- Email: [email protected]
Infants with colic may have had a faster delivery: a short, preliminary report
208
Journal of Manipulative and Physiological Therapeutics Volume 23 • Number 3 • March/April 2000. 0161-4754/2000/$12.00 + 0 76/1/105111 © 2000 JMPT
Infants With Colic May Have Had a Faster Delivery:A Short, PreliminaryReport
INTRODUCTION The cause of infantile colic remains unknown. Many studies have pointed to increased air in the intestines, constrictions in the intestines, levels of intestinal hormones, or the intestinal microflora as the cause, but none has convincingly identified abnormalities in infants with colic. 1-13 Other studies have hypothesized that t parental level of education, feeding patterr . . . . . allergies may be the cause of infantile colic. 2.14-27 But methodologically sound studies have shown that there is not a higher incidence of infantile colic in infants who are breast-fed compared with infants fed with cow's milk, soybased milk, or formula (Nutramigen). Similarly, feed!ng changes, overfeeding, swallowing of air, maternal allergies or infections, birth order, parental education levels, and other social demographic factors do not seem to have any major influence. 4,1°.11,17.24o28-37 However, stress and physical symptoms during pregnancy, dissatisfaction with a sexual relationship, and negative experiences during childbirth seem to be associated with an increased reporting of infantile c o l i c . 38'39 Various modes of delivery (cesarean section, vaginal extraction, or vacuum extraction) have also been studied but no differences could be identified in the incidence of colic in infants delivered by these 3 modes. 4°.41 In addition, the use of pudendal block, epidural analgesia, general anesthesia, or intravenous oxytocin do not seem to increase the risk of infantile colic. 39 For many years, chiropractors and others have manually treated infants with colic symptoms with good results. 4°-5° The background for this treatment has been the clinical observation that functional disturbances of the vertebral column may cause symptoms similar to those of infantile colic, and several studies seem to support this clinical observation.18,4~'4345,47-52 In addition to a randomized controlled trial on the effect of spinal manipulation for infantile colic, an infantile colic behavior profile was ad0ai'nistered to the mothers of infants with colic, asking them (among other things) to provide mother's
This study has been supported financially by The Danish Health Insurance Fund and the Research Committee of the Danish Chiropractors Association. doi:10;1067/mmt.2000.105111
ge, infant's birth weight, weight gain per week, gestational age at birth, duration of birth, and sex of infant. This information was gathered for the purpose of describing the infants in the randomized controlled trial as clearly as possible. All infants fulfilled strict diagnostic criteria for infantile colic .52 While working with these descriptive variles, the conclusion was drawn that the time ,~_ ___by the mothers for the duration of birth was somewhat lower compared with normal birth times.
METHODS Participants for the colic trial were recruited from April 1994 to July 1996 by home health nurses from the National Health Service in the suburb of Ballerup (Copenhagen, Denmark). The structured diagnostic interview administered by the home health nurse was also an infantile colic behavior profile, which measured the parents' subjective evaluation of the severity of the colic. In addition, this profile had a section with many descriptive background variables pertaining to the mother and the infant. In the spring of 1998, the same home health nurses were asked to administer the portion of the infantile colic behavior profile on the duration of birth to 22 mothers of infants without any signs of infantile colic in their districts.
RESULTS In the group of 45 mothers of infants with colic, 40 provided information on the time passed from the start of labor to delivery. In this group, the mean duration of the birth was 9.7 hours. In the group of 22 mothers of infants without any colic symptoms, the mean duration of the bii'th was given as 14.3 hours (Table 1). Comparing the duration of birth in these 2 groups with a 2-tailed unpaired Student t test showed that the birth process in the colic group was faster than in the noncolic group, with a statistical significance of P < .05.
DISCUSSION To the best of our knowledge, this is the first study to identify a physical variable from which infants with colic seem to differ from normal infants. However, whether this finding can be reproduced in other studies remains to be seen.
Journal of Manipulative and Physiological Therapeutics Volume 23 • Number 3 • March/April 2000
Commentary Table I. Comparison of duration of delivel 3' of children with it~mtile colic and normal children
I Children with infantile colic Normal children
No. 40 22
Durationof delivery (h)* 9.7 --. 1.4 14.3 _ 5.3
P > .05. *Values given are mean _ standard error. This study has many methodologic weaknesses. Two of the most obvious weaknesses are that data from the colic group were collected for another purpose 1 to 2 years before data for the noncolic group, and the time from the start of labor to delivery was based on the mother's recollection, which may be tainted by the experience of having an infant with colic. Therefore the results of this study should be interpreted with caution. This must only be seen as a preliminary report, the findings of which must be reproduced in prospective controlled studies, preferably based on more objective hospital records.
