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How to cite this thesis

Surname, Initial(s). (2012) Title of the thesis or dissertation. PhD. (Chemistry)/ M.Sc. (Physics)/ M.A. (Philosophy)/M.Com. (Finance) etc. [Unpublished]: University of Johannesburg. Retrieved from: https://ujcontent.uj.ac.za/vital/access/manager/Index?site_name=Research%20Output (Accessed: Date).

Perceived Effectiveness of Complementary Medicine by Mothers of Infants

with Colic in Gauteng

A dissertation submitted to the

Faculty of Health Sciences, University of Johannesburg,

as partial fulfilment for the

Master’s Degree in Technology Homoeopathy

by

Natalie Christina Di Gaspero

(Student Number: 200901633)

Supervisor:

Dr Radmila Razlog M.Tech Hom (TWR) Date

Co-supervisor:

Dr Reshma Patel M. Tech Hom (UJ) Date

i

DECLARATION

I declare that this dissertation is my own, unaided work. It is being submitted for the Degree of

Master of Technology: Homoeopathy at the University of Johannesburg, Johannesburg. It has

not been submitted before for any degree or examination in any other Technikon or University.

Natalie Christina Di Gaspero

day of 2017.

iii

ABSTRACT

Infantile colic is a self-limiting condition that is characterised by spasmodic, excessive and

inconsolable crying without apparent cause. It is defined according to Wessel’s criteria as crying

in a seemingly healthy infant that lasts for more than three hours each day, on more than three

days a week, for a period of more than three weeks. Infantile colic affects infants between the

ages of 2-16 weeks and tends to naturally resolve itself around 16 weeks of age. Infantile colic is

a common, but poorly understood condition that occurs in 10-30% of infants. Research indicates

that there may be various independent aetiologies of colic. Infantile colic is one of the most

common reasons parents take their infants to paediatric healthcare practitioners despite there

being no widely accepted conventional treatment for colic. Due to the recent growth of the

complementary medicine market in South Africa and numerous complementary medicines being

available over-the-counter, parents may turn to complementary medical treatments for their

infants’ colic. There is currently no gold standard treatment for colic and there is limited research

available on the use, safety and effectiveness of complementary medicine in infantile colic.

The aim of this study was to determine the perceived effectiveness of complementary medicine

by mothers of infants with colic in Gauteng, by means of an Infantile Colic Questionnaire.

A quantitative-descriptive design was used whereby data was collected through a randomised

cross-sectional survey to determine the perceived effectiveness of complementary medicine by

mothers of infants with colic in Gauteng. The Infantile Colic Questionnaire was completed on a

voluntary basis as a convenience sample. Participants were recruited from various baby and

health clinics, health shops, antenatal groups and nursery schools. The research sample consisted

of 150 mothers (participants), aged between 18-45 years with a child/children who

suffer/suffered from symptoms of infantile colic and use complementary medicine as a form of

treatment. The survey was completed on a voluntary basis and interested participants were given

an Information Leaflet and Consent Form. Once consent was given, participants completed the

Infantile Colic Questionnaire. All completed surveys were treated as strictly confidential, and

only the researcher, supervisor and statistician had access to the information. No identifying data

was requested or permitted on the survey. Data obtained was statistically analysed with the

assistance of Statkon through frequencies and multiple response analysis.

Majority of participants made use of both complementary medicine and conventional medicine

(73%) for their infant’s colic. The most commonly used complementary products for infantile

colic were individualised homeopathic remedies (58.6%), probiotics (46.7%) and over-the-

iv

counter herbal medicines (44.1%). Participants obtained their information regarding

complementary medicine from complementary medicine practitioners (61.8%), family and

friends (53.9%) and general practitioners (50%). Complementary medicine was chosen as a

modality for treatment due to it being perceived as safe, less harmful and with fewer or no side

effects.

It was evident that most participants weren’t familiar with the term “complementary medicine”

and were therefore confused as to which products are classified as complementary medicines.

Furthermore, for some products the distinction is vague, as the formulations contain both

complementary and conventional medicines, which further contributed to the misunderstanding.

Results from this study, conducted on the perceived effectiveness of complementary medicine by

mothers of infants with colic in Gauteng, indicated that participants perceived complementary

medicine as an effective form of treatment for infantile colic; however, there is uncertainty

whether it works well in conjunction with conventional medicine. Further education is also

needed on complementary medicine due to the misunderstanding of terms, complementary

medicine and conventional medicine.

In conclusion, complementary medicine is perceived to be an effective form of treatment by

mothers of infants with infantile colic; however, further research and larger scale studies should

be conducted to validate this.

v

DEDICATION

Dedicated to my beloved parents, Alfredo and Lesley.

Without you, none of this would be possible. Thank you for all the sacrifices you have made to

provide me with a world of opportunity. Thank you for your unwavering support and

unconditional love, I owe my success to you.

vi

ACKNOWLEDGEMENTS

I would like to express my sincere gratitude to those that assisted me in completing this thesis:

Dr Radmila Razlog (Supervisor), thank you for your continuous guidance and for dedicating

your valuable time and patience to my research. Your kindness, positivity and passion for

homeopathy have been inspiring throughout my years of study.

Dr Reshma Patel (Co-Supervisor), thank you for your advice and knowledgeable input.

Your help has been invaluable and I am truly grateful.

To my siblings Daniella, Gabriella and Marco Di Gaspero, thank you for standing by my

side and for always believing in me. I am truly blessed to always have your love and

support. Thank you to Daniella for always proofing my work, your help has been invaluable

and I will always be grateful.

Riccardo De Cecco, thank you for always having confidence in me and for inspiring me to

be the best version of myself. Thank you for your endless love and help throughout the

years.

To my friends, I thank you for your part in my journey. For your friendship, encouragement

and support through the years, I couldn’t have done it without you.

The staff within the Department of Homeopathy, thank you for all your guidance and

knowledgeable input.

Mr Anesu Kuhudzai (Statkon), thank you for your assistance and statistical expertise.

To all the participants who willingly gave up their time to partake in the study.

vii

TABLE OF CONTENTS

DECLARATION ........................................................................................................................... i

AFFIDAVIT .................................................................................................................................. ii

ABSTRACT ................................................................................................................................. iii

DEDICATION ............................................................................................................................... v

ACKNOWLEDGEMENTS ........................................................................................................ vi

TABLE OF CONTENTS ........................................................................................................... vii

LIST OF FIGURES .................................................................................................................... xii

CHAPTER ONE: INTRODUCTION .......................................................................................... 1

1.1 Problem statement ...................................................................................................... 1

1.2 Aim of the study ......................................................................................................... 1

1.3 Importance of the study .............................................................................................. 1

1.4 Delimitations of the study .......................................................................................... 2

1.5 Assumptions ............................................................................................................... 3

1.6 Objectives ................................................................................................................... 3

CHAPTER TWO: LITERATURE REVIEW ............................................................................ 4

2.1 Introduction to infantile colic ..................................................................................... 4

2.1.1 Aetiology of infantile colic......................................................................................... 4

2.1.1.1 Lactose intolerance ..................................................................................................... 4

2.1.1.2 Motility ....................................................................................................................... 5

2.1.1.3 Gastro-oesophageal reflux .......................................................................................... 5

2.1.1.4 Gut Hormones ............................................................................................................ 6

2.1.1.5 Gut Microflora ............................................................................................................ 6

2.1.1.6 Food Hypersensitivity ................................................................................................ 6

2.1.1.7 Psychological factors .................................................................................................. 7

viii

2.1.1.8 Migrainous phenomenon ............................................................................................ 7

2.1.1.9 Melatonin and serotonin ............................................................................................. 7

2.1.1.10 Fourth trimester theory ............................................................................................... 8

2.1.1.11 Gastrointestinal gas .................................................................................................... 8

2.1.1.12 Maternal smoking ....................................................................................................... 8

2.1.2 Physical signs and symptoms ..................................................................................... 8

2.1.3 Diagnosis .................................................................................................................... 9

2.1.4 Differential diagnosis for crying ................................................................................ 9

2.1.4.1 Cardiac causes ............................................................................................................ 9

2.1.4.2 Gastrointestinal causes ............................................................................................. 10

2.1.4.3 Infectious causes ...................................................................................................... 11

2.1.4.4 Trauma ..................................................................................................................... 12

2.1.4.5 Other causes ............................................................................................................. 12

2.2 Treatment approaches............................................................................................... 13

2.2.1 Conventional medicine ............................................................................................. 13

2.2.2 Lifestyle and behavioural adjustments ..................................................................... 15

2.2.3 General complementary medicine for infantile colic ............................................... 16

2.2.3.1 Homeopathy ............................................................................................................. 17

2.2.3.2 Aromatherapy ........................................................................................................... 18

2.2.3.3 Ayurveda .................................................................................................................. 19

2.2.3.4 Phytotherapy ............................................................................................................. 19

2.2.3.5 Unani-Tibb ............................................................................................................... 20

2.2.3.6 Naturopathy .............................................................................................................. 21

2.2.4 Over-the-counter complementary medicine for infantile colic ................................ 21

CHAPTER THREE: METHODOLOGY ................................................................................. 28

3.1 Introduction .............................................................................................................. 28

3.2 Research Sample ...................................................................................................... 28

ix

3.2.1. Inclusion criteria ....................................................................................................... 29

3.2.2. Exclusion criteria ...................................................................................................... 29

3.3. Research Procedure and design ................................................................................ 29

3.4 Reliability and validity measures ............................................................................. 30

3.5 Data collection and analysis ..................................................................................... 30

3.6 Ethics ........................................................................................................................ 30

CHAPTER FOUR: RESULTS ................................................................................................... 32

4.1 Introduction .............................................................................................................. 32

4.1.1 Sample ...................................................................................................................... 32

4.2 General ..................................................................................................................... 32

4.2.1 Age of mother/respondent ........................................................................................ 32

4.2.2 Number of children .................................................................................................. 33

4.2.3 Gender of your child/children .................................................................................. 34

4.2.4 Diagnosis of colic ..................................................................................................... 34

4.2.5 Occurrence of colic .................................................................................................. 35

4.2.6 Antenatal class attendance........................................................................................ 37

4.3 Behaviours ................................................................................................................ 38

4.3.1 Crying ....................................................................................................................... 38

4.3.2 Timing of colic symptoms ........................................................................................ 41

4.3.3 Reasons for discomfort ............................................................................................. 43

4.3.4 Vomiting ................................................................................................................... 44

4.3.5 Sleeping .................................................................................................................... 45

4.4 Feeding ..................................................................................................................... 46

4.5 Burping ..................................................................................................................... 46

4.6 Sucking for comfort ................................................................................................. 47

4.7 Methods to soothe baby ............................................................................................ 47

4.8 Treatment ................................................................................................................. 48

x

4.8.1 Use of complementary medicine .............................................................................. 48

4.8.2 Information about complementary medicine ........................................................... 49

4.8.3 Complementary medicines used for colic ................................................................ 50

4.8.4 Conventional medicines used for colic .................................................................... 51

4.8.5 Perceived effectiveness of complementary medicine for colic ................................ 52

4.8.6 Perceived effectiveness of the combined use of conventional medicine with

complementary medicine ......................................................................................... 53

4.8.7 Awareness of side effects of complementary medicine ........................................... 53

CHAPTER FIVE: DISCUSSION .............................................................................................. 54

5.1 Introduction .............................................................................................................. 54

5.2 General information ................................................................................................. 54

5.3 Crying ....................................................................................................................... 55

5.4 Timing of colic symptoms ........................................................................................ 56

5.5 Reasons for discomfort ............................................................................................. 56

5.6 Vomiting ................................................................................................................... 57

5.7 Sleeping .................................................................................................................... 57

5.8 Feeding and burping ................................................................................................. 57

5.9 Methods to soothe .................................................................................................... 58

5.10 Treatments ................................................................................................................ 59

5.11 Consultation with a complementary medicine practitioner ...................................... 59

5.12 Sources of complementary information ................................................................... 60

5.13 Complementary medicine......................................................................................... 60

5.14 Conventional medicine ............................................................................................. 62

5.15 Statements regarding complementary medicine ...................................................... 63

5.16 Limitations and assumptions .................................................................................... 63

CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS ....................................... 65

6.1 Conclusions .............................................................................................................. 65

xi

6.2 Recommendations .................................................................................................... 66

REFERENCES ............................................................................................................................ 68

APPENDIX A ............................................................................................................................... 79

APPENDIX B ............................................................................................................................... 80

APPENDIX C ............................................................................................................................... 81

APPENDIX D ............................................................................................................................... 82

APPENDIX E ............................................................................................................................... 93

APPENDIX F ............................................................................................................................... 97

APPENDIX G .............................................................................................................................. 98

APPENDIX H ............................................................................................................................ 110

APPENDIX I .............................................................................................................................. 111

APPENDIX J.............................................................................................................................. 112

APPENDIX K ............................................................................................................................ 116

APPENDIX L ............................................................................................................................. 118

xii

LIST OF FIGURES

Figure 4.1: Age of respondents in 10 year increments ................................................................. 33

Figure 4.2: Number of children .................................................................................................... 33

Figure 4.3: Gender of child ........................................................................................................... 34

Figure 4.4: Self-diagnosis of colic ................................................................................................ 35

Figure 4.5: Colic diagnosis by a health care practitioner ............................................................. 35

Figure 4.6: Age the colic started ................................................................................................... 36

Figure 4.7: Which child suffered from colic? ............................................................................... 36

Figure 4.8: Antenatal class attendance ......................................................................................... 37

Figure 4 9: Incidence of colic in a day ......................................................................................... 38

Figure 4.10: Duration of colic episode ......................................................................................... 39

Figure 4.11: Ability to soothe the colic baby ............................................................................... 39

Figure 4.12: Duration of crying at any given time ....................................................................... 40

Figure 4.13: Frequency of crying over a period of a week ........................................................... 40

Figure 4.14: Believed reasons for excessive crying ..................................................................... 41

Figure 4.15: Timing of colic symptoms in relation to feeding ..................................................... 42

Figure 4.16: Time of day the colic occurred................................................................................. 42

Figure 4.17: Reasons for discomfort ............................................................................................ 44

Figure 4.18: Vomiting milk after a feed ....................................................................................... 45

Figure 4.19: Reason for sleeping .................................................................................................. 45

Figure 4.20: Feeding methods ...................................................................................................... 46

Figure 4.21: Burping ..................................................................................................................... 47

xiii

Figure 4.22: Use of a dummy or thumb to soothe ........................................................................ 47

Figure 4.23: Methods to soothe baby ........................................................................................... 48

Figure 4.24: Treatment choice for colic ....................................................................................... 49

Figure 4.25: Information sources regarding complementary medicine for colic ......................... 49

Figure 4.26: Complementary medicines used for colic ................................................................ 51

Figure 4.27: Conventional medication used to treat colic ............................................................ 52

Figure 4.28: Perceived effectiveness of complementary medicine for colic ................................ 52

Figure 4.29: Perceived effectiveness of the combined use of conventional medicine with

complementary medicine ............................................................................................................... 53

Figure 4.30: Awareness of side effects of complementary medicine ........................................... 53

Figure J.1:.Number of children suffering from colic ................................................................. 112

Figure J.2.: Sufficiency of the ante-natal class........................................................................... 112

Figure J.3.: Is vomiting normal after a feed? ............................................................................. 113

Figure J.4.: Feeding method changes ......................................................................................... 113

Figure J.5.: Feeding on demand ................................................................................................. 114

Figure J.6.: Increase in feeding hours between 5pm and 12am ................................................. 114

Figure J.7.: Consulted with a complementary medicine practitioner ......................................... 115

1

CHAPTER ONE

INTRODUCTION

1.1 Problem statement

Infantile colic is defined as a behavioural disorder that is characterised by spasmodic, excessive

and inconsolable crying without apparent cause in an otherwise healthy infant. Infantile colic is a

common but poorly understood condition that affects many infants between the ages of 2-16

weeks and is prevalent in both males and females. Infants are classified as having colic if they

cry more than three hours each day, on more than three days a week, for a period of more than

three weeks (Savino, Tarasco, Sorrenti, Lingua, Moja, Gordon et al., 2014b). Infantile colic

occurs in 10-30% of infants making it one of the most common reasons parents take their infants

to paediatric healthcare practitioners. Infantile colic is not only distressing to the infant but on

the family too; and since there is no widely accepted conventional treatment for colic, parents

may turn to complementary medical treatments (Savino & Tarasco, 2010). The recent growth of

the complementary medicine market in South Africa has resulted in complementary medicines

being available in numerous retail outlets where they are obtainable without a prior medical

consultation (Gqaleni, Moodley, Kruger, Ntuli & McLeod, 2016). Despite this, there is currently

no gold standard treatment for colic and there is limited research available on the use, safety and

effectiveness of complementary medicine in infantile colic (Perry, Hunt & Ernst, 2011).

1.2 Aim of the study

The aim of this study was to determine the perceived effectiveness of complementary medicine

by mothers of infants with colic in Gauteng, by means of an Infantile Colic Questionnaire

(Appendix G).

1.3 Importance of the study

There is a growing necessity and demand for complementary medicine in South Africa, despite

conventional medicine being the main source of healthcare (Snyman, 2014). South Africa has

made substantial progress with integrating complementary medicine into the legal framework,

mainly due to the need and increase in demand for medical care (Gqaleni et al., 2016).

In a recent study conducted on the attitudes and perceptions of people in health shops towards

complementary and alternative medicine, it was concluded that complementary medicine is

growing in popularity and that it is used as a form of primary healthcare amongst many South

2

Africans. Out of the respondents, 97.3% (n=554) used vitamins/supplements; 62.3% (n=355)

used herbal preparations; 48.9% (n=278) used homoeopathy; 10.8% (n=61) used Traditional

Chinese Medicine; 10.2% (n=58) used Ayurveda; 6.5% (n=37) used aromatherapy; and 4.3%

(n=24) used Unani-Tibb (Snyman, 2014). In the last few years there has been an influx of

complementary medicine products into the South African market, however the efficacy of some

of these products is unknown (Gqaleni et al., 2016). With limited research available on the use,

safety and effectiveness of complementary medicine in infantile colic, it is important to establish

the use and perceived efficacy of these products (Perry et al., 2011). Not only is it important to

establish which complementary medicines are popular and effective for infantile colic, but also

to identify the effectiveness of these products allowing for further clinical, investigatory and

safety research to be conducted on them.

