Effects of musculoskeletal dysfunction in excessive crying syndromes of infancy.

Abstract

Background: Excessive crying (or infant colic) is a common pain syndrome of infancy without any specific known aetiology or effective management and it is costly in both social and economic terms. Many cases result in long-term poor sleep, behavioural problems and parental stress. The biomechanical aspects of this condition lack adequate investigation despite its strong link with assisted and/or difficult births. Aims and Objectives: This research series aimed to (a) investigate the musculoskeletal health of infants with the condition of excessive crying; and (b) determine any relevance of chiropractic manual therapy in its management. Eight studies each with its’ own specific objectives investigated relevant research questions which were linked to the overall aims. Methods: The eight separate studies used the following methods: (1) demographic survey of paediatric patients attending a university-affiliated chiropractic clinic; (2) record study to determine the prevalence of side effects or adverse events in the patient group less than three years of age; (3) cohort study to substantiate sub-groups of excessively crying infants; (4) prospective observational study to develop a predictive model using likelihood ratios to forecast the presence of infant colic in a clinical population; (5) validation of a one page instrument to assess clinical outcomes against the gold standard crying diary; (6) randomised comparison trial of two types of chiropractic manual therapy for infant colic; (7) randomised controlled single blind trial to determine efficacy of blinding as well as chiropractic manual therapy in management of infant colic; and (8) case-control study to investigate long-term effects of chiropractic manual therapy into toddlerhood. Each of these studies was novel in the field and the first of its kind. Summary of Results: The studies in this thesis added to the body of knowledge through providing unique evidence for the following: (1) parents are willing to take their child to a chiropractic clinic for treatment and most often do so at the recommendation of a medical professional; (2) chiropractic manual therapy is safe for infants and young children; (3) the existence of distinctive / significantly different subgroups within excessively crying infant syndromes; and (4) chiropractic manual therapy is efficacious in the short-term for these cases as well as having durable utility, tested up to the time of toddlerhood. Conclusion: Chiropractic manual therapy was found to be an appropriate, safe and effective intervention for infant excessive crying. These findings may be clinically useful to provide an option for parents and families of afflicted infants and may lend some guidance to clinicians managing difficult cases. This research provides evidence that sub-grouping excessive crying cases may be important to improve outcomes and this may be helpful to develop inclusion/exclusion criteria in future trials. Further multidisciplinary studies are required to determine whether efficacy can be improved with the addition of cooperative care. Further studies should also focus on musculoskeletal effects of difficult births and the medically unexplained symptoms of crying and associated sleeping problems of infants that cannot be explained by any known injury.