CONCLUSION Infants with infantile colic may have been borne through a faster and therefore more forceful delivery than other infants. More and better studies are needed to clarify this hypothesis. Jesper M.M. Wiberg, DC Hold an vej 5 2750 Ballerup Denmark Niels Nilsson, DC, MD, PhD
ACKNOWLEDGMENTS We thank Birthe Hamann and Susanne Stage, without whom this'trial would not have been possible.
REFERENCES 1. Illingworth RS. Common symptoms of disease in children. 9th ed. London: Blackwell Scientific; 1988. p. 109-10. 2. Lothe L, Ivarsson SA, Ekman R, Lindberg T. Motilin and infantile colic. A prospective study. Acta Pediatr Scand 1990;79:410-6. 3. Miller RA, Barr RG. Infantile colic, is it a gut issue? Pediatr Clin North Am 1991 ;38:1407-23. 4. Thomas DW, McGilligan K, Eisenberg LD, Lieberman HM, Rissman EM. Infantile colic and type of milk feeding. AJDC 1987;141:451-3. 5. Lehtonen L, Korvenranta H, Eerola E. Intestinal microflora in colicky and noncolicky infants: bacterial cultures and gas-liquid chromatography. J Pediatr Gastroenterol Nutr 1994; 19:310-4. 6. Miller JJ, McVeagh P, Fleet GH, Petocz P, Brand JC. Effect of yeast lactase enzyme on colic in infants fed human milk. J Pediatrics 1990;117:261-3. 7. Miller JJ, McVeagh P, Fleet GH, Petocz P, Brand JC. Breath hydrogen excretion in infants with colic. Arch Dis Child 1989;64:725-9. 8. Moore D J, Robb TA, Davidson GP. Breath hydrogen response to milk containing lactose in colicky and noncolicky infants. J Pediatr 1988;113:979-84. 9. Fjeldmark T, Rasmussen LB. Kolikborn kan hj~elpes: de skal have nogle bank! Vores Born 1991;3:10-2. 10. St~hlberg MR. Infantile colic: occurrence and risk factors. Eur J Pediatr 1984;143:108-11.
•
209
Wibergand Nilsson
1 I. Illingworth RS. Three months' colic. Arch Dis Child 1954; 29:165-74. 12. Jorup S. Colonic hyperperistalsis in neurolabile infants. Stockholm: Thule Trykkeri; 1952. 13. Klug BH. Behandling af spaedbarnskolik--en kritisk kommentar. M~nedsskr Prakt Laegegern 1991;Apr:275-6. 14. Adams LM, Davidson M. Present concepts of infant colic. Pediatr Ann 1987; 16:817-20. 15. Carey WB. Colic: exasperating but fascinating and gratifying. Pediatrics 1989;84:568-9. 16. Colon AR, DiPalma JS. Colic, see comments. Am Fam Physician 1989;40:122-4. 17. Forsyth BW, Leventhal JM, McCarthy PL. Mother's perceptions of problems of feeding and crying behaviors. A prospective study. Am J Dis Child 1985; 139:269-72. 18. Hewson P, Oberklaid F, Menahem S. Infant colic, distress, and crying. Clin Pediatr 1987;26:69-76. 19. Karofsky PS. Infantile colic. J Fam Pract 1984;19:107-16. 20. Krasilnikoff PA. Kiropraktorbehandling af sp~edbarnskolik chirpractor treatment of infantile colic. Ugeskr Laeger 1988; 150:1823-4. 21. Larsen J-H. Infant's colic and belly massage. Practitioner 1990;234:396-7. 22. Larson K, Ayllon T. The effects of contingent music and differential reinforcement on infantile colic. Behav Res Ther 1990;28:119-25. 23. LeBlanc MH. Soy formula doesn't help colic. Pediatrics 1983 ;71:299-300. 24. Taubman B. Parental counseling compared with elimination of cow's milk or soymilk protein for the treatment of infantile colic syndrome: a randomized trail. Pediatrics 1988;81:756-61. 25. Wessel M, Cobb J, Jackson E, et al. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics 1954; 14:421-34. 26. Woodham C. The mystery behind colic. Community Outlook 1990;Apr: 19-22. 27. Woolridge MW, Fisher C. Colic overfeeding and symptoms of lactose malabsorption in the breast-fed baby: a possible artifact of feed management. Lancet 1988;13:382-4. 