According to the World Health Organisation (WHO), it is estimated that 80% of the population

in developing countries use traditional or complementary medicine for their primary health

needs. South Africa recognises complementary medicine practitioners through the statutory

council, Allied Health Professions Council of South Africa (AHPCSA), however complementary

medicine is not currently integrated into our national health care system (Embrey, 2013). The

inclusion of complementary medicine into our national health care system will be greatly

beneficial to the population. This process can be facilitated by research conducted on the safety

and efficacy of complementary medicine deeming it important for such research to be conducted.

This can facilitate the growth of complementary medicine as a treatment modality as well as

provide a broader understanding to health care practitioners on the public’s usage and experience

with complementary medicine.

Infantile colic is a common but poorly understood condition (Savino & Tarasco, 2010). The

survey may also provide some additional information on the signs and symptoms of colic, the

prevalence and the assumed causes. This allows for further research to be conducted in this field.

1.4 Delimitations of the study

There were a few factors which may have negatively affected the study:

Numerous participants were unfamiliar with the term “Complementary Medicine” and

which over-the-counter products fell into the complementary medicine category. Thus some

findings may have been affected by this.

A few participants made use of both complementary medicine and conventional medicine

simultaneously that made isolating the efficacy of the complementary medicine difficult. It

3

was assumed by the researcher that the positive effects were due to complementary

medicine.

Participants who had more than one child with colic were conflicted when answering

questions where the answer was different for each child. This resulted in a few questions

having multiple answers.

1.5 Assumptions

For the purpose of the study, the following was assumed:

That the survey was completed honestly and truthfully without bias and prejudice.

That the information that was provided by the participant was a true reflection of the

participant’s use of complementary medicine for colic.

That the infant has/had colic based on their presenting symptoms and not another possible

underlying pathology.

1.6 Objectives

The objectives for this study were:

To provide insight into the use and perceived effectiveness of complementary medicines in

order to develop an approach for the treatment of infantile colic.

To provide valuable information regarding the understanding and use of complementary

medicine in Gauteng.

To provide a better understanding of infantile colic due to limited research being available

on the aetiology and development of infantile colic. This may open up the field for

additional research.

4

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction to infantile colic

Infantile colic is defined according to Wessel’s criteria as crying in a seemingly healthy infant

that lasts for more than three hours each day, on more than three days a week, for a period of

more than three weeks (Savino & Tarasco, 2010; Savino et al., 2014b) Around the age of 6

weeks, the occurrence of crying intensifies, especially in the late afternoon and evening. Colic

tends to naturally ease around the age of 16 weeks, the definitive reason for this is unknown

(Savino, Ceratto, De Marco & di Montezemolo, 2014a).

Infantile colic is a prevalent condition that occurs in 10-30% of infants. There is no genetic link

for this condition and it affects infants of all socio-economic groups. It is thought to be equally

prevalent in both genders and there have been no reported differences in incidence between

breast-fed and formula-fed infants (Savino, 2007).

Infantile colic is not only distressing to the infant, but on the family too; and since there is no

widely accepted conventional treatment for colic, parents may turn to complementary medical

treatments (Savino & Tarasco, 2010).

2.1.1 Aetiology of infantile colic

The aetiology of infantile colic is not fully understood despite its frequent occurrence. Research

suggests that there may be numerous independent causes of this disorder (Savino et al., 2014b).

As a result of this, many interventions for infantile colic have been investigated. Many theories

exist as to what could cause infantile colic. One possibility stems off the notion of the gut

hypothesis, with hypertonicity and increased formation of intraluminal gas (Marek, 2011).

Allergic theories suggest that food allergies may result in infantile colic. This may occur due to

lactose intolerance, hypermotility, gastro-oesophageal reflux, gut hormones, gut microflora, and

food hypersensitivity. Other theories include the effect of maternal smoking, low birth weight,

infant migraines, neurohormones and the maternal diet of breastfeeding mothers (Savino &

Tarasco, 2010).

2.1.1.1 Lactose intolerance

Recently lactose intolerance has been identified as a possible causative factor for infantile colic.

This is due to a relative lactase deficiency resulting in the failure to break down the lactose in

5

food. Due to this, large amounts of lactose enter the large intestines where it becomes a substrate

for lactobacilli and bifidobacteria. Fermentation occurs resulting in the rapid production of lactic

acid and hydrogen, which causes the intestines to distend creating pain for the infant. A small

study was conducted on the use of a lactase-treated feed for infants with colic however, as a

small sample size was used, it reduced the efficacy of the study. It was noted that there was a

reduction in both crying time and breath hydrogen in infants who had used a lactase-treated feed.

This supported the theory that symptoms could be alleviated by reducing the lactose content of a

lactose-intolerant infant’s feed; however, infants can expect no relief with this form of treatment

if the colic is due to other factors (Savino, 2007).

2.1.1.2 Motility

During the first few weeks of life, there is a delay in the development of the nervous system that

may lead to intestinal hypermotility in infants. The autonomic nervous system (ANS) consisting

of the sympathetic and parasympathetic nervous systems have been investigated to find the cause

of this ‘hypertonia of infancy’, as it was termed, which was thought to be a result of vagotonia.

Vagotonia is when the equilibrium between the sympathetic and parasympathetic nervous system

(ANS) is favoured towards the parasympathetic nervous system. The theory of this over

stimulation of the parasympathetic nervous system was supported by the beneficial effects that

the following conventional and complementary antispasmodic medications had on colic:

dicyclomine, cimetropium bromide, Matricariae recrutaria, Foeniculum vulgare and Melissa

officinalis (Savino, 2007). However, the findings stating, ‘the balance of the autonomic nervous

system is normal in colicky infants’ suggested that the imbalance in the autonomic nervous

system is not associated with infantile colic (Kirjavainen, Jahnukainen, Huhtala, Lehtonen,

Kirjavainen, Korvenranta et al.,2007).

2.1.1.3 Gastro-oesophageal reflux

The relationship between gastro-oesophageal reflux and colic is controversial as the two are

viewed as different clinical conditions. The confusion between the two occurs when gastro-

oesophageal reflux doesn’t present with its typical symptoms but rather the irritability and

excessive crying of colic. Results from studies that examined the role of gastric emptying and

pathological gastro-oesophageal reflux in colicky infants suggested that in the absence of

regurgitation and vomiting, gastro-oesophageal reflux is not a likely cause for infantile

irritability, and pathological gastro-oesophageal reflux is only implicated in a select few colicky

infants. However, most studies emphasise that the link between infantile colic and gastro-

oesophageal reflux is unlikely (Savino, 2007).

6

2.1.1.4 Gut Hormones

The gastrointestinal tract contains numerous hormones responsible for the regulation of intestinal

motility namely vasoactive intestinal peptide, gastrin, motilin and ghrelin. In gastrointestinal

disorders in children, it has been observed that vasoactive intestinal peptide and gastrin levels are

elevated however; this is not true for colic. The only instance that gastrin levels are elevated in

colic infants is when the child is being formula fed and not breastfed. It has been noted that

motilin, which is responsible for promoting gastric emptying and small bowel peristalsis, is

increased in colicky infants. Raised serum levels of ghrelin have also been found in colicky

infants and this hormone is thought to be responsible for abnormal hyperperistalsis and increased

appetite, symptoms which evident of colic (Savino, 2007).

2.1.1.5 Gut Microflora

Lactobacilli are important non-pathogenic bacteria responsible for the development of local and

systemic immune responses. In infants with colic, it was found that not only were there

decreased counts of intestinal lactobacilli in comparison to healthy infants, but that there was an

increased amount of Lactobacillus brevis and Lactobacillus lactis, which are responsible for

abdominal distension and increased intestinal gas. An inadequate balance of lactobacilli in

colicky infants may trigger immaturity in the intestinal barrier, which may result in abnormal

immune responses (Savino, 2007). In a randomised, double blind, placebo controlled trial it was

discovered that the crying and fussing times in the colic infants who were taking Lactobacillus

reuteri was significantly shorter than those who were in the placebo group (Chau, Lau,

Greenberg, Jacobson, Yazdani-Brojeni, Verma, et al., 2015).

2.1.1.6 Food Hypersensitivity

There is increasing evidence that infantile colic is related to food hypersensitivities. Possible

allergens that cause colic are cow’s milk proteins, breast milk or infant formula. In a systematic

review, it was found that hypoallergenic formulas were effective in reducing colic in formula fed

infants. Another study investigated the effects of eliminating cow’s milk from the mothers’ diet

on infantile colic. It was concluded that there was a significant improvement in the infants’ colic

or complete resolution (Savino, 2007). Other additional dietary exclusions that can be made in

the maternal diet are the removal of eggs, wheat, soy, tree nuts, peanuts and fish. After a two

week exclusion period, there should be a substantial improvement in the infants behaviour if the

symptoms are allergy related (Savino & Tarasco, 2010).

7

2.1.1.7 Psychological factors

Infants with colic are often considered to be irritable, hypersensitive and have a difficult

temperament. However, this doesn’t provide an explanation for the excessive crying but does

indicate it as a contributing factor. Many studies are being conducted to examine the importance

of quality infant-parent interactions in relation to excessive crying and irritability in infants. It

has been observed that less than optimal parent-infant interactions are common with severely

colic infants (Savino, 2007).

2.1.1.8 Migrainous phenomenon

Migraines are considered a highly genetic disorder and it is possible that infants may express

migrainous genes early in brain development. This then presents later on in life as a migraine

headache. In a cross-sectional study, it was found that mothers who had migraines were more

than twice as likely to have a child with colic. However if colic is due to migraines, the

pathophysiology is still not understood enough to be able to determine why the infant cries. It is

poorly understood whether the crying is caused due to a headache or abdominal pain due to an

abdominal migraine. The migraine could result in the infant being excessively sensitive to

external stimuli, commonly seen in migraines, and the sensitivity is expressed as crying. Infants

grow and develop at a rapid rate, especially in the first few weeks of life and their visual

perceptual abilities increase drastically within this time. These overwhelming visual senses could

also result in excessive crying and could provide a reason as to why the colic only approximately

starts at 2 weeks of age (Gelfand, 2016).

2.1.1.9 Melatonin and serotonin

Melatonin is a neurohormone produced by the pineal gland, retina and gastrointestinal tract with

the gastrointestinal tract producing 400 times the amount of melatonin produced by the pineal

gland. Melatonin is not only responsible for the day-night cycle but also in relaxing the intestinal

smooth muscles. Serotonin has the opposite effect as it increases the intestinal smooth muscle

contractions. Melatonin and serotonin levels peak in the evening due to the circadian rhythm, the

same time that colic seems to intensify. The production of endogenous melatonin does not occur

until the infant is 12 weeks of age, when colic generally resolves, suggesting that colic may be

due to abnormal circadian melatonin rhythms (Kumral, Tuzun, Yesilirmak, Duman & Ozkan,

2009; Rosen 2007).

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2.1.1.10 Fourth trimester theory

A popular conventional medical theory as to the cause of infantile colic is a theory termed the

“fourth trimester”. This is a three month period in which the infant has neural regulation

difficulties and the child has to cope with potentially overwhelming sensory stimuli. The way in

which an infant deals with external stimuli varies and there is increasing evidence that the

gastrointestinal tract may be involved in colic via neuroimmune connections (Rosen, 2007).

2.1.1.11 Gastrointestinal gas

Excessive gastrointestinal gas can result in colic in infants and this is due to aerophagia caused

by inconsolable crying or gas production due to fermentation in the intestines. Aerophagia from

crying can result in abdominal distension and flatulence, which causes discomfort for the child

(Wyllie, Hyams & Kay, 2015). The reaction of hydrogen ions and bicarbonate due to bacteria

fermentation in the small intestine results in intraluminal carbon dioxide gas production. This

causes abdominal distension, burping and flatus that are common in colic. The symptoms can

mildly be alleviated by keeping the child in a supine position and choosing the appropriate teat if

bottle feeding (Walker, Goulet & Mieli-Vergani, 2004).

2.1.1.12 Maternal smoking

Studies have revealed a link between infantile colic and exposure to cigarette smoke and its

metabolites. Evidence indicates that maternal smoking causes increased plasma and intestinal

motilin levels. Increased intestinal motilin results in increased gastrointestinal peristalsis, which

causes the abdominal discomfort seen in infantile colic (Kheir, 2012).

2.1.2 Physical signs and symptoms

The physical signs and symptoms of colic include: crying; flushing of the face; drawing up of the

legs; arching of the back; clenched fists; bloated abdomen; abdominal guarding; passing of gas

whilst crying; difficulties passing stool; vomiting after feeding and restless sleep (Renee, 2014).

Infantile colic is often graded as mild, moderate or severe, yet there are no guidelines defining

each grade. Episodes of crying tend to increase at 6 weeks of age, occurring more frequently late

afternoon and evening. Colic tends to spontaneously resolve itself around 3-4 months of age. The

pattern of crying is characteristic of colic and this helps to differentiate it from other more severe

conditions (Savino, 2007).

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2.1.3 Diagnosis

The diagnosis of infantile colic is made through an extensive medical history of the patient as

well as performing the relevant physical examinations based on the presenting symptoms and

case history. It is important to rule out any other underlying conditions as well as excluding any

feeding disorders. The history taking should include the association between the behaviour of the

infant and the duration and timing of the crying. Evaluation to see if the infant is being fed

correctly, is gaining weight, has a fever or has abnormal stools is important. Common conditions

such as cow’s milk protein allergy and gastro-oesophageal reflux need to be ruled out as well as

other uncommon conditions such as bowel intussusception and infections (Savino et al., 2014a).

2.1.4 Differential diagnosis for crying

Crying in infants and young children is common as this is a form of communication. If the

infant’s crying exceeds the normal range of a maximum of 3 hours a day, it is important to

distinguish the cause (Porter & Kaplan, 2011). Other organic causes of crying other than colic

are as follows:

2.1.4.1 Cardiac causes

Coarctation of the aorta

Localised narrowing of the aortic lumen resulting in hypertension, left ventricular hypertrophy

and decreased blood supply to the abdominal organs and lower extremities. Symptoms

experienced vary in each case but range from a headache, chest pain, fatigue, cold extremities

and leg claudication. In order to diagnose coarctation of the aorta, an echocardiogram, computed

tomography (CT) or magnetic resonance (MR) angiography need to be performed (Porter &

Kaplan, 2011).

Heart failure

Heart failure is a syndrome of ventricular dysfunction. The following signs and symptoms may

be found in infants with heart failure: tachycardia; tachypnoea; dyspnoea with feeding;

diaphoresis; restlessness and irritability. Dyspnoea with feeding results in insufficient food

intake so infants are often undernourished and have poor growth (Halpern & Coelho, 2016;

Porter & Kaplan, 2011).

Supraventricular tachycardia

Supraventricular tachycardia is an abnormal heart rhythm arising from improper electrical

conduction in the upper region of the heart. In an infant, this results in the heart rate being

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greater than 180 beats per minute. Symptoms include episodic breathlessness, lethargy, feeding

difficulties and rapid precordial pulsations (Herman & Le, 2007; Porter & Kaplan, 2011).

2.1.4.2 Gastrointestinal causes

Constipation

Constipation is defined as a delay or difficulty in passing stool. Stools may be hard or even

large, occurring for a period of more than 2 weeks. Constipation can often result in anal tears or

fissures as well as a distended abdomen. Constipation causes pain and discomfort in the infant

which results in excessive crying (Freedman, Al-Harthy & Thull-Freedman, 2009; Porter &

Kaplan, 2011).

Gastroenteritis

Gastroenteritis is the inflammation of the lining of the stomach and intestines. Symptoms

include nausea, vomiting, diarrhoea, loss of appetite and abdominal pain. Gastroenteritis should

be monitored closely in infants as dehydration occurs easily due to the rapid loss of fluids

(Porter & Kaplan, 2011).

Gastro-oesophageal reflux

Gastro-oesophageal reflux is due to the incompetence of the lower oesophageal sphincter, which

allows the reflux of gastric contents back up into the oesophagus. The infant presents with

recurring fussiness after feeds, regurgitation, poor weight gain and arching of the back

(Freedman et al., 2009; Porter & Kaplan, 2011). Gastro-oesophageal reflux affects numerous

infants however, like colic; it is self-limiting and usually resolves around 6-12 months of age

(Savino, 2007).

Intussusception

Intussusception is telescoping of one portion of the intestine into an adjacent section of

intestines and results in intestinal obstruction and sometimes intestinal ischemia. Intussusception

presents with recurring colicky pain with vomiting (Herman & Le, 2007; Porter & Kaplan,

2011).

Milk protein intolerance

Milk protein intolerance is the inability to digest milk proteins due to a lack of intestinal

enzymes to break it down. This results in abdominal distension, vomiting, diarrhoea, abdominal

cramps, flatulence and insufficient weight gain. Eliminating the allergen should result in relief

of the symptoms (Halpern & Coelho, 2016; Porter & Kaplan, 2011).

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Volvulus

Volvulus is an intestinal obstruction that impairs the passage of contents through the intestine.

Symptoms include vomiting, obstipation and abdominal colic. Diagnosis is confirmed through

abdominal x-rays (Herman & Le, 2007; Porter & Kaplan, 2011).

2.1.4.3 Infectious causes

Meningitis

Meningitis is the inflammation of the meninges of the brain or spinal cord due to a viral or

bacterial infection. Signs include fever, lethargy, seizures, irritability, high pitched and

inconsolable crying and bulging of the fontanelle. In suspected infantile colic it is important to

rule out neck stiffness and the above mentioned symptoms, through a lumbar puncture, to

eliminate meningitis as a possible cause (Herman & Le, 2007; Porter & Kaplan, 2011).

Otitis media

Otitis media is a bacterial or viral infection of the middle ear. Infants commonly experience the

following symptoms: otalgia, fever, nausea, vomiting and diarrhoea. Diagnosis determined by

performing an otoscopy in which the tympanic membrane is bulging with or without a purulent

discharge. Infants who have otitis media become irritable and have difficulty sleeping,

symptoms common in colic (Herman & Le, 2007; Porter & Kaplan, 2011).

Respiratory infections

Respiratory infections in infants has multiple causes however, the most common ones are

bronchiolitis and pneumonia. Colic infants tend to hold their breath for short periods of time,

making it essential to eliminate any underlying respiratory cause. The infant often presents with

a fever, wheezing, rales, grunting, cyanosis, difficulty breathing when feeding and decreased

breath sounds on auscultation (Freedman et al., 2009; Porter & Kaplan, 2011).

