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Contents lists available at ScienceDirect j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / m e h y Gardar GudmundssonPrivate Praxis, Kjalarland 30, Neurosurgeon, Reykjavik, Iceland The hypothesis states that infantile colic is a pain syndrome and the excessive crying leads to aerophagia and abdominal discomfort. The pain comes from sucking the bottle or the nipple. Feeding for the infant is a heavy workload for the masticatory muscles.
The tiny digastricus muscle moves the hyoid bone, takes part in opening the mouth and retrusion of the mandible and assists in mowing the tongue upward, forward and backwards. In the adult population painfrom this muscle is well documented. The hypothesis explains the crying as being due to muscular pain atfirst, later on pain from the origins and insertions of the muscle. Then with increased muscular strengthand development the pain fades away.
Ó 2010 Elsevier Ltd. All rights reserved.
first 4 months of age, was an important stimulus for shaken babysyndrome [4].
Infantile colic was first described in 1894 and still today we This hypothesis is not the first suggestion that infantile colic have no agreement on the exact cause. The ‘‘rule of three” from may be a pain syndrome. In an article from 1989 by Geertsma 1954 is generally accepted as a definition of infantile colic: crying and Hyams, called: Colic—a pain syndrome of infancy? this idea is more than 3 h per day, for more than 3 days per week, and for more put forward. They state that: ‘‘a closer look at the methodology of than 3 weeks in an infant that is well-fed and otherwise healthy colic studies along with our preliminary results suggest there may [1]. The exact etiology of infantile colic is not well understood be at least two different patterns of disturbing infant crying. It is and may of course be multifactorial. The gastrointestinal tract possible that one is associated with true pain and the other not” [5].
has been suspected by many as harboring the cause and every par- In: ‘‘Infant colic and feeding difficulties” the authors find that the ent of a colic infant focuses on the distended abdomen and the colic group displayed more difficulties with feeding than other in- obvious abdominal discomfort the infant is showing and many fants. There was: ‘‘disorganized feeding behaviours, less rhythmic nutritive and non-nutritive sucking, more discomfort following Other causes as food allergy, flatulence, intestinal hormone feedings, and lower responsiveness during feeding interactions”.
abnormalities, parental factors and dysregulation of the nervous They also point out that: ‘‘infants with colic are noted to show higher pitched, more turbulent cries following a feeding as indi- In a much cited article by Lucassen et al. Effectiveness of treat- ments for infantile colic: systemic review from 1998, the authors This could be symptoms of a pain syndrome. Feeding for the in- conclude that: ‘‘Infantile colic should preferably be treated by fant is directly painful and excessive crying is the obvious result advising carers to reduce stimulation and with 1 week trial of hypoallergenic formula milk” [3]. Claiming that the care and stim-ulation of the infant may work to increase the symptoms but notexcluding the possibility that the milk or milk substitute can make With a self-limiting condition many types of therapies will Feeding is a strenuous effort for the newborn infant. One can seem effective in single cases but in spite of all efforts, no accepted say that this is the only hard work they have to perform in the in- Although self-limiting and benign, infantile colic puts a heavy Sucking the bottle or the nipple is a well coordinated muscular strain on many parents and may in some instances be the underly- activity and many muscles are involved. It is not easy to show ex- ing cause of abuse. Lee et al. published in 2007 findings that pro- actly in which muscle there is most fatigue during feeding, but one vided convergent indirect evidence that crying, especially in the muscle: the digastricus, is a very thin muscle with a demanding joband is the focus of my intention.
The digastricus muscle is a small muscle located under the un- der side of the jaw. It consists of two bellies united by a single ten- 0306-9877/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.mehy.2010.07.014 Author's personal copy
G. Gudmundsson / Medical Hypotheses 75 (2010) 528–529 don which is connected to the hyoid bone. The muscle originates sorts, craniosacral therapy, Bowen Technique and others may from the posterior belly at the mastoid groove for the digastricus be giving relief for infantile colic. If the treatment involves the muscle and inserts by the anterior belly into the lower border of neck and throat area, direct effect might be gained.
the mandible. The posterior belly is innervated by the facial nerve 5. The consistence or texture of the milk formula: food allergy had and the anterior belly is innervated by the mylohyoid nerve which been evaluated as a possible cause of infantile colic. In the branches from the trigeminal nerve. This muscle assists the mylo- ‘‘Infantile colic: a review” article by Leung et al. from 2002 this hyoid and geniohyoid muscles in moving the hyoid bone and the is given some thought. They find it possible that increased per- tongue upward and forward and then upward and backward dur- meability to macromolecules could reflect an immature func- ing the process of swallowing. The digastricus muscle is therefore tion of the gastrointestinal tract and thereby be a mechanism taking part in sucking the nipple and then swallowing.
for food allergy. They refer to studies where changing from In the adult population this muscle can be the source of a very cows milk to a soy-milk formula or other milk formulas seemed to reduce crying time in infants, but they do not consider the Travell and Simons´ have described clearly the symptoms arising consistence or texture of the milk in question, but for an infant from trigger points in the digastricus muscle.
with pain during swallowing this might make a difference [2].