28. BaIT RG, Kramer MS, Pless IB, Boisjoly C, Leduc D. Feeding and temperament as determinants of early infant crying/fussing behavior. Pediatrics 1989;84:514-21. 29. Evans RW, Fergusson DM,AllardyceRA, Taylor B. Maternal diet and infantile colic in breast-fed infants. Lancet 1981; 1:1340-2. 30. Forsyth BW. Colic and the effect of changing formulas: a double-blind, multiple-crossover study. J Pediatr 1989;115:521-6. 31. Forsyth BW, Leventhal JM, McCarthy PL. Problems of early infancy, formula changes, and mother's beliefs about their infants. J Pediatr 1985; 106:1012-7. 32. Hide DW, Guyer BM. Prevalence of infantile colic. Arch Dis Child 1983;57:559-60. 33. Oggero R, Garbo G, Savino F, Mostert M. Dietary modifications versus dicyclomine hydrochloride in the treatment of severe infantile colics. Acta Pediatr 1994;83:222-5. 34. Treem WR, Hyams JS, Blankschen E, Etienne N, Paule CL, Borschel MW. Evaluation of the effect of a fiber-enriched formula on infant colic. J Pediatr 1991; 119:695-701. 35. Lykke K. Uro-og graedem0nster hos normale danske spaedborn med og uden kolik. The patterns of anxiety and crying among normal Danish infants with and without colic. Ugeskr Laeger 1990; 152:3069-72. 36. Rubin SP, Prendergast M. Infantile colic: incidence and treatment in a Norfolk community. Child Care Health Dev 1984;I0:219-26. 37. Shaver BA. Maternal personality and early adaptation as related to infantile colic. Psychological aspects of a first pregnancy. New York: Raven Press; 1974. p. 209-15. 38. Rautava P, Helenius H, Lehtonen L. Psychosoeial predisposing factors for infantile colic. BMJ 1993;307:600-4.
210
Journal of Manipulative and Physiological Therapeutics Volume 23 • Number 3 • March/April 2000
Commentary
• Wiberg and Nilsson
39. H0gdall CK, Vestermark V, Birch M, Plenov G, Toftager-Larsen K. The significance of pregnancy, delivery and postpartum factors for the development of infantile colic. J Perinat Med 1991; 19:251-7. 40. Blom L, M0holt K, Istre O, Bondesen H. F0dselsm~dens betydning for senere udvikling af spaedbarnskolik. Ugeskr Laeger 1988; 150:1847-9. 41. Buchmann J, Biilow B. Funktionelle kopfgelenkensst0rungen bei neugeborenen in zusammenhang mit lagerreaktionsverhalten und tonusasymetrie. Manuelle Medizin 1983;21:59-62. 42. Anderson GB, Mollerup AM. Spaedb0rnskolik. En undersogelse i Gudme Kommune. Bristol-Myers. Cc&Co Holstebro; 1991. 43. Biedermann H. Kinematic imbalance due to suboccipital strain in newborns. J Manual Med 1992;6:151-6. 44. Fossgreen J. Referat af mode om "manuel behandling af born." GOttingen 30 Okt.- 1 Nov. Manuelle Medicine 1992;3:47. 45. Gutmann G. Das atlas-blockierungs-syndrom des s~iuglings und des kleinkindes. Manuelle Medicine 1987;25:5-10.
46. H0gdall CK. Kolik i spaedbarnsalderen. Mdrskrft Prk Laegerning 1987;65:11-7. 47. Klougart N, Nilsson N, Jacobsen J. Infantile colic treated by chiropractors: a prospective study of 316 cases. J Manipulative Physiol Ther 1989; 12:28 I-8. 48. Munck LK, Hoffmann H, Amtoft Nielsen A. Kiropraktorbehandling af born i f0rste leve~ (incidens og henvendelsses,~rsager). Ugeskr Laeger 1988; 150:1841-4. 49. Nilsson N. Infantile colic and chiropractic. Eur J Chiropr 1985 ;33:264-5. 50. Still AT. Research and practice. Kirksville (MO):I910. 51. Moesgaard K, Rasmussen LR. Children in Danish chiropractic clinics: a descriptive questionnaire study. Eur J Chiropr 1989; 37:117-24. 52. Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-22.