Urinary tract infection

Signs and symptoms of a urinary tract infection in infants are usually non-specific and include

difficulty feeding, diarrhoea, vomiting, failure to thrive, mild jaundice, lethargy, fever and

hypothermia. In some cases infants may present with abdominal pain, foul-smelling urine,

dysuria, increased urinary frequency or urinary retention (Herman & Le, 2007; Porter & Kaplan,

2011).

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2.1.4.4 Trauma

Corneal abrasion

Corneal abrasion is a superficial injury to the eye that is usually self-limiting. It is most often

caused due to a foreign body in the infant’s eye or due to a superficial corneal scratch from the

infants’ sharp or uncut nails. The infant becomes irritable and cries inconsolably, symptoms

typical of colic (Halpern & Coelho, 2016; Porter & Kaplan, 2011).

Fracture or abuse

Irritability, fussiness and crying may be as a result of child abuse. Signs of abuse include

unexplained bruises and fractures as well as the favouring of a limb. A thorough history and

examination should be performed to rule it out as a possibility (Porter & Kaplan, 2011).

Hair tourniquet

Hair tourniquet occurs when a hair wraps around an appendage, such as a toe, finger or penis,

and there is swelling distal to the hair. A thorough examination needs to be performed to rule

this out as a possible diagnosis (Halpern & Coelho, 2016; Porter & Kaplan, 2011).

Head trauma with intracranial bleeding

The infant will have an inconsolable, high pitched cry with localised swelling on the skull. A

head CT should be performed to eliminate this as a diagnosis (Herman & Le, 2007; Porter &

Kaplan, 2011).

Shaken baby syndrome

Colic, which is not only distressing on the child, but on the parents too, and in some cases it

results in a caregiver ‘shaking the baby’. Shaken baby syndrome occurs due to the brain

rebounding on the skull resulting in bruising, swelling and bleeding of the brain. The child will

present with behavioural changes, inconsolable and high pitched cry, irritability, lethargy,

vomiting, loss of consciousness and convulsions (Porter & Kaplan, 2011).

2.1.4.5 Other causes

Testicular torsion

In boys it is important to examine the penis and scrotum. In testicular torsion the infant will

present with ecchymosis and firmness of the testes. This is a medical emergency and the infant

will be irritable, fussy and crying due to the discomfort (Porter & Kaplan, 2011).

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Vaccine reaction

It is common for children to experience a mild reaction after a vaccination, especially if a live

vaccine was administered. The child may present with a fever, rash, vomiting and diarrhoea.

The symptoms should not persist longer than 3-7 days (Halpern & Coelho, 2016; Porter &

Kaplan, 2011).

2.2 Treatment approaches

The treatment of infantile colic is aimed at reducing the intensity of crying or eliminating factors

that appear to exacerbate the crying. There is no gold standard treatment for colic and as a result

many treatment options are utilised (Bailey, D'Auria & Haushalter, 2013).

2.2.1 Conventional medicine

Conventional medicine is defined as a health care system compromising of medical doctors and

other healthcare professionals that treat symptoms and diseases with drugs, radiation or surgery.

Commonly it is also referred to as allopathic medicine, mainstream medicine, orthodox medicine

and Western medicine. Conventional medicine makes use of a broad spectrum of medications

including both over-the-counter and prescription medications. Numerous conventional

treatments are available for infantile colic (National Cancer Institute, 2016). In a systematic

review of treatments for infantile colic, it was found that there was little evidence to support

many conventional medicines and that many of them are prohibited due to the reported side

effects. It was found that an integrative approach, combining both conventional and

complementary medicines, to be the most effective (Rosen, 2007).

Some of the following products available for infantile colic include:

Adcock Ingram Muthi Wenyoni

Muthi Wenyoni is an antacid consisting of calcium carbonate and magnesium carbonate, which

helps to relieve dyspepsia by neutralising stomach acid (Resmed, 2016). This medication is

popular amongst South Africans for treating ‘inyoni’ or ‘umphezulu’, a condition which is

associated with diarrhoea and dehydration accompanied with a high pitched cry. The side

effects that could result from the calcium carbonate are constipation, vomiting and loss of

appetite. The magnesium carbonate could cause side effects such as nausea, diarrhoea and

abdominal discomfort (Bland, Rollins, Broeck & Coovadia, 2014).

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Buscopan®

Hyosine butylbromide is an antispasmodic used in infants over one month of age. Buscopan®

relieves pain by exerting a spasmolytic action on the smooth muscle of the gastrointestinal,

biliary and genitourinary tracts. It is indicated in conditions with gastrointestinal spasms, colic

being one of them (Whittaker, 2010). The side effects that could result from hyosine

butylbromide are urticaria, xerostomia, tachycardia, dyshidrosis, and urinary retention

(Boehringer Ingelheim, 2013).

Colief® Infant Drops

Colief® is a natural product containing the enzyme lactase that aids in the breakdown of lactose

due to lactose intolerance or insufficient lactase production (Colief, 2011). Infants experience

digestive discomfort due to abdominal distension as a result of bacterial fermentation in the

large intestines. Lactase is best given before a feed in order to increase the lactase levels to

match the high levels of lactose in breast milk or cow’s milk based formula (Whittaker, 2010).

Colief® is safe to use and there are no reported side effects. It has been noted that in some cases

the stool may become looser and more frequent; however, if the infant is happy and gaining

weight, there is no need for concern but the number of drops per dose should be reduced

(Colief, 2011).

Nexium®

Nexium® is a scheduled medication for the short-term treatment of gastro-oesophageal reflux

disorder. Nexium® contains esomeprazole magnesium which suppresses the secretion of gastric

acid that may be causing erosive esophagitis. The acid-mediated gastro-oesophageal reflux

could be causing the colic and discomfort in the infant. The infant should not take Nexium® for

longer than a period of six weeks and the safety and effectiveness of it hasn’t been established

in infants less than one month of age (Anderson, 2014). The side effects that could result from

esomeprazole magnesium are headaches, dizziness, xerostomia, abdominal pain,

gastrointestinal disturbances, skin reactions, insomnia, constipation, flatulence and nausea

(AstraZeneca, 2015).

Telament Paediatric Colic Drops®

Telament Paediatric Colic Drops® contains simethicone that is indicated for symptoms

associated with excessive gas accumulation in the gastrointestinal tract such as colic, flatulence

and dyspepsia (Adcock Ingram, 2004a). Simethicone works by dispersing and preventing gas

bubble formation in the intestinal tract. Three double-blind, placebo-controlled studies aimed at

establishing the efficacy of simethicone, all had conflicting results. The first study showed that

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infants had fewer crying episodes with simethicone whereas the second study showed that the

placebo was more effective. The third study showed neither the simethicone nor placebo as

effective (Whittaker, 2010). The use of simethicone is a widely accepted over-the-counter

medication for infantile colic however studies indicated that there is no benefit on colic

symptoms. If there is any calming effect, it is suspected to be due to the sweet taste (Halpern &

Coelho, 2016). The side effects that could result from Telament Paediatric Colic Drops® are

abdominal distension, diarrhoea, constipation, flatulence and gastro-oesophageal reflux

(Adcock Ingram, 2004a).

2.2.2 Lifestyle and behavioural adjustments

Breastfeeding mothers are often advised to adjust their diet to see if there is any relief in the

infants’ symptoms. Mother’s should avoid cow’s milk and dairy. Bottle fed infants are advised to

use formulas that contain partially hydrolysed whey proteins as well as prebiotic

oligosaccharides (Savino et al., 2014a). Oligosaccharides are found in high concentrations in

breast milk and are minimal in cow’s milk or cow’s milk based formulas. The supplementation

of infant formulas with prebiotic oligosaccharides has been found to increase intestinal

bifidobacteria and promote infant health (Stiverson, Williams, Chen, Adams, Hustead, Price et

al., 2014). This has shown to be an effective form of treatment (Savino et al., 2014a).

Common comforting methods used in colic infants include: increased carrying, swaddling, a crib

vibrator and infant massage. However, most of these comforting methods aren’t always

beneficial. In one study it was found that swaddling is an effective soothing technique and it was

found to be more effective than infant massage in calming colic infants (Evanoo, 2007).

Baby exercises assist with stretching the abdominal muscles while improving circulation to the

muscles. This is achieved by the infant lying on their back, while their legs are gently cycled

around in a bicycle motion. This assists with the movement of the stool or gas along the

gastrointestinal tract which may relieve any discomfort the infant may be experiencing

(Eshelman, 2013).

Behavioural interventions involve advising or counselling parents on how to soothe infants more

effectively and how to not overstimulate them (Savino & Tarasco, 2010).

In an online survey conducted in New Zealand on colic and reflux by parents who had infants

with excessive crying and/or colicky behaviour, it was noted that complementary medicines,

cranial and baby massage and behavioural interventions relieved colic symptoms completely in

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less than 3% of infants however most of these treatments did not significantly improve the colic

symptoms (Hodge & Murphy, 2014).

Two studies conducted on the implementation of the behavioural intervention, regulation,

entertainment, structure and touch (REST), found a significant reduction in infant crying

(Evanoo, 2007). The intervention is utilised in both the infants and the parents. REST for infants

consists of:

Regulation: manage the state of the infant and as a parent, be able to understand the infants’

cues. Preventing overstimulation in the beginning of the infants’ life is important.

Entertainment: synchronise the infants’ behaviour with external stimuli such as noise or

light.

Structure: it is essential to establish a routine as to create stability in the infants’ day to day

life.

Touch: this aims to provide close skin to skin contact and can incorporate soothing

techniques such as holding the infant or rocking them (Evanoo, 2007).

REST (reassurance, empathy, support and time out) is also implemented in parents as many

parents feel helpless or overwhelmed when their infant cries excessively. This often leads to

frustration and in some cases the parents shake the child which may result in shaken baby

syndrome. REST for parents consists of:

Reassurance: reassure the parent that they are caring for the infant correctly and that colic is

a self-limiting condition.

Empathy: listen to the parent and recognise the challenge of caring for a colic infant.

Support: from health care providers or support groups. Teach the parent the appropriate

response to the infant (REST intervention for the infant)

Time out: explain the importance of the parent taking time to rest and take a break from the

infant each day. Let them know that it is acceptable to allow for someone else to watch the

infant or for the infant to be placed safely in a crib or play area if the parent is feeling

overwhelmed or frustrated (Evanoo, 2007).

2.2.3 General complementary medicine for infantile colic

Complementary medicine (CM) is defined by the World Health Organisation (WHO) as “a broad

set of health care practices that are neither part of that country’s own tradition, nor integrated

into the dominant health care system”. In some countries, the term is often used interchangeably

with traditional and complementary medicine (T&CM), a term that is used globally to describe

17

traditional products, practitioners and practices (WHO, 2016). However, in South Africa,

traditional medicine and complementary medicine are seen as two different modalities.

According to the Medicines Control Council (MCC) of South Africa, complementary medicine

means any substance or mixture that originates from plants, minerals or animal that is intended

to be used to alleviate or prevent illness. To guarantee the safety and efficacy of medicines, the

MCC controls the manufacturing, distribution and sale (MCC, 2016).

Complementary medicine is regulated in South Africa by the MCC whereby the standards are

established by the Medicines Related Substances Act, (Act 101 of 1965) (MCC, 2016). As of

2001, Allied Health Professions Council of South Africa (AHPCSA) regulates practitioners who

practice in the field of complementary medicine. AHPCSA regulates all health professions in

terms of the Allied Health Professions Act, 63 of 1982 (the Act) and includes the following

complementary health disciplines: Ayurveda, Chinese Medicine and Acupuncture, Chiropractic,

Homeopathy, Naturopathy, Osteopathy, Phytotherapy, Therapeutic Aromatherapy, Therapeutic

Massage Therapy, Therapeutic Reflexology and Unani-Tibb (AHPCSA, 2015).

2.2.3.1 Homeopathy

Homeopathy is a holistic, natural, health care system that has been around for more than 200

years. Homeopathy makes use of plant, animal or mineral based remedies aimed at treating each

patient individually in order to stimulate the body’s own healing ability. According to the WHO,

homeopathy is the second largest therapeutic system in the world (WHO, 2016). Homeopathy

focuses on treating the totality of symptoms by not only taking into account the physical

symptoms, but the mental and emotional too, making it a true holistic treatment (School of

Homeopathy, 2012).

The word homeopathy is derived from the Greek words “homoios” which means like and

“pathos”, meaning suffering. The origin of the word leads to one of the main homeopathic

principles “like cures like”, meaning that a crude substance which produces symptoms in a

healthy person can cure similar symptoms in a sick person, if administered as a minimal dose.

The Law of Similars, was developed by the founder of homeopathy, Dr. Samuel Hahnemann. He

also founded the principle, “the minimum dose”. Hahnemann states that the diseased body only

needs small doses of a remedy to bring about a cure. However, the opposite is true in allopathy.

In order to achieve a greater physiological response; the dose needs to be increased. This often

leads to uncomfortable and unnatural side effects. Whereas in homeopathy, the minimum dose is

able to overcome the disease and this is achieved in a gentle and permanent manner. This is

further described in the second aphorism, which is found in the Organon of Medicine: “The

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highest ideal of cure is rapid, gentle and permanent restoration of the health, or removal and

annihilation of the disease in its whole extent, in the shortest, most reliable, and most harmless

way, on easily comprehensible principles” (De Schepper, 2008). This is the reason that

homeopathy is favoured in the treatment of infantile colic: it is considered to be safe in infants

and it does not have the adverse effects of conventional medicine. There are numerous

homeopathic remedies that can be prescribed to treat colic based on the infant’s individualised

symptoms (Loo, 2008). A similimum research study was conducted to establish the efficacy of

individualised homeopathic remedies in the treatment of colic. Results showed that there was an

improvement in the infant’s colic as well as the infant’s overall temperament and physical health.

However, due to the small sample size additional larger scale studies should be conducted to

further validate this finding (Vermeulen, 2004).

Homeopathic remedies are administered in varying strengths through a process of dilution and

succussion (addition of energy through agitation). This is sub-sequentially referred to as a

potency. Samuel Hahnemann discovered that the therapeutic action of a substance is improved

through a process of potentisation in which a substance is diluted and then succussed or triturated

(School of Homeopathy, 2012). Standardised methods of dilution are achieved through liquid

dilution or trituration. Soluble substances undergo liquid dilution and succussion in a bottle until

the desired potency is reached whereas insoluble substances are combined with lactose powder

and triturated until the desired potency is achieved (Kayne & Kayne, 2007).

There are varying scales of potentisation in which a potency is compounded according to

prescribed ratios. These include the:

Decimal scale (X=1:10) or (D=1:10)

Centesimal scale (C=1:100)

Millesimal scale (M=1:1000)

Quinquagintimillesimal sacale (LM=1:50000) (Kanye & Kanye, 2007).

2.2.3.2 Aromatherapy

Aromatherapy is a natural and holistic therapy that aims at treating the mind, body and spirit

through essential oils. The essential oils assist the body to function at its optimal level. Essential

oils are extracted from the seed, flower, leaves, bark or root of the plants through a process

known as distillation. Aromatherapy doesn’t only heal through smell alone, as the name implies,

but through other therapeutic properties as well. Aromatherapy also has antiviral, antibacterial,

antibiotic, anti-inflammatory and antiseptic effects, whereby the oils are absorbed into the

bloodstream. The aim of the essential oils is to relax the body and improve the circulatory and

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lymphatic systems throughout the body. Aromatherapy strives to restore equilibrium in the body

so that the body can unlock its natural healing potential (Aroma SA, 2016).

Anethum graveolens is an essential oil found in the seeds of dill, it reduces intestinal spasm and

griping. The carminative volatile oil aids in digestion, passage of gas and stimulates the appetite

(Jana & Shekhawat, 2010). Piminella anisum oil, commonly known as aniseed oil is well known

for its ability to ease colic by reducing flatulence, hiccoughs and nausea. It is also helps with

abdominal distension and facilitates digestion. Foeniculum vulgare oil is commonly known as

fennel, it is indicated for constipation, colic, indigestion and flatulence (Roberts, 2012). The

posology of Anethum graveolens is 0.1g-0.3g, Piminella anisum is 0.3g and Foeniculum vulgare

tincture is 5ml-7.5ml (WHO, 2007).

Lavandula officinalis, commonly known as lavender oil, is an essential oil that has shown to

have no toxicity. It has significant antispasmodic properties and it also relaxes, calms and

alleviates stress (Roberts, 2012). It is frequently used for infantile colic and in a study conducted

on the effectiveness of aromatherapy massage using lavender oil as a treatment for infantile

colic, showed that it was effective in reducing colic symptoms (Çetinkaya & Başbakkal, 2012).

The posology of lavender is 1-4 drops internally (approximately equivalent to 20mg-80mg)

(WHO, 2007)

2.2.3.3 Ayurveda

Ayurveda is an ancient Indian healing technique that promotes a powerful mind-body health

system. The word Ayurveda means science of life, “Ayur” meaning life and “Veda” meaning

science or knowledge. Two main principles define Ayurveda: the mind and body are connected

and; nothing has more power to heal the body other than the mind. Ayurveda aims to promote a

harmonious balance between the physical body, mental state and spirituality. This is achieved by

focusing on lifestyle, diet, exercise, rest, relaxation and herbal treatments (Chopra, 2017).

Anethum graveolens is commonly known as dill and is used in ayurvedic medicine. It treats

abdominal discomfort, colic and stimulates digestion. Anethum graveolens is one of the

ingredients in Gripe Water® which relieves colic pain in infants and helps to expel flatulence in

children (Jana & Shekhawat 2010).

2.2.3.4 Phytotherapy

Phytotherapy or herbalism is the oldest medical practice in the world. It uses herbal medicine

that is derived from plants to treat illnesses. Phytotherapists use individualised treatments to

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balance and heal the body through herbal extracts (tinctures), syrups, creams, lotions or

ointments (South African Association of Herbal Practitioners, 2011).

Marticaria chamomilla flos and Achillea millefolium are common herbs that are used in infantile

colic. Marticaria chamomilla flos (chamomile) is very useful in young children where there is

irritability, restlessness and colic. There are episodes of colic where only small amounts of

flatulence are passed at a time. The intestines are in constant motion and there is griping in the

lower abdomen. Achillea millefolium (yarrow) is commonly indicated in conditions where there

is inflammation, pains, spasms, flatulence and dyspepsia. It has been used in gastrointestinal

disorders as an antispasmodic and an anti-inflammatory (Saeidnia, Gohari, Mokhber-Dezfuli &

Kiuchi, 2011). It also helps to alleviate pain from abdominal distension and trapped flatus (Jellin,

2015). The posology of Marticaria chamomilla flos in children is 0.6ml-2ml for a single dose

and Achillea millefolium is 5ml three times a day (WHO, 1999; WHO, 2009).

