BACKGROUND:Infantile colic is the term used for excessive, inconsolable crying in babies during their first few months of life. It is estimated that 5-20 per cent of babies get it. Most babies grow out of colic after a few months, and it rarely lasts longer than a year. However, during those late nights and bouts of crying, few treatments are available.
Gripe water is a traditional remedy and, although the ingredients vary, fennel has been included in some formulations. Gripe water was first marketed by William Woodward, an American working in England in the 1840s. It was used to treat malaria, but Woodward noticed that when it was given to babies it had a soothing effect on them.
The original Woodward gripe water contained water, alcohol, dill oil, sodium bicarbonate (or baking soda) and sugar. In spite of its worldwide popularity, studies have not examined its effectiveness. Based on other research, the ingredient most likely to relieve colic is sugar.
Various herbs have been added by gripe-water manufacturers, particularly fennel because of its reputation for relieving colic. It is a perennial herb, and various parts of the plant are used for their anise flavour. Fennel seeds (which are actually its fruit) are used along with an oil extracted from the seeds.
EVIDENCE FROM STUDIES
Earlier this year, the first systematic review of all complementary and alternative medicines used to relieve colic found that many different therapies and remedies are commonly used. However, most have little or no evidence to support their use. Sugar water and fennel were the two remedies with the most supportive research.
The only randomised, controlled trial of fennel oil alone for colic involved more than 100 babies. The improvements seen in the fennel group were significantly better than those in the placebo group.
Two-thirds of those given fennel had their symptoms removed, compared to one-quarter of those given a placebo liquid.
Two other studies similarly compared a fennel preparation to placebo, but in both these studies fennel was part of a herbal mixture. Both studies found that the babies given the herbal remedy had significant reductions in colic episodes compared to those given the placebo.
Although these results are encouraging, the benefits cannot be directly attributed to fennel, since the babies received a number of herbs in these two studies.
PROBLEMATIC ASPECTS
Fennel’s side effects have not been carefully evaluated. Fennel oil can cause allergic reactions, which are usually seen on the skin and with breathing. One of the studies testing fennel in a herbal mixture noted that a few babies experienced constipation, sleepiness, loss of appetite or skin reactions. Great care is needed when giving babies any herbal remedy, as there is very little evidence available in this area.
RECOMMENDATIONS
Overall, little evidence is available to guide parents of babies with colic. Fennel has a small amount of research to support its use, but the studies have their limitations.
Although the precise cause of colic is not known, dietary and behavioural factors may play a role. Sensitivity or allergies to foods might be involved, which can be transmitted from breast milk or powdered milk.
Behavioural factors that have been proposed include interactions between parents and infants, the baby’s temperament and parental anxiety. Changing one of these factors at a time, and noting the colic’s intensity, frequency and duration, might help identify some of the factors contributing to an individual baby’s symptoms.
Dónal OMathúna has a PhD in pharmacy, researching herbal remedies, and an MA in bioethics, and is a Senior Lecturer in the School of Nursing, Dublin City University.