Journal of Manipulative and Physiological Therapeutics Volume 23 • Number 3 • March/April 2000. 0161-4754/2000/$12.00 + 0 76/1/105111 © 2000 JMPT
Infants With Colic May Have Had a Faster Delivery:A Short, PreliminaryReport
INTRODUCTION The cause of infantile colic remains unknown. Many studies have pointed to increased air in the intestines, constrictions in the intestines, levels of intestinal hormones, or the intestinal microflora as the cause, but none has convincingly identified abnormalities in infants with colic. 1-13 Other studies have hypothesized that t parental level of education, feeding patterr . . . . . allergies may be the cause of infantile colic. 2.14-27 But methodologically sound studies have shown that there is not a higher incidence of infantile colic in infants who are breast-fed compared with infants fed with cow's milk, soybased milk, or formula (Nutramigen). Similarly, feed!ng changes, overfeeding, swallowing of air, maternal allergies or infections, birth order, parental education levels, and other social demographic factors do not seem to have any major influence. 4,1°.11,17.24o28-37 However, stress and physical symptoms during pregnancy, dissatisfaction with a sexual relationship, and negative experiences during childbirth seem to be associated with an increased reporting of infantile c o l i c . 38'39 Various modes of delivery (cesarean section, vaginal extraction, or vacuum extraction) have also been studied but no differences could be identified in the incidence of colic in infants delivered by these 3 modes. 4°.41 In addition, the use of pudendal block, epidural analgesia, general anesthesia, or intravenous oxytocin do not seem to increase the risk of infantile colic. 39 For many years, chiropractors and others have manually treated infants with colic symptoms with good results. 4°-5° The background for this treatment has been the clinical observation that functional disturbances of the vertebral column may cause symptoms similar to those of infantile colic, and several studies seem to support this clinical observation.18,4~'4345,47-52 In addition to a randomized controlled trial on the effect of spinal manipulation for infantile colic, an infantile colic behavior profile was ad0ai'nistered to the mothers of infants with colic, asking them (among other things) to provide mother's
This study has been supported financially by The Danish Health Insurance Fund and the Research Committee of the Danish Chiropractors Association. doi:10;1067/mmt.2000.105111
ge, infant's birth weight, weight gain per week, gestational age at birth, duration of birth, and sex of infant. This information was gathered for the purpose of describing the infants in the randomized controlled trial as clearly as possible. All infants fulfilled strict diagnostic criteria for infantile colic .52 While working with these descriptive variles, the conclusion was drawn that the time ,~_ ___by the mothers for the duration of birth was somewhat lower compared with normal birth times.
METHODS Participants for the colic trial were recruited from April 1994 to July 1996 by home health nurses from the National Health Service in the suburb of Ballerup (Copenhagen, Denmark). The structured diagnostic interview administered by the home health nurse was also an infantile colic behavior profile, which measured the parents' subjective evaluation of the severity of the colic. In addition, this profile had a section with many descriptive background variables pertaining to the mother and the infant. In the spring of 1998, the same home health nurses were asked to administer the portion of the infantile colic behavior profile on the duration of birth to 22 mothers of infants without any signs of infantile colic in their districts.
RESULTS In the group of 45 mothers of infants with colic, 40 provided information on the time passed from the start of labor to delivery. In this group, the mean duration of the birth was 9.7 hours. In the group of 22 mothers of infants without any colic symptoms, the mean duration of the bii'th was given as 14.3 hours (Table 1). Comparing the duration of birth in these 2 groups with a 2-tailed unpaired Student t test showed that the birth process in the colic group was faster than in the noncolic group, with a statistical significance of P < .05.
DISCUSSION To the best of our knowledge, this is the first study to identify a physical variable from which infants with colic seem to differ from normal infants. However, whether this finding can be reproduced in other studies remains to be seen.
Journal of Manipulative and Physiological Therapeutics Volume 23 • Number 3 • March/April 2000
Commentary Table I. Comparison of duration of delivel 3' of children with it~mtile colic and normal children
I Children with infantile colic Normal children
No. 40 22
Durationof delivery (h)* 9.7 --. 1.4 14.3 _ 5.3
P > .05. *Values given are mean _ standard error. This study has many methodologic weaknesses. Two of the most obvious weaknesses are that data from the colic group were collected for another purpose 1 to 2 years before data for the noncolic group, and the time from the start of labor to delivery was based on the mother's recollection, which may be tainted by the experience of having an infant with colic. Therefore the results of this study should be interpreted with caution. This must only be seen as a preliminary report, the findings of which must be reproduced in prospective controlled studies, preferably based on more objective hospital records.