In a systematic review conducted on nutritional supplements and other complementary

medicines for infantile colic, the following was found: three studies on herbal supplements;

namely Foeniculum vulgare (fennel), Matricaria chamomilla (chamomile), Verbena (vervain),

Glycyrrhiza glabra (liquorice) and Melissa officinalis (lemon balm) all significantly improved

the colic symptoms; and reflexology showed a significant decrease in symptoms however there

was no difference between targeted and non-targeted reflexology (Perry et al., 2011).

2.2.3.5 Unani-Tibb

Unani-Tibb is a system of integrative medicine whose key principle is that the body has the

ability to heal itself and that it can maintain optimal health. It is based on the teachings of

Hippocrates and Galen, which was then developed into Unani-Tibb by Ibn Sina. Unani-Tibb

focuses on empowering the patient through knowledge on their body and their disorder.

Treatment is aimed at self-healing through lifestyle changes, herbal medication, hands-on

therapy such as massage, cupping and acupressure or dietary changes (The South African

Society of Integrative Medicine, 2015).

Unani-Tibb has a principle of temperaments which describes each person’s physical,

psychological, emotional and spiritual qualities. There are four categories: Sanguinous, which is

hot and moist; Phlegmatic, which is cold and moist; Melancholic, which is cold and dry; and

lastly Bilious, which is hot and dry. By knowing ones temperament you are able to make positive

lifestyle adjustments to improve your health and quality of life.

21

Colic is associated with the Phlegmatic temperament of cold and moist. This results in an

immature digestive system and difficulty in digesting milk and other foods. In order to correct

this, heat is needed to balance out the digestion and the coldness experienced (Tibb, 2016).

2.2.3.6 Naturopathy

Naturopathy is a natural approach to healing that encourages each person’s inherent-self healing

process. Naturopathy is focused on holistic treatment that minimises the risk of harm and

facilitates the body’s own healing ability. This is achieved through herbal and homeopathic

supplements, dietary and lifestyle adjustments, vitamins and mineral recommendations and

manipulative therapies (The American Association of Naturopathic Practitioners, 2016).

2.2.4 Over-the-counter complementary medicine for infantile colic

Infantile colic is one of the most common reasons parents take their infants to paediatric

healthcare practitioners (Rosen, 2007). Complementary medicine is often promoted in the

treatment of infantile colic however there has been no synthesis of information to provide

practitioners about their uses and benefits (Perry et al., 2011).

The recent growth in the South African complementary medicine market has resulted in

complementary medicines being available for purchase in numerous health shops, pharmacies

and some large supermarket chains. The majority of the medicines are currently unscheduled,

allowing for them to be purchased over-the-counter without a practitioner prescription (Gqaleni

et al., 2016).

The complementary medicine products that are currently available over-the-counter in South

Africa include:

Homeopathy

Aromatherapy

Ayurveda

Traditional Chinese medicine

Herbal preparations (Phytotherapy)

Unani-Tibb

Vitamins, minerals and supplements (Naturopathy) (Snyman, 2014).

Some of the following complementary products that are available over-the-counter for infantile

colic includes:

22

Colic Calm

Colic Calm is a homeopathic preparation that relieves abdominal discomfort, flatulence and

gastroesophageal reflux found in colic. Colic calm contains the following homeopathic remedies:

Matricaria chamomilla (3X) indicated for irritability, restlessness and hypersensitivity to pain;

Foeniculum vulgare (3X) for muscle spasms, indigestion and accumulation of gas; Carum carvi

(3X) indicated for indigestion and as an anti-spasmodic; Mentha piperita (3X) assists with gas

expulsion and gastrointestinal spasms; Zingiber officinale (3X) relieves nausea and promotes

gastric mobility; Melissa officinalis (3X) promotes sleep and reduces flatulence; Aloe socotrina

(3X) assists with diarrhoea, flatulence and abdominal cramping; Prunus spinosa (3X) relaxes

spasms; and Carbo vegetabilis (1X) provides relief from flatulence, abdominal distension

cramping, indigestion and belching. There are no reported side effects; however, due to the

activated charcoal (Carbo vegetabilis) the stool may become darker in colour, although this is

not harmful to the infant (Colic Calm, 2013).

Heel Nux Vomica Homaccord®

Nux Vomica Homaccord® is a homeopathic preparation indicated for functional disorders of the

gastrointestinal and hepatic regions. The main homeopathic remedies are Nux vomica (D2, D30,

D200, D1000), Bryonia cretica (D2, D6, D10, D15, D30, D200, D1000), Lycopodium clavatum

(D3, D200, D1000) and Citrillus colocynthis (D3, D10, D30, D200) which assist with abdominal

cramps, distension, flatulence, indigestion and detoxification. There are no known side effects

(Heel, 2014a).

A cohort study was conducted in four European countries to investigate the efficacy of Nux

Vomica Homaccord® drops on either gastric symptoms or intestinal symptoms. Results

indicated that more than 80% of cases rated the Nux Vomica Homaccord® as either very good or

good. Although the study was not specifically aimed at infantile colic but rather digestive

disorders, constipation and functional liver disturbances; the symptoms from these conditions

may overlap with symptoms found in colic (Heel, 2014a).

Heel Spascupreel®

Spascupreel® is available as homeopathic tablets and ampules indicated for spasms in the

stomach, intestine and gall bladder. Spascupreel® contains the following homeopathic remedies,

which are indicated for gastrointestinal cramps and spasms: Citrullus colocynthis (D4),

Ammonium bromatum (D4), Atropinum sulfuricum (D4), Veratrum album (D6), Magnesium

phosphoricum (D6), Gelsemium sempervirens (D6), Passiflora incarnate (D2), Agaricus (D4),

23

Chamomilla recutita (D3), Cuprum sulfuricum (D6) and Aconitum napellus (D6). There are no

reported side effects (Heel, 2014b).

A study was conducted on the effects of Spascupreel® versus hyoscine butylbromide

(Buscopan®) for gastrointestinal cramps in children younger than 12 years of age, and it was

found that both medications reduced severity of spasms, pain and frequency of crying. In

conclusion, parents who preferred to opt for alternative therapy for their infants/children could

make use of Spascupreel® as an effective and well tolerated option (Muller-Krampe, Oberbaum,

Dipl-Math, & Weiser, 2007).

Heel Viburcol®

Viburcol® is a homeopathic suppository for restless children with or without fever and who have

discomfort due to the pain caused by colic. The homeopathic remedies contained in each

suppository are: Chamomilla recutita (D1), Atropa Belladona (D2), Plantago major (D3),

Pulsatilla pratensis (D2) and Calcium carbonicum (D8), which reduces inflammation, pain,

irritability and fussiness. There are no known side effects or contraindications and Viburcol® is

safe to use from birth (Heel, 2014c).

In a controlled cohort study comparing the effects of Viburcol® with Paracetamol in children

younger than 12 years of age on restlessness and irritability associated with an illness, 93% of

the patients reported the overall efficacy of Viburcol® as either very good or good. Results also

indicated that 87% of children showed a significant improvement in their symptoms after 3 days

of treatment with Viburcol®. The study did not specifically focus on the effects that Viburcol®

has on infantile colic; nevertheless, the positive effects that it has on restlessness and irritability

can assist with colic symptoms (Muller-Krampe, Gottwald & Weiser, 2007).

Bayer Iberogast®

Iberogast® is a herbal product that is used to restore intestinal health and to relieve discomfort in

the stomach and abdomen. Iberogast® (100ml) contains the following herbs that relieves

abdominal cramps and spasms, flatulence, indigestion and restore normal gastrointestinal

motility: Iberis amara (bitter candytuft) (15ml), Angelica archangelica (angelica) (10ml),

Matricaria chamomilla (chamomile) (20ml), Silybum marianum (milk thistle) (10ml), Melissa

officinalis (lemon balm) (10ml), Mentha piperita (peppermint) (5ml), Chelidonium majus

(greater celandine) (10ml), Carum carvi (caraway fruits) (10ml) and Glycyrrhiza glabra

(liquorice) (10ml) (Bayer, 2015). In a study conducted on the safety and efficacy of Iberogast®,

it was found that there are no serious adverse effects. However, hypersensitivity reactions such

24

as pruritus, dyspnoea or skin reactions may occur rarely (Ottillinger, Storr, Malfertheiner &

Allescher, 2012).

Herbal teas

Various herbal teas mainly include Matricaria chamomilla (chamomile), Lavandula angustifolia

(lavender), Foeniculum vulgare (fennel), Anethum graveolens (dill), Pimpinella anisum

(aniseed), Mentha piperita (peppermint), Glycyrrhiza glabra (liquorice) and Achillea millefolium

(yarrow), which are all known for their ability to soothe the digestive tract, relieve colic and

spasmodic pains, relax and calm as well as reduce flatulence, dyspepsia and nausea (Jellin,

2015).

Natura® Magen

Natura® Magen is a homeopathic preparation aiding in soothing the digestive mucosa and is

therefore effective in the treatment of colic, dyspepsia, indigestion, digestive upsets, nausea and

vomiting. The formulation reduces nausea, vomiting, belching and bloating after eating and

decreases cramping, gastric pain and flatulence. Magen contains the following homeopathic

remedies: Anamirta cocculus (D8), Antimonium crudum (D10), Arsenicum iodatum (D6), Atropa

belladonna (D8), Carbo vegetabilis (D30), Cephaelis acuminata (D8), Cinchona succirubra

(D3), Daphne mezereum (D8), Magnesium phosphoricum (D10) and Strychnos nux-vomica (D4).

There are no known side effects (Natura, 2016a).

A randomised, double-blind placebo controlled study was conducted to establish the effect of

Magen on infantile colic. In contrast to the placebo group, Magen was found to be an effective

form of treatment for colic (p=0.0005), with most of the improvement occurring after 3 days of

use. Due to the small sample size of 30 participants, a larger scale study should be conducted to

further validate the product’s efficacy on infantile colic (Pestana-Caldeira, 2010).

Natura® Sedaped

Sedaped is a homeopathic preparation for spasmodic colic, irritability, vomiting and diarrhoea.

The homeopathic mode of action is to reduce spasmodic pains, provide an analgesic action and

relieve nervous hypersensitivity. Sedaped contains the following homeopathic remedies:

Atropium sulphuricum (D10) reducing inflammation and neuralgic pains; Banisteropsis caapi

(D60) reducing hypersensitivity; Cuprum aceticum (D30) for spasmodic abdominal pains;

Gelsemium sempervirens (D8) for inflammation; Magnesium phosphoricum (D10) for spasmodic

colic pains and acts like an analgesic; Veratrum viride (D8) assists with hiccoughs; Verbena

officinalis (D8) works as a general anti-spasmodic; and Zincum metallicum (D10) assists with

25

flatulent colic, hiccoughs and muscular twitches. There are no reported side effects (Natura,

2016b).

Sister Lilian ColicCare

ColicCare is comprised of tissue salts and homeopathic remedies that assist in the treatment of

cramps, muscle spasms and crying. The following remedies reduce the colic symptoms:

Magnesium phosphoricum (D6), Natrum phosphoricum (D6), Chamomilla vulgaris (D6),

Lycopodium clavatum (30CH), Atropa belladonna (30CH), Dioscorea vilossa (30CH) and

Plumbum metallicum (30CH). There are no known adverse effects or contraindications (Sister

Lilian Remedies, 2016).

Tummy Calm®

Tummy Calm® is a homeopathic medication that relieves the symptoms of colic such as

flatulence, bloating and abdominal discomfort. Tummy Calm® contains the following

homeopathic remedies: Calcarea phosphoricum (12X), Carbo vegetabilis (2X), Matricaria

chamomilla (12X), Citrillus colocynthis (12X), Lycopodium clavatum (12X), Moschus

moschiferus (12X), Natrum muriaticum (12X), Silicea terra (12X) and Thuja occidentalis (12X).

The homeopathic remedies are indicated for abdominal distension; abdominal cramping;

diarrhoea; flatulence; belching; hiccoughs; indigestion as well as soothing and calming the

infant. There are no reported side effects however, due to the activated charcoal (Carbo

vegetabilis), the stool may become darker or black in colour. This is not harmful to the infant and

is only temporary (Tummy Calm, 2014).

Himalaya Bonnisan®

Bonnisan® is based on Unani-Tibb and is a herbal formula that relieves muscle spasms, protects

the gastrointestinal mucosa and expels gas through its key ingredients of Anethum graveolens

(0.0018ml per 5ml) oil, Tinospora gulancha (0.5ml per 5ml) and Phyllanthus emblica (0.5ml per

5ml). This formula alleviates the abdominal symptoms of colic. There are no known side effects

if taken as per the prescribed dosage (Himalaya, 2016).

Tibb Bonnycare

Bonnycare is based on Unani-Tibb principles and is a herbal formula that assists with infantile

colic, flatulence and gastrointestinal discomfort. Bonnycare (5ml) contains Anethum graveolens

oil (0.0018ml) and Tinospora cordifolia (1mg) that acts as a carminative and antispasmodic in

colic; Terminalis chebula (0.5mg) is an antibacterial that prevents diarrhoea; Cichorium intybus

(0.5mg) and Emblica officinalis (0.5mg) are antioxidants and normalises the gastrointestinal

flora; Piper longum (0.5mg); and Elletaria cardamomum (0.5mg) supports digestion and

26

provides a carminative effect on the gastrointestinal tract. The combination of these herbs

provides relief from infantile colic. There are no reported adverse reactions (Tibb Health

Sciences, 2011).

Telament Paediatric Gripe Water®

The Gripe Water contains sodium bicarbonate (50mg per 5ml) and Anethum graveolens oil

(2.15mg per 5ml) that is an antispasmodic and antiflatulent. There are no known adverse

reactions however, hypersensitivity to the ingredients due to allergies have been reported in rare

cases (Adcock Ingram, 2014b).

Woodwards Gripe Water®

The Gripe Water contains Anethum graveolens oil (2.3mg per 5ml) and sodium hydrogen

carbonate (52.5mg per 5ml) that relieves abdominal pain and is an antacid and antiflatulent.

There are no reported side effects however, infants who are allergic to the ingredients may

experience hypersensitivity reactions (Woodwards, 2017).

Lennon Behoedmiddel® vir Kinders

Behoedmiddel® is an antacid containing magnesium carbonate and prepared chalk, which helps

to relieve gastro-oesophageal reflux and abdominal discomfort. Possible adverse reactions from

magnesium carbonate are diarrhoea and mucosal irritation and the prepared chalk may cause

constipation (Lennon, 2000).

Probiotics

Various probiotics are available over-the-counter and they are frequently used to reduce colic by

promoting bowel mobility and intestinal health. It is believed that the possible mechanism of

action of the probiotics is that it improves bowel motility and function thus reducing possible

visceral pain. The use of the probiotic, Lactobacillus reuteri, has shown to be more effective in

the treatment of colic than simethicone or placebo (Savino et al., 2014a). A randomised study

consisted on ninety breastfed colic infants who were randomly assigned to receive either the

Lactobacillus reuteri ATCC 55730 or simethicone for 28 days. Results showed that 95% of

participants receiving L. reuteri had a significant decrease in the crying time compared to the 7%

of participants in the simethicone group. L. reuteri improved the colic behaviour within seven

days of treatment (Savino & Tarasco, 2010).

A double-blind, randomised, placebo-controlled study was conducted on the probiotic

Lactobacillus reuteri DSM 17938 (daughter strain of L. reuteri ATCC 55730) in reducing colic

symptoms in breastfed infants. Infants receiving L. reuteri had an improvement in colic

27

symptoms and showed a significant decrease (p=0.045) in crying and fussing time. The results

suggested that L. reuteri may induce changes in the gut microbiota, particularly to the levels of

Escherichia coli. Previous studies have indicated a drastic discrepancy in intestinal microbiota

between colic and non-colic infants suggesting inadequate levels of lactobacilli in colic infants.

The gastrointestinal tracts of infants with colic tend to be colonised with gas forming microbiota

such as Clostridium difficile, Escherichia species and Klebsiella species, which leads to

abdominal discomfort, distension and flatulence (Chau et al., 2015).

In a study conducted on the quantitative differences in lactobacillus species found in breastfed

colic infants compared to non-colic infants, it was found that breastfed colic infants had fewer

lactobacilli. Furthermore a second study was conducted and found that Lactobacillus

acidophilus was less prevalent in colic infants. However, Lactobacillus brevis and Lactobacillus

lactis was found to be more prevalent in colic infants. Results indicated that some strains of

lactobacillus protect against gastrointestinal neuroimmune disruption and reduce pain, whereas

others contribute to ailments or diseases (Rosen, 2007).

In a systematic evaluation conducted on probiotic and synbiotic safety in infants less than two

years of age, it was found that in all 57 clinical trials and eight follow up studies, probiotics and

synbiotics are safe for infants to use (van den Nieuwboer, Claassen, Morelli, Guarner &

Brummer, 2014).

28

CHAPTER THREE

METHODOLOGY

3.1 Introduction

The aim of the quantitative-descriptive design study was to determine the perceived

effectiveness of complementary medicine by mothers of infants with colic in Gauteng, by means

of an Infantile Colic Questionnaire (Appendix G). The survey was completed on a voluntary

basis as a convenience sample. Prior permission was attained from the University of

Johannesburg’s (UJ) Higher Degrees Committee (Appendix A) and the University of

Johannesburg’s Research Ethics Committee (Appendix B) before commencement of the

research.

