Understanding and Treating Colic


Parenting an infant can be totally overwhelming. One of the earliest challenge many face is learning to deal with periods of intractable crying. I often speak with sleep deprived parents when they’re looking for something — anything — to stop their baby from crying. They’ve typically been told by friends of family that their baby must have “colic” and they’ve come to the pharmacy, looking for a treatment. Colic is common, affecting up to 40% of babies in the few months of life.

While distressing, colic is a diagnosis of exclusion — that it, it is given only after other causes have been ruled out (hunger, pain, fatigue, etc.). The most common definition for colic is fussing or crying for more than 3 hours per day, more than 3 days per week, for more than 3 weeks. These criteria, first proposed by Morris Wessel in 1954, continue to be used today. However, scientific evidence to explain the cause is lacking. Ideas proposed include:

  • changes in gastrointestinal bacteria/flora
  • food allergies
  • lactose intolerance
  • excess gas in stomach
  • cramping or indigestion
  • intolerance to substances in the breast milk
  • behavioural issues secondary to parenting factors

Despite its intensity, colic resolves on its own with no interventions. By three months of age, colic has resolved in 60% of infants. By four months, it’s 90%. It sounds harmless and short-lived, but colic’s ability to induce stress in parents cannot be overstated. Parents may be angry, frustrated, depressed, exhausted, or just feel guilty, ascribing their baby’s cries to some parenting fault. Continue reading

Medication from the coffee shop? Examining caffeine for the treatment of ADHD

Is Caffeine a valid treatment for ADHD?“I don’t want to give my child any drugs or chemicals for their ADHD,” says a parent. “Instead, I’m thinking about using caffeine. Sound strategy?”

It may be dispensed by a barista and not a pharmacist, and the unit sizes may be small, medium and large, but caffeine is a chemical and also a drug, just as much as methylphenidate (Ritalin) is. Caffeine is even sold as a drug — alone and in combination with other products. But I regularly speak with consumers who are instinctively resistant to what they perceive as drug therapy — they want “natural” options. Caffeinehas been touted as a viable alternative to prescription drugs for ADHD. But is caffeine a science-based treatment option? This question is a good one to illustrate the process of applying science-based thinking to an individual patient question. Continue reading

Kicking Glucosamine to the Evidence Curb

Today’s post is from pharmacist and SBP contributor Avicenna. Here’s his bio and his prior posts.

As a community pharmacist, I’m frequently asked about over-the-counter (OTC) and natural health products (NHPs) for the treatment of different chronic conditions. This consultation can be complicated by a reluctance for consumers to seek a physician’s advice (and a diagnosis) before beginning therapy. As a partner in the health care system it’s important to give both credible, science-based advice, while ensuring a patient’s primary care physician is aware of the consultation and recommendations.

Arthritis pain is a common complaint, and I’m regularly asked about glucosamine, and sometimes chondroitin (which it is often co-packaged with). As is true for most natural products, glucosamine’s popularity is not related to persuasive clinical evidence. Rather it seems to be secondary to perceptions of efficacy, driven by personal experience, anecdotes and persuasive marketing.  However, unlike many other supplements, glucosamine has been extensively studied in clinical trials, and is at least plausible as a pain reliever for conditions affecting joint articulations, such as osteoarthritis (OA).  The evidence, unfortunately, is largely contradictory, and on balance, disappointing. Continue reading

Who’s to Blame for Drug Shortages?

Are more empty vials something to expect?
All the best effort to practice science-based medicine are for naught when the optimal treatment is unavailable. And that’s increasingly the case – even for life-threatening illnesses. Shortages of prescription drugs, including cancer drugs, seem more frequent and more significant than at any time in the past. Just recently manufacturing deficiencies at a large U.S.-based contract drug manufacturer meant that over a dozen drugs stopped being produced. This lead to extensive media coverage, speculating on the causes and implications of what seems like a growing problem. So who’s to blame? Continue reading