CONCLUSION Infants with infantile colic may have been borne through a faster and therefore more forceful delivery than other infants. More and better studies are needed to clarify this hypothesis. Jesper M.M. Wiberg, DC Hold an vej 5 2750 Ballerup Denmark Niels Nilsson, DC, MD, PhD
ACKNOWLEDGMENTS We thank Birthe Hamann and Susanne Stage, without whom this'trial would not have been possible.
REFERENCES 1. Illingworth RS. Common symptoms of disease in children. 9th ed. London: Blackwell Scientific; 1988. p. 109-10. 2. Lothe L, Ivarsson SA, Ekman R, Lindberg T. Motilin and infantile colic. A prospective study. Acta Pediatr Scand 1990;79:410-6. 3. Miller RA, Barr RG. Infantile colic, is it a gut issue? Pediatr Clin North Am 1991 ;38:1407-23. 4. Thomas DW, McGilligan K, Eisenberg LD, Lieberman HM, Rissman EM. Infantile colic and type of milk feeding. AJDC 1987;141:451-3. 5. Lehtonen L, Korvenranta H, Eerola E. Intestinal microflora in colicky and noncolicky infants: bacterial cultures and gas-liquid chromatography. J Pediatr Gastroenterol Nutr 1994; 19:310-4. 6. Miller JJ, McVeagh P, Fleet GH, Petocz P, Brand JC. Effect of yeast lactase enzyme on colic in infants fed human milk. J Pediatrics 1990;117:261-3. 7. Miller JJ, McVeagh P, Fleet GH, Petocz P, Brand JC. Breath hydrogen excretion in infants with colic. Arch Dis Child 1989;64:725-9. 8. Moore D J, Robb TA, Davidson GP. Breath hydrogen response to milk containing lactose in colicky and noncolicky infants. J Pediatr 1988;113:979-84. 9. Fjeldmark T, Rasmussen LB. Kolikborn kan hj~elpes: de skal have nogle bank! Vores Born 1991;3:10-2. 10. St~hlberg MR. Infantile colic: occurrence and risk factors. Eur J Pediatr 1984;143:108-11.
•
209
Wibergand Nilsson
1 I. Illingworth RS. Three months' colic. Arch Dis Child 1954; 29:165-74. 12. Jorup S. Colonic hyperperistalsis in neurolabile infants. Stockholm: Thule Trykkeri; 1952. 13. Klug BH. Behandling af spaedbarnskolik--en kritisk kommentar. M~nedsskr Prakt Laegegern 1991;Apr:275-6. 14. Adams LM, Davidson M. Present concepts of infant colic. Pediatr Ann 1987; 16:817-20. 15. Carey WB. Colic: exasperating but fascinating and gratifying. Pediatrics 1989;84:568-9. 16. Colon AR, DiPalma JS. Colic, see comments. Am Fam Physician 1989;40:122-4. 17. Forsyth BW, Leventhal JM, McCarthy PL. Mother's perceptions of problems of feeding and crying behaviors. A prospective study. Am J Dis Child 1985; 139:269-72. 18. Hewson P, Oberklaid F, Menahem S. Infant colic, distress, and crying. Clin Pediatr 1987;26:69-76. 19. Karofsky PS. Infantile colic. J Fam Pract 1984;19:107-16. 20. Krasilnikoff PA. Kiropraktorbehandling af sp~edbarnskolik chirpractor treatment of infantile colic. Ugeskr Laeger 1988; 150:1823-4. 21. Larsen J-H. Infant's colic and belly massage. Practitioner 1990;234:396-7. 22. Larson K, Ayllon T. The effects of contingent music and differential reinforcement on infantile colic. Behav Res Ther 1990;28:119-25. 23. LeBlanc MH. Soy formula doesn't help colic. Pediatrics 1983 ;71:299-300. 24. Taubman B. Parental counseling compared with elimination of cow's milk or soymilk protein for the treatment of infantile colic syndrome: a randomized trail. Pediatrics 1988;81:756-61. 25. Wessel M, Cobb J, Jackson E, et al. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics 1954; 14:421-34. 26. Woodham C. The mystery behind colic. Community Outlook 1990;Apr: 19-22. 27. Woolridge MW, Fisher C. Colic overfeeding and symptoms of lactose malabsorption in the breast-fed baby: a possible artifact of feed management. Lancet 1988;13:382-4. 