3.2 Research Sample

The research sample consisted of 150 participants (Wilson Van Voorhis & Morgan, 2007). The

sample consisted of mothers aged between 18-45 years who have/had a child/children with

infantile colic and used complementary medicine as a form of treatment. A search engine was

used to randomly select various places from different regions in Gauteng. Weleda Pharmacies

and Wellness Warehouse were selected as both are popular complementary medicine retailers

meeting inclusion criteria. Schools and baby clinics were also chosen due to its great

accessibility to the required sample group, mothers aged between 18-45 years who have/had

child/children with infantile colic. Various businesses were selected at random to allow for

unsystematic selection outside of the aforementioned sources. Recruitment of participants

occurred through word-of-mouth and advertising flyers (Appendix C), which were placed around

the following baby and health clinics; health shops; nursery schools; and health and beauty

businesses in the Gauteng region, with relevant permission prior (Appendix D):

Weleda Pharmacy in Bryanston

Weleda Pharmacy in Fourways

Wellness Warehouse in Bedfordview

Mary’s Little Lambs Baby Clinic in Edenvale

Bedfordview Mother and Baby Clinic in Bedfordview

Baker Street Pharmacy Clinic in Edenvale

Edenvale Private Nursery School in Edenvale

St Anthony’s College in Mulbarton

29

Hair Related in Edenvale

Wellbean Pilates Studio in Edenvale

New Era Chickens in Modderfontein

3.2.1. Inclusion criteria

Prospective participants needed to meet the following criteria in order to participate in the

research study. Mothers were included who:

Were aged between 18-45 years;

Have/had one or more children who suffer/suffered from symptoms of infantile colic; and

Are using/have used complementary medicine as a form of treatment for infantile colic.

3.2.2. Exclusion criteria

Participants were excluded from the study if:

They have never used or heard of complementary medicine

3.3. Research Procedure and design

A quantitative-descriptive design was used whereby data was collected through a randomised

cross-sectional survey. A total of 152 participants were recruited via an advertisement and word

of mouth. The surveys were distributed at various baby and health clinics; health shops; nursery

schools; and health and beauty businesses in the Gauteng region. Interested participants were

given an Information Leaflet (Appendix E) that explained the purpose and procedure of the

study. All interested prospective participants were given a Consent Form (Appendix F) to

complete and once consent had been given, participants then completed the Infantile Colic

Questionnaire (Appendix G). Participants were required to answer the questionnaire by crossing

the appropriate response box or by a short written response. This allowed for ease of answering

the questions and limited the time it took to complete the survey, which encouraged greater

participation in the study. Participants were provided with a private area to complete the survey

in. The survey took approximately 8-10 minutes to complete. On completion, the survey was

placed into a sealable envelope and placed into a lockable box. All completed surveys were

treated as strictly confidential and only the researcher, supervisor and statistician had access to

the information. No identifying data was requested or permitted on the survey.

The researcher spent several days at each aforementioned place recruiting participants. Staff

members from each place were also recruited for assistance and thoroughly briefed on the

research procedure. A document containing the research procedure was attached to the lockable

30

box (Appendix H). The staff members were requested to provide each interested participant with

a new envelope containing an Information Leaflet, Consent Form and Questionnaire as well as a

clipboard and pen. Participants were guided to the identified private area to complete the survey

in and to allow for privacy. Once completed, staff members collected the envelopes with the

documents inside, ensured the envelope was sealed and placed a ‘completed’ label on the

envelope seal. The lockable box was stored in a safe place within the various places. Staff

members were not permitted to answer any questions pertaining to the survey. The researcher

could be contacted telephonically to answer any queries and to collect the completed surveys.

3.4 Reliability and validity measures

The Infantile Colic Questionnaire is used as a reliable tool in research related to infantile colic

and reflux (Murphy, 2015). Research studies on colic in new-borns have utilised the

questionnaire (Appendix I) (Hodge & Murphy, 2014). Development of a valid and reliable

questionnaire is important as it reduces measurement errors by utilising several steps to test the

questionnaires used for data collection (Radhakrishna, 2007). Prior to the commencement of the

study, five mothers who met the study criteria were asked to participate in a pilot study, pre-

testing the questionnaire. Findings were analysed and changes were made accordingly, with

expert supervisory input from the statistician (Kuhudzai, 2016a). The results recorded were not

utilised during analysis of the study.

3.5 Data collection and analysis

Statistical analysis was prepared with the assistance of Statkon using SPSS Statistics (Statistical

Package for Social Sciences) (version 23). The following tests were utilised:

Frequencies and custom tables

Multiple response analysis for questions where more than one answer can be selected.

Open ended responses (Kuhudzai, 2016b).

Data presented as frequencies and custom tables provided information on infantile colic and the

usage of complementary medicine for infantile colic by mothers in Gauteng (Kuhudzai, 2016b).

3.6 Ethics

This study aimed to uphold and protect the well-being of all participants. It was explained to all

participants that they have the right to anonymity, privacy and confidentiality. The participants

were informed about the requirements, duration and purpose of the study. Each participant was

given an Information Leaflet (Appendix E) as well as a Consent Form (Appendix F), which was

31

signed before the study commenced. The researcher was honest and transparent and was

available to the participants if they had any other questions and concerns about the study. No

identifying information was requested from the participant ensuring anonymity throughout the

study. The completed surveys were placed in a sealable envelope and stored in a lockable box

which only the researcher, supervisor and statistician had access to, ensuring confidentiality.

Completion of the survey took place in a private area, thus ensuring privacy and confidentiality.

The research did not infringe on any human rights, or deceive on any findings. There were no

anticipated risks by participating in this study. It was stressed that this study was voluntary and

that participants had the right to withdraw from the study at any time, up until the questionnaire

had been submitted, for whatever reason and without consequence. Feedback of the results of the

study was provided to the participants who requested it.

Ethical clearance was obtained from the Faculty of Health Sciences, Research Ethics Committee

(REC-01-126-2016) and Higher Degrees Committee (HDC-01-46-2016) prior to the conduction

of the research (Appendix A and B).

32

CHAPTER FOUR

RESULTS

4.1 Introduction

The research study aimed to establish the use and perceived effectiveness of complementary

medicine for infantile colic. A further objective of the study was to gather more information on

infantile colic, which is a poorly understood condition (Savino et al., 2014a). The data was

collected through the Infantile Colic Questionnaire (Appendix G). A pilot study was conducted,

pre-testing the questionnaire. Adjustments were made to questions: 4; 8; 11; 12; 15; and 24 to

allow for easier statistical data collection. Changes were made through expert advisory input

from the statistician (Kuhudzai, 2016a).

Participants of the study consisted of mothers who have/had one or more children who

suffer/suffered from colic and used complementary medicine as a form of treatment. The

participant sample was drawn from various areas within Gauteng, different socioeconomic areas

and different types of clinics/businesses/shops in order to allow for the best data representation

of the area. The chosen data collection areas were selected by using an internet search engine and

through popular areas that were frequently visited by mothers, as recommended by the

community. The survey was conducted between October and December 2016.

4.1.1 Sample

A total of 220 questionnaires were printed and distributed to the various data collection areas in

Gauteng. A total of 157 questionnaires were completed of which only 152 questionnaires were

utilised in the data collection as they were completed correctly and with no missing answers.

4.2 General

4.2.1 Age of mother/respondent

The participants were asked to provide their age as part of the inclusion criteria. The age of the

participants was spread across the age groups of 18-29, 30-39 and 40-45. As seen in Figure 4.1,

majority of the respondents were aged between 30-39 years making up 44.1% (n=67) of the

sample; then 18-29 years at 32.2% (n=49); and 40-45 years at 23.7% (n=36).

33

Figure 4.1: Age of respondents in 10 year increments

4.2.2 Number of children

Participants were asked how many children they had. As seen in Figure 4.2, 40.8% (n=62) had

one child; 39.5% (n=60) had two children; 15.1% (n=23) had three children; 4% (n=6) had four

children; and 0.66% (n=1) had five or more children.

Figure 4.2: Number of children

32.2% (n=49)

44.1% (n=67)

23.7% (n=36)

0

10

20

30

40

50

60

70

80

18-29 years 30-39 years 40-45 years

Nu

mb

er o

f p

arti

ciap

nts

(n)

Age of respondent

40.8% (n=62)

39.5% (n=60)

15.1% (n=23)

4% (n=6) 0.6%

(n=1) 0

10

20

30

40

50

60

70

1 Child 2 Children 3 Children 4 Children 5 Children ormore

Nu

mb

er o

f P

aric

ipan

ts (

n)

Number of children

34

4.2.3 Gender of your child/children

Participants were asked the gender of their child/children. From Figure 4.3, the combined total

of each gender of the children was calculated in which 55% (n=156) of participants’ children are

female and 45% (n=126) are male.

Figure 4.3: Gender of child

4.2.4 Diagnosis of colic

Participants were asked whether they had self-diagnosed their baby as having colic or if their

baby was diagnosed by a healthcare practitioner as having colic.

As seen in Figure 4.4, 56.6% (n=86) of participants indicated that they did not self-diagnose their

baby as having colic; whilst 43.4% (n=66) self-diagnosed their baby as having colic. Further to

this in Figure 4.5, 76.3% (n=116) of participants’ children were diagnosed by a health care

practitioner as having colic and 23.7% (n=36) were not diagnosed by a health care practitioner.

48% (n=73)

22.4% (n=34)

10% (n=15)

2.6% (n=4)

0% (n=0)

52% (n=79)

36.8% (n=56)

10.5% (n=16)

2.6% (n=4)

0.6% (n=1)

0

10

20

30

40

50

60

70

80

90

First born Second born Third born Fourth born Fifth born

Nu

mb

er o

f P

arti

cip

ants

(n

)

What is the gender of your child/children:

Male Female

35

Figure 4.4: Self-diagnosis of colic

Figure 4.5: Colic diagnosis by a health care practitioner

4.2.5 Occurrence of colic

Participants were asked at what age their baby’s colic started. From Figure 4.6 it is evident that

in most instances the colic started within the first 4-8 weeks of age, with a combined total of

88.8% (n=135) of the sample experiencing colic during that time; 28.3% (n=43) of participants’

babies experienced colic at 5-6 weeks of age; 24.3% (n=37) at 6-7 weeks; 23% (n=35)

experienced colic at 4-5 weeks; and 13.2% (n=20) at 7-8 weeks. As seen in the Figure 4.6, a

combined total of 11.1% (n=17) experienced colic after 8 weeks of age of which 3.9% (n=6) at

8-9 weeks; 2.6% (n=4) at 9-10 weeks; 2% (n=3) at 11-12 weeks; and 1.3% (n=2) at 10-11 weeks

and 12-13 weeks.

56.6% (n=86)

43.4% (n=66)

0

10

20

30

40

50

60

70

80

90

100

No Yes

Nu

mb

er o

f P

arti

cip

ants

(n

)

Did you self-diagnose your baby as having colic?

23.7% (n=36)

76.3% (n=116)

0

20

40

60

80

100

120

140

No Yes

Nu

mb

er o

f P

arti

ciap

ants

(n

)

Was your baby diagnosed by a health care practitioner as having colic?

36

Figure 4.6: Age the colic started

Participants were asked whether their suffering baby was their first, second, third, fourth or fifth

child. As seen in Figure 4.7, 68.4 % (n=104) of the suffering children were the first born; 38.8%

(n=59) were their second born; 9.9% (n=15) were their third born; 0.7% (n=1) were their fourth

born with none of the suffering children being their fifth born or more.

Figure 4.7: Which child suffered from colic?

23% (n=35)

28.3% (n=43)

24.3% (n=37)

13.2% (n=20)

3.9% (n=6) 2.6%

(n=4) 1.3% (n=2)

2% (n=3)

1.3% (n=2)

0

5

10

15

20

25

30

35

40

45

50

4-5 weeks 5-6 weeks 6-7 weeks 7-8 weeks 8-9 weeks 9-10weeks

10-11weeks

11-12weeks

12-13weeks

Nu

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(n

)

At what age did your baby’s colic start?

68.4% (n=104)

38.8% (n=59)

9.9% (n=15)

0.7% (n=1)

0% (n=0)

0

20

40

60

80

100

120

First born Second born Third born Fourth born Fifth born or more

Nu

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(n

)

Is/were your suffering child/children your:

37

Participants were then asked how many of their children experienced colic, 82.2% (n=125) of

participants indicated that only one of their children experienced colic; 15.1% (n=23) indicated

that two of their children experienced colic; and 2.6% (n=4) of participants indicated that three

of their children experienced colic. Please refer to Appendix J for bar graph J.1.

4.2.6 Antenatal class attendance

Participants were asked whether they attended an ante-natal class. If the participants had

attended an ante-natal class, the participants were then asked whether they had learned enough in

the class to care for their new-born in the post-natal stages.

As seen in Figure 4.8, 53% (n=81) of participants responded that they had attended an ante-natal

class; whilst 47% (n=71) of participants had not attended an ante-natal class.

Figure 4.8: Antenatal class attendance

Of the 81 participants that had responded yes to having attended an ante-natal class: 67.9%

(n=55) of participants felt that the ante-natal classes taught them enough to care for their new-

borns in the post-natal stage; whilst 32.1% (n=26) did not feel that the ante-natal class prepared

them sufficiently. Please refer to Appendix J, bar graph J.2. Participants who did not feel

sufficiently prepared were asked to state what would have better prepared them. A few

participants reported that they needed more information on what colic was and how to handle a

child with colic as well as methods on soothing the child. Additional responses may be found in

Appendix K.

47% (n=71)

53% (n=81)

66

68

70

72

74

76

78

80

82

No Yes

Nu

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(n

)

Did you attend an antenatal class?

38

4.3 Behaviours

4.3.1 Crying

Participants were asked, on average, how many times in a single day their babies experienced

colic and how long the bout of colic would last for.

As seen in Figure 4.9, 32.2% (n=49) of babies experienced colic twice a day; 27.6% (n=42) three

times a day; 22.4% (n=34) once a day; 9.2% (n=14) four times a day; 7.2% (n=11) five times a

day; and 1.3% (n=2) more than five times a day. Two participants responded with different

answers: one saying that the child experienced colic the whole time and that it only subsided

after bath time and up until 12am; the second participant said that her child experienced colic

every 2 hours, which was after every feed.

Figure 4.9: Incidence of colic in a day

Further to this, Figure 4.10 shows that 31.6% (n=48) of babies experienced colic for 11-20

minutes at a time; 26.3% (n=40) for 21-30 minutes; 24.3% (n=37) of babies experienced colic

for 10 minutes or less; 8.6% (n=13) for 31-45 minutes; 5.3% (n=8) experienced colic for more

than one hour; and 3.9% (n=6) for 46-60 minutes.

0% (n=0)

22.4% (n=34)

32.2% (n=49)

27.6% (n=42)

9.2% (n=14) 7.2%

(n=11)

1.3% (n=2)

0

10

20

30

40

50

60

None Once Twice Three times Four times Five times More thanfive times

Nu

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(n

)

On average, how many times does/did your baby experience colic in a day?

39

Figure 4.10: Duration of colic episode

Participants were asked how many times a day their baby cried without being able to soothe

them. As seen in Figure 4.11, 25.7% (n=39) of participants stated that they could not soothe their

baby twice in a day; 23.7% (n=36) of participants stated that they could not soothe their baby

either once or three times in the day; 11.2% (n=17) of participants felt that they were either not

able to soothe their baby four times a day or that they were always able to soothe their baby; and

3.3% (n=5) couldn’t soothe their baby five times. Two participants who responded “other” stated

that they weren’t able to soothe their child countless times or that they couldn’t soothe their child

at all.

Figure 4.11: Ability to soothe the colic baby

24.3% (n=37)

31.6% (n=48)

26.3% (n=40)

8.6% (n=13)

3.9% (n=6)

5.3% (n=8)

0

10

20

30

40

50

60

0-10 minutes 11-20 minutes 21-30 minutes 31-45 minutes 46-60 minutes More than 1hour

Nu

mb

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f P

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ants

(n

)

On average, how long does/did your baby experience a bout of colic?

11.2% (n=17)

23.7% (n=36)

25.7% (n=39) 23.7%

(n=36)

11.2% (n=17)

3.3% (n=5) 1.3%

(n=2)

0

5

10

15

20

25

30

35

40

45

None Once Twice Three times Four times Five times Other

Nu

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(n)

How many times does/did your baby cry without you being able to soothe him/her in a day?

40

Participants were asked how many days a week and for how long their baby cried. As seen in

Figure 4.12, 38.8% (n=57) of participants stated that their baby cried for between 1-10 minutes

at a time; 32.9% (n=50) of participants stating that their baby's crying lasted for 11-20 minutes;

18.4% (n=28) cried for 21-30 minutes; 6.6% (n=10) cried for 31-40 minutes; 3.3% (n=5) cried

for 51-60 minutes; and 1.3% (n=2) cried for 41-50 minutes.

Figure 4.12: Duration of crying at any given time

As seen in Figure 4.13, 22.4% (n=34) cried for two days a week; 21.7% (n=33) cried for three

days a week; 11.8% (n=18) cried for five days a week or every day of the week; 11.2% (n=17)

cried for four days a week; and 6.6% (n=10) cried for six days a week.

Figure 4.13: Frequency of crying over a period of a week

38.8% (n=57)

32.9% (n=50)

18.4% (n=28)

6.6% (n=10)

1.3% (n=2)

3.3% (n=5)

0

10

20

30

40

50

60

1-10 minutes 11-20 minutes 21-30 minutes 31-40 minutes 41-50 minutes 51-60 minutes

Nu

mb

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f P

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ants

(n

)

On average, how long does/did your baby cry for at a time?

0% (n=0)

14.5% (n=22)

22.4% (n=34)

21.7% (n=33)

11.2% (n=17)

11.8% (n=18)

6.6% (n=10)

11.8% (n=18)

0

5

10

15

20

25

30

35

40

No days 1 day 2 days 3 days 4 days 5 days 6 days 7 days

Nu

mb

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nts

(n

)

How many days in a week does/did your baby cry like this?

41

Participants were asked what was causing their baby to cry so much, with more than one answer

being able to be selected. As seen in Figure 4.14, 83.6% (n=127) cried as a result of pain or

discomfort; 73% (n=111) cried due to tiredness; 62.5% (n=95) of participants felt that a dirty

nappy was the cause of their baby crying; 43.4% (n=66) stating that irritation was the cause;

41.4% (n=63) of participants stated that hunger was the cause of their baby crying; 32.2% (n=49)

felt that their baby was fed up; 24.3% (n=37) stated that the cause was due to the mothers

tension; 20.4% (n=31) believed it was due to their child being fussy; and 9.2% (n=14) believed

their child was crying so much due to them being nervous.

Figure 4.14: Believed reasons for excessive crying

4.3.2 Timing of colic symptoms

Participants were asked when the majority of the colic symptoms occurred as well as the time of

day that the majority of the symptoms occurred. As seen in Figure 4.15, 63.8% (n=97) of colic

symptoms occurred straight after feeding; 23.7% (n=36) occurred one hour after feeding; 5.9%

(n=9) of participants noticed colic symptoms two hours after feeding; 5.3% (n=8) of participants

noticed the symptoms four hours after feeding; and 1.3% (n=2) after three hours of feeding.