The trigger points in the muscle spread pain and ‘‘soreness” to neighbouring structures. Trigger points from the posterior belly can radiate up to the sternocleidomastoid muscle, the throat in frontof the muscle and sometimes onto the occiput. Trigger points in the Finding a cure for this self-limiting, benign but at times anterior belly refer pain to the four lower incisor teeth and the alve- exhausting condition will spare the infant for a painful condition olar ridge below them. Other symptoms are pain on swallowing.
Therapy is vapocoolant spray and stretch of the muscle and di- Treatment might be of 4 types, but first it must be strongly rect lidocain injection if the stretch therapy is insufficient [7].
emphasized that the vicinity of the carotid artery and the vagus In my practice as a neurosurgeon I have had some patients with nerve and other important structure demands expert knowledge what can be called ‘‘the digastricus syndrome”. Many of them have and care during the development of the best form for treatment.
professions or hobbies that make heavy demand on the mouth andthroat. Singers, waiters or other professions with heavy ‘‘vocal” de- 1. Understanding of the condition and gentle massage of the mus- cles in question might in some cases be adequate treatment.
My hypothesis is that infantile colic is a pain syndrome, rising 2. Medical treatment: pain killers or other drugs of the NSAID cat- mostly from the digastricus muscle but other muscles of the ton- egory may be useful. Topical ointment might help.
gue, floor of mouth and throat can be involved. The infants mostly 3. Manual therapy directed at the muscles and their origins and at risk are the ones with a muscle system that is not strong enough to meet the challenges of feeding. Muscle pain results. Gradually 4. Direct injections with lidocain into the muscular bellies. This of the muscles gain strength, but the origin and insertion may be course is very difficult and should only be done under ultra- painful for a considerable longer period. This is therefore a self- Interestingly, crying itself may therefore be painful! 1. Feeding for the infant is a demanding muscular effort. It has been demonstrated that during breastfeeding the infant has to [1] Roberts DM, Ostapchuk M, O´Brian JG. Infantile colic. Am Fam Physician build up negative pressure up to 98 mm Hg for 75 s prior to [2] Leung AKC, Lemay JF. Infantile colic: a review. JRSH 2004;124(4):162–6.
milk ejection. Breastfeeding is on the average 8 min and 6 times [3] Lucassen PLBJ, Assendelft WJJ, Gubbels JW, van Eijk JTM, Van Geldrop, Neven a day. Bottle feeding is of course less demanding [8].
AK. Effectiveness of treatments for infantile colic: systematic review. BMJ1998;316:1563–9.
2. Muscular pain comes from the overuse of muscle in the speak- [4] Lee CB, Barr RG, Nicole C, Wicks A. Age-related incidence of publicly reported ing population. The fact that the infant uses crying to commu- nicate its dissatisfaction must not overshadow the fact, that it [5] Geertsma MA, Hyams JS. Colic—a pain syndrome of infancy? Pediatr Clin North 3. Chiropractors claim to be able to reduce symptoms of colic with [6] Miller-Loncar C, Bigsby R, High P, Wallach M, Lester B. Infant colic and feeding spinal manipulation: In an article from 1999, Jesper et al.
difficulties. Arch Dis Child 2004;89:908–12.
[7] Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: trigger described a clinical trial where a short term spinal manipulation point manual. vol.1. Upper Half of the Body. 2nd ed. Williams and Wilkins; was significantly superior to medical treatment with Dimethicone (Dicyclomine). The spinal manipulation included [8] Ogbuanu IU, Karmaus W, Arshad SH, Kurukulaaratchy RJ, Ewart S. The effect of motion palpation of the articulations of vertebral column and breastfeeding duration on lung function at age 10 years: a prospective birthcohort study. Thorax 2008;101:543. doi: 10.1136/thx.2008.
[9] Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal 4. Searching the internet for remedies for infantile colic many manipulation in the treatment of infantile colic: a randomized controlled forms of treatment seem to be available. Massage of various clinical trial with a blinded observer. JMPT 1999;22(8):517–22.

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