants.
This type of trial is the best way of assessing a specific intervention, as the random assignment of participants to groups reduces the risk of bias and means any differences seen are likely to be the result of the intervention.
And as all the babies were presumably unaware on a conscious level of the treatment they were receiving, there was a level of blinding normally lacking in acupuncture research.
What did the research involve?
The study was carried out at four child health centres in Sweden.
Parents seeking help for their baby's colic were informed of the trial and invited to participate if they met eligibility criteria.
The researchers randomly assigned infants to one of three treatments groups.
In addition to usual child healthcare, the infants received:
- standardised minimal acupuncture – based on a Western understanding of the nervous system
- semi-standardised individual acupuncture – inspired by traditional Chinese medicine, which is based on 'acupuncture points'
- no acupuncture
To be eligible for the trial, infants had to meet the following requirements:
- fulfil criteria for colic – crying for at least three hours a day at least three days a week
- aged two to eight weeks
- have healthy and appropriate weight gain
- have tried a diet excluding cow's milk protein from breastfeeding mothers or appropriate formula for at least five days
Infants were excluded if they were born preterm (earlier than 37 weeks), taking any medication, or had previously tried acupuncture.
Parents recorded their infants' fussing and crying in a daily diary at the start of the trial (baseline) and at the end of the first and second week.
At the first visit, the nurse collected informed consent and background data.
At each of the following visits, parents were asked questions about changes in crying, bowel habits and sleep patterns, and any side effects they associated with acupuncture.
Three days after completing the second week, a follow-up phone interview was carried out.
The main outcome of interest was the difference in total crying time – this is the sum of the time spent fussing, crying and colicky crying between baseline and the end of the second week.
The researchers were also interested in the number of infants in each group who continued to fulfil the criteria for colic.
The intervention was delivered by trained acupuncturists. The nurses providing assessments at the child health centres and the parents were blinded to the treatment group.
What were the basic results?
Of 157 infants randomised, a total of 147 started the intervention, and 144 completed the trial.
As the trial ended early, it was not possible for the researchers to include an adequate number of infants in each of the acupuncture groups to provide solid findings.
The acupuncture groups were therefore combined to compare the overall effects of acupuncture with no acupuncture.
While receiving either type of acupuncture, the infants:
- did not cry on 200 occasions
- cried for up to one minute on 157 occasions
- cried for more than one minute on 31 occasions
When compared with usual care alone, the total crying time at the end of week one and two was significantly lower for infants receiving acupuncture (170 versus 206 minutes a day in week one, and 137 versus 176 in week two).
However, this was no longer statistically significant at later follow-up (123 versus 164 minutes a day).
Looking at the three individual outcomes, the overall amount of time spent crying decreased significantly more in the acupuncture groups compared with usual care (40% reduction versus 22% reduction) between baseline and the end of the second week.
However, no significant difference was seen for fussing or colicky crying by the second week.
During the follow-up period, only colicky crying showed a significant difference in favour of acupuncture (92% reduction versus 65% reduction).
More infants receiving acupuncture cried less than three hours per day – and therefore no longer fulfilled criteria for colic – in the first and second week.
Looking at adverse effects, the acupuncturists reported the babies cried during more than three-quarters of the treatment sessions.
There were reports of blood in 15 out of 200 treatments. Otherwise, no adverse effects were reported.
How did the researchers interpret the results?
The researchers concluded that, 'Among those initially experiencing excessive infant crying, the majority of parents reported normal values once the infant's crying had been evaluated in a diary and a diet free of cow's milk had been introduced.
'Therefore, objective measurement of crying and exclusion of cow's milk protein are recommended as first steps to avoid unnecessary treatment.
'For those infants that continue to cry more than three hours a day, acupuncture may be an effective treatment option. The two styles of [acupuncture] tested in [the trial] had similar effects; both reduced crying in infants with colic and had no serious side effects.
'However, there is a need for further research to find the optimal needling locations, stimulation and treatment intervals.'
This randomised controlled trial aimed to compare two types of acupuncture treatment with usual care in infants with colic.
This trial has a number of strengths and limitations. It was well designed, and the researchers increased its validity by using a robust study protocol. Assessors were also blinded to treatment group.
However, the researchers did not analyse enough infants to be able to reliably detect a meaningful difference between the two different types of acupuncture, and therefore had to pool the groups.
As such, the study only looks at acupuncture in general and cannot provide information on a particular form of delivery.
It's also possible that parents who were willing to try acupuncture were not representative of all parents of children with colic.
These cases may be more severe, causing parents to try more controversial treatments.
The follow-up period was short at two weeks, and we do not know if any effects seen would be sustained without continuous treatment.
There was also an imbalance at baseline in the number of infants who were breastfed – as this is a risk factor for colic, this may have increased the risk of bias.
The researchers reported no serious side effects. But considering that this is a treatment for excessive crying, you could question the merit of a procedure that causes further crying.
As this trial was not able to look at the effects of the two different forms of acupuncture on colic, a larger trial is required to confirm whether acupuncture could be an effective and acceptable form of treatment for colic, and how it could be delivered.
If your baby has colic, there are lots of ways you can try to comfort them: you can try holding your baby during a crying episode, sitting or holding them upright during feeding to prevent them swallowing air, and avoiding drinking too much tea, coffee and other caffeinated drinks if you're breastfeeding.
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