41.4% (n=63)

62.5% (n=95)

24.3% (n=37)

83.6% (n=127)

20.4% (n=31)

43.4% (n=66)

9.2% (n=14)

32.2% (n=49)

73% (n=111)

0

20

40

60

80

100

120

140

Hunger Dirty nappy Yourtension

Pain ordiscomfort

Fussy Irritated Nervous Fed up Tired

Nu

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(n

)

From the list tick what you believe is/was causing your baby to cry so much? More than one answer is allowed.

42

Figure 4.15: Timing of colic symptoms in relation to feeding

In Figure 4.16 it can be seen that: 40.1% (n=61) of participants noticed colic symptoms in their

babies in the evening; 19.7% (n=30) of participants noticed their babies experiencing colic in

either the morning or afternoon; 10.5% (n=16) noticed it between 12am-6am; and 9.9% (n=15)

noticed the colic symptoms all the time.

Figure 4.16: Time of day the colic occurred

63.8% (n=97)

23.7% (n=36)

5.9% (n=9) 1.3%

(n=2)

5.3% (n=8)

0

20

40

60

80

100

120

Straight afterfeeding

One hour afterfeeding

Two hours afterfeeding

Three hours afterfeeding

Four hours afterfeeding

Nu

mb

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ants

(n

)

When do/did the majority of the colic symptoms occur?

19.7% (n=30)

19.7% (n=30)

40.1% (n=61)

10.5% (n=16)

9.9% (n=15)

0

10

20

30

40

50

60

70

Morning Afternoon Evening 12am-6am All the time

Nu

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(n

)

What time of day do/did majority of the colic symptoms occur?

43

4.3.3 Reasons for discomfort

Participants were asked what they believed was making their babies feel uncomfortable,

allowing for more than one answer to be selected. Most participants believed their baby's

symptoms related in some way to wind or bowel movements: 75% (n=114) was due to build-up

of wind; 59.2% (n=90) from difficulty bringing up wind; 57.2% (n=87) believed that discomfort

caused the colic symptoms; and 55.3% (n=84) said it was due to bowel movements.. Other

believed aetiologies can be seen in Figure 4.17, 46.7% (n=71) felt it was due to fatigue; 39.5%

(n=60) thought it was due to feeling full; 34.2% (n=52) from a dirty nappy; 33.6% (n=51) due to

hunger; 30.3% (n=46) from overfeeding; 27% (n=41) as a result of formula choice; 20.4%

(n=31) felt it was from fast flowing breast milk; 19.7% (n=30) due to an under developed

digestive system; 17.8% (n=27) as a result of being bottle fed too fast; 16.4% (n=25) due to a

large supply of breast milk; 13.8% (n=21) from the mother’s tension; 13.2% (n=20) felt it was

caused by vaccinations; 12.5% (n=19) due to the food from the mother’s diet; 9.9% (n=15) either

due to food allergies or a growth spurt; and 9.2% (n=14) felt that it was due to the environment

that the baby was in. Three participants stated that the reason they believed their child was

uncomfortable was due to genetics, “bad digestive system”, frequent breastfeeding due to

insufficient milk supply and that their baby was premature.

44

Figure 4.17: Reasons for discomfort

4.3.4 Vomiting

Participants were asked whether their babies ever vomited after being fed and if they considered

this as normal. In Figure 4.18, 71.1% (n=108) of participants said that their baby had vomited

after being fed; and 28.9% (n=44) of participants said that their baby didn’t vomit after a feed.

Further to this, 67.1% (n=102) of participants believed this was not a normal thing for babies to

do after being fed; and 32.9% (n=50) believed it was normal. This can be seen in Appendix J, bar

graph J.3.

9.2% (n=14)

9.9% (n=15)

9.9% (n=15)

12.5% (n=19)

13.2% (n=20)

13.8%(n=21)

16.4% (n=25)

17.8% (n=27)

19.7% (n=30)

20.4% (n=31)

27% (n=41)

30.3% (n=46)

33.6% (n=51)

34.2% (n=52)

39.5% (n=60)

46.7% (n=71)

55.3% (n=84)

57.2% (n=87)

59.2% (n=90)

75% (n=114)

0 20 40 60 80 100 120

Environment

Growth spurt

Food allergy

Food from mothers diet

Vaccinations

Your tension

Large supply of breast milk

Being bottle fed too fast

Undeveloped digestive…

Fast flowing breast milk

Formula choice

Overfeeding

Hunger

Dirty nappy

Feeling full

Fatigue

Bowel movements

Discomfort

Difficulty bringing up wind

Build-up of wind

Number of Participants (n)

From the list, tick what you believe was making your baby feel uncomfortable? More than one answer can be selected:

45

Figure 4.18: Vomiting milk after a feed

4.3.5 Sleeping

Participants were asked what caused their baby to sleep. In Figure 4.19, 55.9% (n=85) saying

that it was hard to say whether it was because the baby was comfortable and tired, or because the

baby was exhausted from crying; 32.2% (n=49) stated that they believed the baby slept because

he/she was comfortable and tired; and 11.8% (n=18) stating that it was because the baby was

exhausted from crying.

Figure 4.19 Reason for sleeping

28.9% (n=44)

71.1% (n=108)

0

20

40

60

80

100

120

No Yes

Nu

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ants

(n

)

Does/did your baby ever vomit milk after a feed?

32.2% (n=49)

11.8% (n=18)

55.9% (n=85)

0

10

20

30

40

50

60

70

80

90

Comfortable and tired Exhausted from crying Hard to say

Nu

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(n

)

Do you feel your baby sleeps mostly because he/she felt:

46

4.4 Feeding

With regards to feeding, participants were asked how they fed their baby; if they changed their

baby’s feeding methods in order to try to ease the colic symptoms; if they fed on demand from

birth; and if they increased feeding between 5pm and 12am. As seen in Figure 4.20, 44.7%

(n=68) of participants used a combination of breastfeeding and bottle feeding; 33.6% (n=51) of

participants breastfed their babies; 17.1% (n=26) bottle fed formula; while 4.6% (n=7) bottle fed

breast milk.

Figure 4.20: Feeding methods

In bar graph J.4 in Appendix J, 64.5% (n=98) of participants changed their feeding method in

order to try and ease the colic symptoms while 35.5% (n=54) didn’t adjust their feeding method.

Further to this, 71.1% (n=108) of participants fed on demand from birth and 54.6% (n=83) of

participants increased feeding in the evening hours (being between 5pm and 12am). Please refer

to Appendix J, bar graph J.5 and J.6.

4.5 Burping

Participants were asked if they consciously burped their baby, with 78.3% (n=119) saying that

they did, as seen in Figure 4.21.

36.6% (n=51)

4.6% (n=7)

17.1% (n=26)

44.7% (n=68)

0

10

20

30

40

50

60

70

80

Breastfeed Bottle feed breastmilk

Bottle feed formula Combination ofbreast and bottle

Nu

mb

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(n

)

Breastfeed, bottle feed or combination

47

Figure 4.21: Burping

4.6 Sucking for comfort

Participants were asked if their baby used a dummy or sucked his/her thumb to soothe. As seen

in Figure 4.22, 71.1% (n=108) stated that this was the case.

Figure 4.22: Use of a dummy or thumb to soothe

4.7 Methods to soothe baby

Participants were asked if any of the options as per the graph were effective in calming their

baby. The most effective/common methods were: 59.2% (n=90) bouncing or jiggling; and 51.3%

(n=78) pacing. Other less effective methods include: 44.7% (n=68) baby massage; 44.1% (n=67)

pushing in a pram; 34.9% (n=53) hot bath; 34.2% (n=52) front pack or sling; 30.9% (n=47)

21.7% (n=33)

78.3% (n=119)

0

20

40

60

80

100

120

140

No Yes

Nu

mb

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f P

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cip

ants

(n

)

Do/did you consciously burp your baby?

28.9% (n=44)

71.1% (n=108)

0

20

40

60

80

100

120

No Yes

Nu

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(n

)

Does/did your baby use a dummy or suck his/her thumb to soothe?

48

swaddling; 22.4% (n=34) lullabies; 19.1% (n=29) drinking warm water; and 9.2% (n=14) for

either white noise or sugar and water.

Figure 4.23: Methods to soothe baby

4.8 Treatment

4.8.1 Use of complementary medicine

Participants were asked whether they had used complementary medicine or conventional

medicine to treat their baby's colic; and whether or not they had previously consulted with a

complementary medicine practitioner. As seen in Figure 4.24, 73% (n=111) of participant’s

stated that they had used both conventional and complementary medicine; and 27% (n=41)

stating that they had only used complementary medicine.

Appendix J, bar graph J.7 shows that 68.4% (n=104) of participants responded that they had

consulted with a complementary medicine practitioner whereas 31.6% (n=48) stated that they

had not.

9.2% (n=14)

9.2% (n=14)

19.1% (n=29)

22.4% (n=34)

30.9% (n=47)

34.2% (n=52)

34.9% (n=53)

44.1% (n=67)

44.7% (n=68)

51.3% (n=78)

59.2% (n=90)

0 10 20 30 40 50 60 70 80 90 100

Sugar & water

White noise

Drinking warm water

Lullabies

Swaddling

Front pack or sling

Hot bath

Pram

Baby massage

Pacing

Bouncing or jiggling

Number of Participants (n)

Are/were any of the following effective in making your baby calm?

49

Figure 4.24: Treatment choice for colic

4.8.2 Information about complementary medicine

Participants were asked where they had received their information regarding complementary

medicine for colic from, allowing for more than one answer to be selected. As seen in Figure

4.25, 61.8% (n=94) of participants got their information from complementary practitioners;

53.9% (n=82) from friends and family; 50% (n=76) from a general practitioner; 49.3% (n=75)

from the internet; 35.5% (n=54) from health shops; 20.4% (n=31) from books or magazines; and

5.9% (n=9) from the television. Other places that participants got their information from

included: Weleda pharmacy group staff; chiropractors; clinic sisters; government clinics;

homeopathy course; midwives and sangomas, which all accounted for 9.9% (n=15) of

participants.

Figure 4.25: Information sources regarding complementary medicine for colic

27% (n=41)

0 (n=0)

73% (n=111)

0

20

40

60

80

100

120

Complementary or naturalmedicine

Conventional or main-streammedicine

Both

Nu

mb

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ants

(n

)

What do/did you use to treat your child’s colic?

49.3% (n=75)

20.4% (n=31)

35.5% (n=54)

53.9% (n=82)

5.9% (n=9)

50% (n=76)

61.8% (n=94)

9.9% (n=15)

0

10

20

30

40

50

60

70

80

90

100

Internet Books/magazines Health shops Friends/family TV/Radio GeneralPractitioner

ComplementaryPractitioner

Other

Nu

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(n

)

Where do/did you get your information regarding complementary medicine for colic from? You may choose more

than one answer:

50

4.8.3 Complementary medicines used for colic

Participants were asked which complementary medicines they used for their child's colic

whereby more than one response could be selected. The most commonly used complementary

medicines were as follows: 58.6% (n=89) individual homeopathic remedies; 46.7% (n=71)

probiotics; 44.1% (n=67) either Colic Calm or herbal medicines; 41.4% (n=63) gripe water;

34.9% (n=53) herbal teas; 27% (n=41) Bonnisan®; 21.7% (n=33) vitamins and minerals; 17.8%

(n=27) Tummy Calm®; 14.5% (n=22) Sister Lilian ColicCare; 11.8% (n=18) Nux Vomica

Hommacord®; 11.2% (n=17) Lennon Behoedmiddel vir Kinders; 10.5% (n=16) Heel

Viburcol®; 9.2% (n=14) either Iberogast® or Heel Spascupreel®; 7.2% (n=11) Tibb Bonnycare;

4.6% (n=7) either Natura® Magen or aromatherapy oils; and 2.6% (n=4) Natura® Sedaped.

Other complementary medicines that participants made use of, that were not listed were:

Bennetts® colic mixture; Hylands colic tablets; Infacol and Neocate formula and Pegasus

remedies which all accounted for 5.2% (n=8) participants.

Participants were asked reasons why complementary medicine was chosen when treating their

child’s colic. These responses can be found in Appendix L.

51

Figure 4.26: Complementary medicines used for colic

4.8.4 Conventional medicines used for colic

Participants were asked which conventional medicines, if any, they used to treat their child's

colic, more than one answer could be selected. The most commonly used conventional medicines

were: 50% (n=76) Buscopan®; 32.9% (n=50) Telament Paediatric Colic Drops®; 25.7% (n=39)

Muthi Wenyoni; 22.4% (n=34) Colief® Infant Drops; and 13.2% (n=20) used Nexium®. In

addition, 3.3% (n=5) of mothers used other products namely: Bennetts® colic mixture; Lennon

Behoedmiddel vir Kinder’s; and Iberogast.

0 %(n=0)

2.6% (n=4)

4.6% (n=7)

4.6% (n=7)

5.2% (n=8)

7.2% (n=11)

9.2 % (n=14)

9.2% (n=14)

10.5% (n=16)

11.2% (n=17)

11.8% (n=18)

14.5% (n=22)

17.8% (n=27)

21.7% (n=33)

27% (n=41)

34.9% (n=53)

41.4% (n=63)

44.1% (n=67)

44.1% (n=67)

46.7% (n=71)

58.6% (n=89)

0 20 40 60 80 100

None

Natura® Sedaped

Aromatherapy oils

Natura® Magen

Other

Tibb Bonnycare

Heel Spascupreel®

Iberogast®

Heel Viburcol®

Lennon Behoedmiddel vir Kinders

Heel Nux Vomica Homaccord®

Sister Lilian ColicCare

Tummy Calm®

Vitamins/minerals

Himalaya Bonnisan®

Herbal teas

Gripe Water

Herbal medicines

Colic Calm

Probiotics

Individualised homeopathic remedies

Number of Participants (n)

Do/did you use any of the following complementary medicines for your child’s colic? You may choose more than one answer:

52

Figure 4.27: Conventional medication used to treat colic

4.8.5 Perceived effectiveness of complementary medicine for colic

Participants were asked if they felt that complementary medicine was effective in the treatment

of colic. Figure 4.28 shows 66.4% (n=101) of participants felt that complementary medicine was

effective, whereas 30.3% (n=46) were unsure and 3.3% (n=5) did not believe it was effective.

Figure 4.28: Perceived effectiveness of complementary medicine for colic

11.2% (n=17)

25.7% (n=39)

50% (n=76)

22.4% (n=34)

13.2% (n=20)

32.9% (n=50)

3.3% (n=5)

0

10

20

30

40

50

60

70

80

None Muthi Wenyoni Buscopan® Colief® Infantdrops

Nexium® TelamentPaediatric Colic

Drops®

Other

Nu

mb

er o

f P

arti

cip

ants

(n

)

Do/did you use any of the following medicines for your child’s colic? You may choose more than one answer:

3.3% (n=5)

30.3% (n=46)

66.4% (n=101)

0

20

40

60

80

100

120

Disagree Unsure Agree

Nu

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f P

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ants

(n

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In your experience is complementary medicine effective for colic:

53

4.8.6 Perceived effectiveness of the combined use of conventional medicine with

complementary medicine

Participants were asked if complementary medicine works well in conjunction with conventional

medicine in treating colic. As seen in Figure 4.29, 38.2% (n=58) of participants felt that

complementary medicine works well in conjunction with conventional medicine; 55.9% (n=85)

were unsure; and 5.9% (n=9) felt that it did not work well in conjunction with conventional

medicine.

Figure 4.29: Perceived effectiveness of the combined use of conventional medicine with

complementary medicine

4.8.7 Awareness of side effects of complementary medicine

Participants were asked if, in their experience, complementary medicine had no side effects. As

seen in Figure 4.30, 47.4% (n=72) agreed that complementary medicine had no side effects in

their experience; 44.7% (n=68) were unsure; and 7.9% (n=12) disagreed as in their experience,

complementary medicine had side effects.

Figure 4.30: Awareness of side effects of complementary medicine

5.9% (n=9)

55.9% (n=85)

38.2% (n=58)

0

20

40

60

80

100

Disagree Unsure AgreeNu

mb

er o

f P

arti

cip

ants

(n

)

In your experience does complementary medicine work well in conjunction with conventional medicine for colic:

7.9% (n=12)

44.7% (n=68)

47.4% (n=72)

0

20

40

60

80

Disagree Unsure Agree

Nu

mb

er o

f P

arti

cip

ants

(n

)

In your experience does complementary medicine have no side effects:

54

CHAPTER FIVE

DISCUSSION

5.1 Introduction

The aim of this study was to determine the perceived effectiveness of complementary medicine

by mothers of infants with colic in Gauteng. A quantitative descriptive design was used whereby

data was collected through a randomised, cross-sectional survey. A sample size of 150

participants was required with 220 Infantile Colic Questionnaires (Appendix G) being distributed

throughout the Gauteng region. A total of 157 questionnaires were completed with only 152

questionnaires being utilised for data collection as they were completed correctly and with no

omitted responses. The data was analysed with the assistance of UJ Statkon, through frequencies,

custom tables, multiple response analysis and open ended responses (Kuhudzai, 2016b). The

results identified the following areas of statistical significance.

5.2 General information

The typical occurrence of infantile colic was determined by demographical and basic

information provided by participants. Data obtained referenced both the mother of the infant and

the colic infant, this included: age of mother (4.2.1); number of children (4.2.2); gender of child

(4.2.3); diagnosis of colic (4.2.4); occurrence of colic (4.2.5); and antenatal class attendance

(4.2.6). The results indicated that majority of mothers were aged between 30-39 years (44.1%)

and had either one (40.8%) or two (39.5%) children. Results indicated a fairly even spread with

regards to the gender of the child however, majority of the infants were female (55%). Most

participants did not self-diagnosis their child as having colic (56.6%), with most infants

diagnosed as having colic by a medical health practitioner (76.3%). The results showed that the

prevalent age for colic to start was between 4-8 weeks of age (88.8%). Most colic started at 5-6

weeks of age (28.3%), with the number of reported cases sharply decreasing after 8 weeks of

age. The results indicated that the first born child was more likely to have suffered from colic

(68.4%) and that only one child in the family experienced colic (82%). Results showed that most

participants attended an antenatal class (53%) and that they were sufficiently taught about how to

take care of their new-borns in the postnatal stage (67.9%).