28. BaIT RG, Kramer MS, Pless IB, Boisjoly C, Leduc D. Feeding and temperament as determinants of early infant crying/fussing behavior. Pediatrics 1989;84:514-21. 29. Evans RW, Fergusson DM,AllardyceRA, Taylor B. Maternal diet and infantile colic in breast-fed infants. Lancet 1981; 1:1340-2. 30. Forsyth BW. Colic and the effect of changing formulas: a double-blind, multiple-crossover study. J Pediatr 1989;115:521-6. 31. Forsyth BW, Leventhal JM, McCarthy PL. Problems of early infancy, formula changes, and mother's beliefs about their infants. J Pediatr 1985; 106:1012-7. 32. Hide DW, Guyer BM. Prevalence of infantile colic. Arch Dis Child 1983;57:559-60. 33. Oggero R, Garbo G, Savino F, Mostert M. Dietary modifications versus dicyclomine hydrochloride in the treatment of severe infantile colics. Acta Pediatr 1994;83:222-5. 34. Treem WR, Hyams JS, Blankschen E, Etienne N, Paule CL, Borschel MW. Evaluation of the effect of a fiber-enriched formula on infant colic. J Pediatr 1991; 119:695-701. 35. Lykke K. Uro-og graedem0nster hos normale danske spaedborn med og uden kolik. The patterns of anxiety and crying among normal Danish infants with and without colic. Ugeskr Laeger 1990; 152:3069-72. 36. Rubin SP, Prendergast M. Infantile colic: incidence and treatment in a Norfolk community. Child Care Health Dev 1984;I0:219-26. 37. Shaver BA. Maternal personality and early adaptation as related to infantile colic. Psychological aspects of a first pregnancy. New York: Raven Press; 1974. p. 209-15. 38. Rautava P, Helenius H, Lehtonen L. Psychosoeial predisposing factors for infantile colic. BMJ 1993;307:600-4.
210
Journal of Manipulative and Physiological Therapeutics Volume 23 • Number 3 • March/April 2000
Commentary
• Wiberg and Nilsson
39. H0gdall CK, Vestermark V, Birch M, Plenov G, Toftager-Larsen K. The significance of pregnancy, delivery and postpartum factors for the development of infantile colic. J Perinat Med 1991; 19:251-7. 40. Blom L, M0holt K, Istre O, Bondesen H. F0dselsm~dens betydning for senere udvikling af spaedbarnskolik. Ugeskr Laeger 1988; 150:1847-9. 41. Buchmann J, Biilow B. Funktionelle kopfgelenkensst0rungen bei neugeborenen in zusammenhang mit lagerreaktionsverhalten und tonusasymetrie. Manuelle Medizin 1983;21:59-62. 42. Anderson GB, Mollerup AM. Spaedb0rnskolik. En undersogelse i Gudme Kommune. Bristol-Myers. Cc&Co Holstebro; 1991. 43. Biedermann H. Kinematic imbalance due to suboccipital strain in newborns. J Manual Med 1992;6:151-6. 44. Fossgreen J. Referat af mode om "manuel behandling af born." GOttingen 30 Okt.- 1 Nov. Manuelle Medicine 1992;3:47. 45. Gutmann G. Das atlas-blockierungs-syndrom des s~iuglings und des kleinkindes. Manuelle Medicine 1987;25:5-10.
46. H0gdall CK. Kolik i spaedbarnsalderen. Mdrskrft Prk Laegerning 1987;65:11-7. 47. Klougart N, Nilsson N, Jacobsen J. Infantile colic treated by chiropractors: a prospective study of 316 cases. J Manipulative Physiol Ther 1989; 12:28 I-8. 48. Munck LK, Hoffmann H, Amtoft Nielsen A. Kiropraktorbehandling af born i f0rste leve~ (incidens og henvendelsses,~rsager). Ugeskr Laeger 1988; 150:1841-4. 49. Nilsson N. Infantile colic and chiropractic. Eur J Chiropr 1985 ;33:264-5. 50. Still AT. Research and practice. Kirksville (MO):I910. 51. Moesgaard K, Rasmussen LR. Children in Danish chiropractic clinics: a descriptive questionnaire study. Eur J Chiropr 1989; 37:117-24. 52. Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-22.