According to the Community Survey conducted in 2016 in South Africa by Statistics South

Africa, the average number of children per household is three and a half children in South Africa

(Statistics South Africa, 2016). This average of the findings from the Community Survey differs

55

from the average one child reported in the findings of this study. In Gauteng the common age

group of mothers is age 35-39 years; however, in South Africa it is 25-29 years (Statistics South

Africa, 2016). The average age of mothers as per the results of this study was 30-39 years, which

correlates with the common age group of mothers for Gauteng.

The Community Survey also revealed that 51% of the South African population were female

(Statistics South Africa, 2016). This closely correlates with results found in this study which

indicated that 55% of the suffering children were female. In a research study conducted by

Savino, it was found that infantile colic is thought to be equally prevalent in both genders

(Savino, 2007).

According to Savino (2007), infantile colic tends to intensify around 6 weeks of age and usually

resolves itself at 12 weeks of age (Savino, 2007). The most prevalent age reported in this study

for colic starting, was around 4-8 weeks with the most common age being 5-6 weeks. This result

correlates with another research study that shows colic intensifies at 6 weeks which can be an

outcome of parents only became fully aware that their child may have colic when the colic was

at its peak. Most participants in this study noted a decline in the colic symptoms from 8-13

weeks of age, in line with other reported trends where colic tends to decline between 7-12 weeks

(Evanoo, 2007).

5.3 Crying

In this section (4.3.1) participants were asked about the infant’s colic episodes and their crying

patterns. The majority of participants reported that their infant experienced colic twice a day

(32.2%) with a combined total of bouts occurring three days a week or more (63.1%). These

bouts lasted 11-20 minutes at a time (31.6%). Participants stated they had difficulty soothing

their infant twice a day (25.7%), which is in line with the frequency of colic episodes per day

(twice per day). Participants reported that their infants cried excessively for 1-10 minutes at a

time (38.8%).

Wessel’s criteria defines colic as crying in a seemingly healthy infant that lasts for more than

three hours each day, on more than three days a week, for a period of more than three weeks

(Savino et al., 2014b). With regards to the duration criteria (hours per day), this was found not to

be true in this study as majority of infants experienced a bout of colic for 11-20 minutes at a

time, with this occurring twice a day resulting in a total colic time of 22-40 minutes a day.

However a few participants reported that they weren’t able to soothe their child countless times

or they weren’t able to soothe their child at all. In this study it was reported that 36.9% of infants

56

experienced colic one to two days a week however, 63.1% of participants experienced colic three

or more times a week. The results from this study therefore, correlate to the Wessel’s criteria of

three times a week.

In this study, the most common reasons stated for excessive crying in the infant were: pain or

discomfort (83.6%); being tired (73%); and a dirty nappy (62.5%); while the least reported

reasons were: the mothers’ tension (24.3%); the infant being fussy (20.4%); and the infant being

nervous (9.2%).

The above results correlates with a study conducted in New Zealand on colic and reflux, where it

was found that majority of respondents (78.6%) reported that the apparent reason for the infants

excessive crying was due to general discomfort and fatigue (Hodge & Murphy, 2014).

The most common causes for crying as reported by Halpern & Coelho (2016) was as a result of

either colic, infections, gastrointestinal causes, trauma, behavioural disorders, drug reactions,

violence or abuse, haematological causes or cardiovascular causes. Colic is reported to affect 20-

30% of infants which manifests itself in excessive crying (Halpern & Coelho, 2016).

5.4 Timing of colic symptoms

In this section, participants were asked when most of the colic symptoms occurred as well as the

time of the day that they occurred (4.3.2). The majority of participants noted colic symptoms

occurred straight after feeding (63.8%) and that colic most often occurred in the evening

(40.1%).

According to Savino (2007), colic and crying episodes tend to occur more frequently in the late

afternoon and evening. This is a characteristic symptom that differentiates colic from other

severe conditions. Many parents increase the frequency of feeding in the evenings. The findings

from this study are therefore consistent with the findings of Savino (2007). When considering the

size of the infant’s stomach and the time it takes for the food to be digested, it is likely some

infants are being over fed. Overfeeding is known to produce colic and reflux symptoms (Hodge

& Murphy, 2014).

5.5 Reasons for discomfort

Participants were asked what they believed was making their infant uncomfortable (4.3.3). The

most common reasons were: build-up of wind (75%); difficulty bringing up wind (59.2%); and

57

discomfort (57.2%); while the least common reasons were: food from the mother’s diet (12.5%);

either food allergy or growth spurt (9.9%); and the environment (9.2%).

In a study by Hodge and Murphy (2014), it was found that majority of parents believed that the

discomfort in their colic child was due to symptoms associated with wind. This included wind

build-up and difficulty bringing up wind. The results of Hodge and Murphy’s (2014) study are

therefore consistent with the findings compiled in this study.

5.6 Vomiting

Participants were asked if their infant vomited and if they felt this was a normal thing for their

baby to do (4.3.4). It was reported that 71.1% of participants noted that their baby did vomit after

being fed and that this was not a normal thing for their baby to do (67.1%).

According to Hegar, Dewanti, Kadim, Alatas, Firmansyah, and Vandenplas (2009), most infants

vomit after a feed and many parents find this distressing. Small amounts of vomit or spit up after

a feed is considered normal and often occurs in the first three months of life. Vomit or spit up

peaks at 4 months of age but resolves by 12 months. Vomiting after a feed should only be a

concern if the infant doesn’t gain weight or is uncomfortable.

5.7 Sleeping

Participants were asked what resulted in their infants sleeping (4.3.5). Majority of participants

(55.9%) stated that it was difficult to determine the factor that induced sleep and they weren’t

sure if it was due to the infant being comfortable and tired, or exhausted from crying.

Findings from a study conducted in New Zealand on colic and reflux suggested that majority of

parents (60%) believed that their infants were sleeping due to exhaustion from crying compared

to 9% of parents who believed it was due to the infant being comfortable and tired (Hodge &

Murphy, 2014).

5.8 Feeding and burping

In this section, participants were asked about their feeding methods; if they changed their infants

feeding method; if they fed their infant on demand from birth; and if they increased their feeding

in the evening (4.4). Participants were also asked if they consciously burped their babies (4.5).

Most participants used a combination of breastfeeding and bottle feeding (44.7%) and the

feeding method was changed by 65.4% of participants in order to try and ease the colic

symptoms.

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Rosen (2007) found that solely breastfeeding infants will not necessarily prevent the occurrence

of colic despite the fact that breastfeeding is the best source of nutrition for infants. Certain foods

either ingested by breastfeeding mothers or by formula fed infants can cause irritability or

fussiness in infants. This may be due to food allergies in the infant and avoidance of these

allergy foods may prevent colic or assist the colic symptoms. In a randomised trial by Critch

(2011), allergenic foods such as cow’s milk, soy, wheat, eggs, peanuts, tree nuts and fish were

eliminated from the breastfeeding mother’s diet to try and ease the infant’s colic. A total of 161

infants who are solely breastfed and experienced excessive irritability and extended periods of

crying were randomly selected for a one week trial. Of these participants, 90 were put on a low

allergen maternal diet, while the other 54 were put in a control group where no dietary changes

were made. There was a significant improvement in the crying time in 74% of the low allergen

breastfed infants compared to the control group which showed only a 34% improvement. This

indicates that colic symptoms can be eased by altering or eliminating allergenic foods from the

maternal diet. Colic symptoms in infants who are partially or fully formula fed cow’s milk or soy

formulas tend to aggravate if they are atopic infants. Introduction of hydrolysed formulas have

shown to reduce colic symptoms in infants who had excessive irritability (Savino, 2007).

In this study it was reported that 71.1% of participants fed their infant on demand from birth and

they increased feeding hours in the evening between 5:00pm-12:00am (54.6%).

In a survey conducted on colic and reflux by Hodge and Murphy (2014), it was found that 70%

of mothers increase their feeding intervals in the evening hours with some mothers almost

continuously feeding their infants throughout the night, supporting the findings in this study that

majority of participants increased their feeding hours in the evening.

Majority of participants (78.3%) in this study consciously burped their infant.

In a randomised controlled study conducted on the efficacy of burping in lowering colic and

regurgitation episodes in healthy term babies, a total of 71 participants were recruited for period

of 3 months. The study concluded that in 95% of cases, burping did not significantly lower the

occurrence of colic. However, due to the small sample size, research should be conducted to

further validate this result (Kaur, Bharti & Saini, 2014).

5.9 Methods to soothe

In this section participants, were asked if their infants used a dummy (pacifier) and/or their

thumb to self soothe (4.6) as well as what methods were effective in soothing their baby (4.7).

The majority of participants reported that their baby used a dummy and/or their thumb (71.1%)

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to self soothe. The most effective methods of soothing reported by participants were: bouncing

or jiggling (59.2%); pacing (51.3%); and baby massage (44.7%), with the least effective being:

drinking warm water (19.1%); white noise (9.2%); and drinking sugar water (9.2%).

A recent study conducted by Hodge and Murphy (2014) revealed that the most common methods

to soothe a crying infant were pacing with the child, bouncing the baby, swaddling the baby and

carrying the baby in a sling. The majority of participants made use of a dummy or allowed their

infant to suck their thumb in an attempt for the child to self soothe.

These results correlate with the results found in this study that common methods to soothe an

infant are bouncing and making use of a dummy or thumb sucking.

5.10 Treatments

The use of both complementary medicine and conventional medicine (4.8.1) was seen in 73% of

participants, while complementary medicine alone was only used by 27% of participants to treat

their infant’s colic.

There is no widely accepted conventional treatment for colic and many parents feel dissatisfied

with conventional health care, resulting in those parents seeking out complementary medicine

treatments (Savino & Tarasco, 2010). In a systematic review on randomised clinical trials on

nutritional supplements and other complementary medicines for infantile colic, it was found that

there was significant evidence on the effectiveness of fennel extract, mixed herbal teas and sugar

solutions for infantile colic. Of the 15 included randomised clinical trials, 11 trials showed

significant results in favour of complementary medicine. However, flaws did exist in these

clinical trials. Despite the favourable outcome of complementary medicine for infantile colic, the

flaws in the trials resulted in inadequate conclusions regarding the use of complementary

medicine for infantile colic. Recommendations for further research on complementary medicine

for colic are suggested due to the prevalence of colic and the difficulty in treating the condition

(Perry et al., 2011).

5.11 Consultation with a complementary medicine practitioner

In this section 4.8.2, it is observed that the majority of participants (68.4%) had consulted with a

complementary medicine practitioner. This could be directly related to the fact that three

complementary/natural pharmacies were utilised for data collection compared to the one

conventional/main-stream pharmacy. This resulted in a high probability of the participants

having been referred to a natural pharmacy by a complementary medicine practitioner.

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Of the 152 participants, 31.6% of participants had not consulted with a complementary medicine

practitioner. This could be due to participants being unfamiliar with the term complementary

medicine practitioner and therefore not fully understanding which health practitioners are

classified as complementary medicine practitioners. The recent influx of complementary

medicines into the South African market has allowed the medicines to be purchased in numerous

shops. The majority of the medicines are currently unscheduled, allowing for them to be

purchased over-the-counter without a practitioner prescription resulting in an increase in self-

medication (Gqaleni et al., 2016).

According to Savino and Tarasco (2010), no widely accepted conventional treatment is available

for colic, resulting in many parents turning to complementary medicine. Homeopathic

medications are commonly used for infantile colic due to its low risk for adverse reactions,

causing parents to consider it a safe treatment for their infants (Rosen, 2007).

5.12 Sources of complementary information

Participants gained their information regarding complementary medicine for colic (4.8.2) mainly

from complementary practitioners (61.8%), friends and family (53.9%), general practitioner

(50%) and the internet (49.3%). The reason numerous participants received information from a

complementary practitioner and a general practitioner could be correlated to the fact that 68.4%

of participants had consulted with a complementary medicine practitioner for their infant’s colic

and that 73% of participants had used both conventional and complementary medicine for the

colic. Furthermore, one of the most common reasons for parents taking their infants to a

paediatric healthcare practitioner is due to infantile colic (Rosen, 2007).

Shapiro (2007) states that in today’s technological era, the use of the internet to access

information about colic is likely, as 3.2 billion people worldwide and 52.4% of Gauteng’s

population have access to the internet. It is common for people to research medical or health

related issues on the internet with the majority of people searching on behalf of a family member

or friend. However, not only do people use the internet for health information but they also use it

as a support group.

5.13 Complementary medicine

Participants were asked to state which complementary products they had used for their infants

colic (4.8.3). The following products were utilised by majority of participants: individualised

homeopathic remedies (58.6%); probiotics (46.7%); either Colic Calm or herbal medicines

(44.1%); and gripe water (41.4%). The high use of individualised homeopathic remedies could

61

correlate to the fact that 68.4% of participants had consulted with a complementary medicine

practitioner.

According to Savino and Tarasco (2010), parents have been choosing homeopathic remedies to

relieve colic symptoms due to their non-toxic nature and very low concentrations of active

ingredients. Individualised homeopathic remedies, prescribed by homeopaths, take into account

all aspects of the infant and the disease picture thus, providing you with a holistic individualised

treatment (Vermeulen, 2011). Colic Calm is also a homeopathic preparation indicated to relieve

abdominal discomfort, flatulence and gastro-oesophageal reflux (Colic Calm, 2013). Due to most

participants having consulted with a complementary medicine practitioner, it could be assumed

that due to the high use of individualised homeopathic remedies that majority of participants

were consulting with a homeopath. Infantile colic accounts for the most visits to a paediatric

practitioner as well as for the use of complementary medicine in infants. Colic is generally the

first crises in a new families life and therefore opting for an integrative approach, where the mind

and body are take into account, is important (Rosen, 2007).

The use of probiotics and herbal remedies has been found to reduce the median crying time in

infants with colic. Probiotics are effective at reducing crying time in infants (Bailey et al., 2013).

In a recent study by Chau et al. (2015), it was found that the probiotic Lactobacillus reuteri was

more effective than placebo in reducing the crying and fussing time in infants with colic. Savino

and Tarassco (2010) found that breastfed infants who received a herbal formula containing

Matricariae recrutita, Foeniculum vulgare and Melissa officinalis, had a reduction in their colic

symptoms within one week of use.

Gripe water is a widely known product for colic. Gripe water formulas are not standardised and

according to the Natural Medicines Comprehensive Database, five different formulas are listed

for gripe water (Rosen, 2007). The herbs found in gripe water are effective antispasmodics and

analgesics however there are no well conducted clinical trials to support the use of gripe water

(Whittaker, 2010).

In this study participants were also asked to provide reasons why they chose to treat their infant’s

colic with complementary medicine. Most participants stated that it was recommended to them

by a health care practitioner; friends or family; that it has no side effects; and is perceived as

safer and less harmful for their child (Appendix L), which is in line with Savino and Tarasco

(2010).

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Complementary medicine is popular due to its lower incidence of adverse effects when

compared to pharmaceutical treatments. There has been an increase in patients selecting

complementary medicine over conventional medicine due to this fact. Herbal products are

viewed as natural products and patients assume that it is far safer and less likely to have side

effects; however this may not always be the case (Gqaleni et al., 2016). This is due to the lack of

standardisation of the dosage of herbal formulas and the possible content of sugar and alcohol in

the formulas available. Parents are advised to use herbal products with care or only through

prescription by a registered practitioner (Savino & Tarasco, 2010).

5.14 Conventional medicine

The most commonly used conventional medicines (4.8.4) reported were: Buscopan® (50%);

Telament Paediatric Colic Drops® (32.9%); Muthi Wenyoni (25.7%); and Colief® Infant Drops

(22.4%).

Simethicone (Telament Paediatric Colic Drops®), lactase (Colief® Infant Drops) and hyoscine

butylbromide (Buscopan®) are commonly recommended over-the-counter medications, in South

Africa, for infantile colic. Pharmacists are advised to counsel customers that if the over-the-

counter colic preparation provides no relief for the colic after a few days, that the product should

be discontinued and they should consult with a doctor (Whittaker, 2010).

Simethicone aims to reduce gas production however, in several randomised controlled trials,

simethicone was found to be as effective as placebo (Bailey et al., 2013). Lactase is an effective

form of treatment if colic is due to transient lactose intolerance. However, if the colic is not due

to lactose intolerance, lactase is not an effective form of treatment (Savino, 2007). A study

conducted on the efficacy of hyoscine butylbromide found it to be an effective form of treatment

for abdominal pain and cramping and that hyoscine butylbromide is safe and well tolerated

(Lacy, Wang, Bhowal, & Schaefer, 2013). No clinical studies have been conducted on the

efficacy of Muthi Wenyoni. It is suggested that the possible perceived effectiveness of Muthi

Wenyoni is due to the alcohol content which may induce sleep and relaxation in the infant

(Bland et al., 2014). The unconvincing efficacy of the conventional medicine products may be

due to the potential side effects and unknown mode of action (Halpern & Coelho, 2016).

A study conducted on the use of complementary and alternative medicine in a general paediatric

clinic found that 47% of participants made use of both conventional and complementary

medications (Jean & Cyr, 2007). An additional study was conducted on the use of

complementary medicine by children and the impact it has on parent-doctor communication and

63

general practitioner-complementary medicine practitioner communication. Results indicated that

parents expect integrative care from both their practitioners and want to be able to freely discuss

the use of both treatment modalities with both practitioners (Ben-Arye, Traube, Schachter,

Haimi, Levy, Schiff et al., 2010).

5.15 Statements regarding complementary medicine

Participants were asked their opinions on statements regarding complementary medicine. More

than half the participants (66.4%) agreed that complementary medicine is an effective form of

treatment for infantile colic; this opinion is supported by Rosen, Bukutu, Le, Shamseer and

Vohra (2007) whereby complementary therapies have shown to be beneficial in infantile colic.

Participants stated that they were uncertain if complementary medicine works well in

conjunction with conventional medicine for infantile colic (55.9%), this opinion is supported by

Ben-Arye et al., (2010) as more clinical studies are needed on the integration of complementary

and conventional medicine. Most participants (47.4%) agreed with the statement that

complementary medicine had no side effects however; 44.7% of participants were uncertain

about the statement. The opinion that most participants felt that complementary medicine had no

side effects is supported by Gqaleni et al., (2016) as the increase in the use of complementary

medicine can be associated with its low frequency of adverse effects.

5.16 Limitations and assumptions

There were a few factors that could have negatively affected the study and yielded an

unfavourable outcome by influencing the validity of the study.

Numerous participants were unfamiliar with the term “complementary medicine” and which

over-the-counter products fell into the complementary medicine category. It was also evident

that some participants were unable to differentiate between complementary medicine and

conventional medicine. This resulted in some participants selecting conflicting answers or stating

that they made use of other over-the-counter conventional medications for colic that were in fact

complementary products (e.g.: Iberogast), and vice versa. The lack of understanding of the terms

could have affected the answering of the questions and thus the outcome of the study.

A few participants (27%) made use of both complementary medicine and conventional medicine

simultaneously while treating their infant’s colic rendering it difficult to isolate the efficacy of

complementary medicine. This also relates back to the misunderstanding of the two terms,

“complementary medicine” and “conventional medicine”, in which participants were uncertain

64

that they were using two different modalities to treat their infant’s colic (Wieland, Manheimer, &

Berman, 2011). It was assumed that the positive effects were due to complementary medicine.

Added to this, sometimes the distinction between a complementary medicine product and

conventional medicine product is vague (Wieland et al., 2011). For example a product such as

gripe water contains both conventional and herbal ingredients; including dill seed oil, and

sodium bicarbonate. The same is true for the Bennetts® colic formula that contains

diphenhydramine and Atropa belladonna (Kilian, 2011). Therefore further patient education and

knowledge sharing is required to correctly differentiate the two treatment modalities. It is vital

that health care practitioners are able to educated and inform their patients about the difference

(Wieland et al., 2011).

Participants who had more than one child with colic were conflicted when answering questions

where the answer differed for each child. This resulted in a few questions having multiple

answers and resulted in data capturing conflicts or the questionnaire having to be excluded from

the study all together. Potentially valuable information regarding colic and complementary

medicine could have been omitted due to this.

It was assumed that all participants had an infant that suffered from colic and that they had

utilised complementary medicine as a form of treatment. Patients are often reluctant to admit to a

health care provider that they are using both forms of treatment, complementary medicine and

conventional medicine (Gqaleni, et al., 2016). Due to the fact that the research conducted is on

complementary medicine, participants could have felt uncomfortable to reveal their use of

conventional medications. This however, was assumed not to be a possibility, and that all

participants completed the questionnaire truthfully, honestly and without bias.

The participant’s demographic information such as race and financial status was not asked in the

questionnaire so as to not isolate a social group as potentially having infants that appeared to cry

more than other social groups. Socio-economic aspects have been noted to influence the

manifestation of, and increased the chance of seeking medical assistance for infantile colic. Such

aspects or factors include level/standard of education of participants, economic situation and

employment type (Yalçın, Örün, Mutlu, Madendağ, Sinici, Dursun et al., 2010). Research

conducted on the socio-economic groupings within South Africa (more specifically Gauteng

with respect to this research) may be valuable when accessing the prevalence of colic within

each socio-economic group. This combined with information on the lifestyle of the participants

(e.g. diet, smoking, alcohol, drugs/medication) would provide valuable information (Yalçın et

al., 2010).

65

CHAPTER SIX

CONCLUSIONS AND RECOMMENDATIONS

6.1 Conclusions

Infantile colic is a common concern for parents whose children suffer from the condition,

resulting in many parents consulting a health care practitioner. This study found colic to be the

most prevalent around 5-6 weeks of age and that it tends to ease between 8-13 weeks of age.

Infants experienced prolonged and continual bouts of crying and discomfort however, most

infants did not satisfy Wessel’s criteria, “the rule of three”. The aim of this study was to

determine the perceived effectiveness of complementary medicine by mothers of infants with

colic in Gauteng, by means of an Infantile Colic Questionnaire (Appendix G). A quantitative

descriptive design was used whereby data was collected through a randomised, cross-sectional

survey. Recruitment of participants occurred through advertisements (Appendix C) and word-of-

mouth. The Infantile Colic Questionnaires (Appendix G) were distributed at various baby and

health clinics; health shops; nursery schools; and health and beauty businesses in the Gauteng

region. A total of 152 surveys were completed and analysed through frequencies, custom tables,

multiple responses and open ended responses.

Analysis of the results indicated that most participants made use of both complementary

medicine and conventional medicine for their infant’s colic. However it was evident that most

participants aren’t familiar with the term “complementary medicine” and were therefore

confused as to which products are classified as complementary medicine. For some products the

distinction is vague as the products contain both complementary and conventional medicine,

which further contributed to the misunderstanding of the terms. This appears to be a common

trend amongst other studies on complementary medicine, indicating a need for further education

and research conduction (Wieland et al., 2011).

The most commonly used complementary products for infantile colic were individualised

homeopathic remedies, probiotics and over-the-counter herbal medicines. These results are

consistent with other studies conducted on integrative treatment approaches for infantile colic

(Rosen, 2007). The use of these complementary products correlates to the result that most

participants had consulted with a complementary medicine practitioner. Results showed that

complementary medicine practitioners, family and friends and general practitioners were the

main sources of information for parents. Complementary medicine was chosen as a modality for

treatment due to it being perceived as safe, less harmful and with fewer or no side effects.

66

The most commonly used over-the-counter conventional medications were products containing:

hyoscine butylbromide, lactase and simethicone. This finding is consistent with other studies on

commonly recommended products by pharmacists for infants (Whittaker, 2010).

As a result of parents concern with infantile colic, the frequency of consultations with healthcare

practitioners increased as well as the use of complementary medicine (Rosen, 2007). Results

from the research conducted on the perceived effectiveness of complementary medicine by

mothers of infants with colic in Gauteng, indicated that participants perceived complementary

medicine as an effective form of treatment for infantile colic. However, there is uncertainty

whether it works well in conjunction with conventional medicine.

The outcome of this research study indicated that further education is needed on complementary

medicine due to the misunderstanding of terms, complementary medicine and conventional

medicine. Complementary medicine is perceived to be an effective form of treatment for

infantile colic; however, further research and larger scale studies should be conducted to validate

this result.

6.2 Recommendations

This study or future studies, may offer potential improvement or refinement by incorporating the

following recommendations:

The number of participants in the study may be increased. A sample group larger than 152

participants should be utilised to allow for further validation of these results and to allow for a

representation of a wider population.

Conducting a similar study in other regions of the country will yield a more comprehensive

perspective of the use of complementary medicine for colic in South Africa.

Providing definitions, synonyms and examples of complementary medicine and conventional

medicine on the questionnaire so that participants may have a better understanding of the

terms. This will allow participants to feel more comfortable in answering the questions as

they will have a better understanding of the terms and it will also not subject them to feeling

uncomfortable for asking for an explanation of the term. This will also indirectly result in

more of the population becoming educated on complementary medicine.

The inclusion criteria for the study should only include participants who have only used

complementary medicine as a singular form of treatment for colic. The outcome of the

67

confusion between the terms, complementary medicine and conventional medicine, made

isolating the effects of only the complementary medicine difficult.

The inclusion criteria should be more in line with Wessel’s criteria for colic, so that the

timing, duration and frequency of the colic will be able to be fully determined. This will allow

for a better understanding of the severity of the colic and if complementary medicine is

effective in more severe colic cases.

The data collection tool should take into consideration participants who have had more than

one infant suffering from colic. Participants should be required to fill in a questionnaire

pertaining to each colicky infant or the questionnaire should be designed in such a way that

permits participants to answer the questions for multiple suffering children. If not, the

participant should be requested to answer the questionnaire based on the most recent suffering

infant.

A more intensive pilot study should be conducted to determine the reliability of the

questionnaire as questions 16 and 27 in the Infantile Colic Questionnaire were very similar.

Both questions enquired about the reasons for the baby feeling uncomfortable and the reasons

for the baby crying so much. The question could either be combined or the repetition deleted.

Include the demographical and socioeconomic information of the participants in the

questionnaire in order to obtain further valuable information about the access to

complementary medicine.

68

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APPENDIX A

HIGHER DEGREES APPROVAL LETTER

80

APPENDIX B

ETHICS COMMITTEE APPROVAL LETTER

81

APPENDIX C

ADVERTISEMENT

If so, you may be able to participate in a research survey that is looking at the perceived

effectiveness of complementary medicine in the treatment of Infantile Colic.

Moms between the ages of 18-45 years are invited to participate in the research study.

The research study is being conducted by the Department of Homeopathy at the University of

Johannesburg.

Ethical Clearance Number: REC-01-126-2016

If you are interested, please contact:

Natalie on 083 227 7110

82

APPENDIX D

PERMISSION LETTERS

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APPENDIX E

INFORMATION LEAFLET

DEPARTMENT OF HOMOEOPATHY

RESEARCH STUDY INFORMATION SHEET

10th October 2016

Good Day

My name is Natalie Christina Di Gaspero and I WOULD LIKE TO INVITE YOU TO

PARTICIPATE in a research study on The Perceived Effectiveness of Complementary

Medicine by Mothers of Infants with Colic in Gauteng.

Before you decide on whether to participate, I would like to explain to you why the research is

being done and what it will involve for you. I will go through the information sheet with you

and answer any questions you have. This should take about 10-20 minutes. The study is part of

a research project being completed as a requirement for a Masters Degree in Homoeopathy

through the University of Johannesburg.

THE PURPOSE OF THIS STUDY is to determine the perceived effectiveness of

complementary medicine by mothers of infants with colic in Gauteng in order to develop an

approach for the treatment of colic.

Below, I have compiled a set of questions and answers that I believe will assist you in

understanding the relevant details of participation in this research study. Please read through

these. If you have any further questions I will be happy to answer them for you.

DO I HAVE TO TAKE PART? No, you don’t have to. It is up to you to decide to participate

in the study. I will describe the study and go through this information sheet. If you agree to take

part, I will then ask you to sign a consent form.

94

WHAT EXACTLY WILL I BE EXPECTED TO DO IF I AGREE TO PARTICIPATE?

You will be asked to complete a short survey about your child’s colic and the survey should take

approximately 10 minutes to complete. The survey is completed on a voluntary basis and should

you wish to participate, you will need to sign a consent form. No identifying information will be

requested from you and you will remain anonymous throughout the study. To ensure your

privacy, the survey will be completed in a private area. Participation is voluntary and you are

free to withdraw from the study for whatever reason and without consequence, up until the point

that the survey is placed in a lockable box. Once you have completed the survey it will be placed

into a sealable envelope and placed into a lockable box. All completed surveys will be treated as

strictly confidential and only the researcher, supervisor and statistician will have access to the

information.

WHAT WILL HAPPEN IF I WANT TO WITHDRAW FROM THE STUDY? If you

decide to participate, you are free to withdraw your consent without giving a reason and without

any consequences, up until the point that the completed survey is placed in the lockable box. If

you wish to withdraw your consent, you must inform me as soon as possible.

IF I CHOOSE TO PARTICIPATE, WILL THERE BE ANY EXPENSES FOR ME, OR

PAYMENT DUE TO ME: There will be no expense to you should you decide to participate in

the study. You will not be paid to participate in this study.

RISKS INVOLVED IN PARTICIPATION: There are no anticipated risks for participating in

this study.

BENEFITS INVOLVED IN PARTICIPATION: By participating in this study you are able to

assist in providing more information on colic and the use of complementary medicines for colic

in infants.

WILL MY TAKING PART IN THIS STUDY BE ANONYMOUS? Yes. Anonymous means

that your personal details will not be recorded anywhere by me. As a result, it will not be

possible for me or anyone else to identify your responses once these have been submitted.

WHAT WILL HAPPEN TO THE RESULTS OF THE RESEARCH STUDY? The results

will be written into a research report that will be assessed. In some cases, results may also be

published in a scientific journal. In either case, you will not be identifiable in any documents,

95

reports or publications. You will be given access to the study results if you would like to see

them, by contacting me.

WHO IS ORGANISING AND FUNDING THE STUDY? The study is being organised by

me, under the guidance of my research supervisor at the Department of Homoeopathy in the

University of Johannesburg. The study is being funded by the University of Johannesburg

Masters Supervisor Linked Research Bursary.

WHO HAS REVIEWED AND APPROVED THIS STUDY? Before this study was allowed

to start, it was reviewed in order to protect your interests. This review was done first by the

Department of Homoeopathy, and then secondly by the Faculty of Health Sciences Research

Ethics Committee at the University of Johannesburg. In both cases, the study was approved.

Ethics Clearance number: REC-126-2016

Higher Degrees Clearance number: HDC-01-46-2016

WHAT IF THERE IS A PROBLEM? If you have any concerns or complaints about this

research study, its procedures or risks and benefits, you should ask me. You should contact me at

any time if you feel you have any concerns about being a part of this study. My contact details

are:

Natalie Di Gaspero

083 227 7110

natz_dg90@hotmail.com

You may also contact my research supervisor:

Dr Radmila Razlog

011 559-6233

radmilar@uj.ac.za

Or you may contact my research co-supervisor:

Dr Patel

011 559-6780

rpatel@uj.ac.za

96

If you feel that any questions or complaints regarding your participation in this study have not

been dealt with adequately, you may contact the Chairperson of the Faculty of Health Sciences

Research Ethics Committee at the University of Johannesburg:

Prof Marie Poggenpoel

011 559-6686

mariep@uj.ac.za

FURTHER INFORMATION AND CONTACT DETAILS: Should you wish to have more

specific information about this research project information, have any questions, concerns or

complaints about this research study, its procedures, risks and benefits, you should communicate

with me using any of the contact details given above.

Researcher:

Natalie Di Gaspero

97

APPENDIX F

CONSENT FORM

DEPARTMENT OF HOMOEOPATHY

RESEARCH CONSENT FORM

The Perceived Effectiveness of Complementary Medicine by Mothers of Children with Infantile Colic in

Gauteng

Please initial each box below:

I confirm that I have read and understand the information sheet dated Click here to enter the

date, as is appears on the information sheet. for the above study. I have had the opportunity to consider

the information, ask questions and have had these answered satisfactorily.

I understand that my participation is voluntary and that I am free to withdraw from this study

at any time without giving any reason and without any consequences to me.

I agree to take part in the above study.

________________________________ ________________

Signature of Participant Date

_______________________ _________________________________ ________________

Name of Researcher Signature of Researcher Date

98

APPENDIX G

Infantile Colic Questionnaire

Philippa Murphy©

The purpose of this questionnaire is to collect data about your child’s colic.

Please answer the following questions below as accurately as you can.

Mark your desired answer with an X or provide a description on the line where required.

Your answers will remain anonymous.

Inclusion Criteria

1. Your age:

18-29 years 1

30-39 years 2

40-45 years 3

2. How many children do you have?

1 Child 1

2 Children 2

3 Children 3

4 Children 4

5 Children or more 5

3. Does/did your baby/babies suffer from symptoms of colic?

No 0

Yes 1

Instructions

99

General

4. What is the gender of your child/children:

N/A Male Female

4.1 First born 0 1 2

4.2 Second born 0 1 2

4.3 Third born 0 1 2

4.4 Fourth born 0 1 2

4.5 Fifth born 0 1 2

5. Did you self-diagnose your baby as having colic?

No 0

Yes 1

6. Was your baby diagnosed by a health care practitioner as having colic?

No 0

Yes 1

7. At what age did your baby’s colic start?

4-5 weeks 1

5-6 weeks 2

6-7 weeks 3

7-8 weeks 4

8-9 weeks 5

9-10 weeks 6

10-11 weeks 7

11-12 weeks 8

12-13 weeks 9

13-14 weeks 10

14-15 weeks 11

15-16 weeks 12

100

8. Is/were your suffering child/children your:

No Yes

8.1 First born 0 1

8.2 Second born 0 1

8.3 Third born 0 1

8.4 Fourth born 0 1

8.5 Fifth born or more 0 1

9. How many of your children suffered from colic?

1 Child 1

2 Children 2

3 Children 3

4 Children 4

5 Children or more 5

10. Did you attend an antenatal class?

No 0

Yes 1

11. If so, do you feel you learnt enough in the class to care for your new-born in the post-natal

stages?

No 0

Yes 1

Not Applicable (N/A) 2

If not, what learning do you feel would have better prepared you?

101

12. On average, how many times does/did your baby experience colic in a day?

None 1

Once 2

Twice 3

Three times 4

Four times 5

Five times 6

More than five times 7

If more, please specify:

13. On average, how long does/did your baby experience a bout of colic?

0-10 minutes 1

11-20 minutes 2

21-30 minutes 3

31-45 minutes 4

46-60 minutes 5

More than 1 hour 6

14. When do/did the majority of the colic symptoms occur?

Straight after feeding 1

One hour after feeding 2

Two hours after feeding 3

Three hours after feeding 4

Four hours after feeding 5

15. What time of day do/did majority of the colic symptoms occur?

Morning 1

Afternoon 2

Evening 3

12am-6am 4

Behaviours

102

All the time 5

16. From the list, tick what you believe was making your baby feel uncomfortable? More than

one answer can be selected:

No Yes

16.1 Hunger 0 1

16.2 Feeling full 0 1

16.3 Bowel movements 0 1

16.4 Build-up of wind 0 1

16.5 Difficulty bringing up wind 0 1

16.5 Dirty nappy 0 1

16.6 Growth spurt 0 1

16.7 Formula choice 0 1

16.8 Your tension 0 1

16.9 Overfeeding 0 1

16.10 Environment 0 1

16.11 Large supply of breast milk 0 1

16.12 Fast flowing breast milk 0 1

16.13 Being bottle fed too fast 0 1

16.14 Food from mothers diet 0 1

16.15 Undeveloped digestive system 0 1

16.16 Food allergy 0 1

16.17 Vaccinations 0 1

16.18 Discomfort 0 1

16.19 Fatigue 0 1

If other, please specify:

17. Does/did your baby ever vomit milk after a feed?

No 0

Yes 1

103

18. Do/did you feel that vomiting after feeding is a normal thing for your baby to do?

No 0

Yes 1

Feeding

19. Do/did you:

Breastfeed 1

Bottle feed breast milk 2

Bottle feed formula 3

Combination of breast and bottle 4

20. Did you change your baby’s feeding method to try and ease the colic symptoms?

No 0

Yes 1

21. Have/did you fed/feed on demand from birth?

No 0

Yes 1

22. Does/did your feeding increase in the evening hours (from around 5pm to 12am)?

No 0

Yes 1

Burping

23. Do/did you consciously burp your baby?

No 0

Yes 1

104

Behaviours

24. How many times does/did your baby cry without you being able to sooth him/her in a day?

None 1

Once 2

Twice 3

Three times 4

Four times 5

Five times 6

Other 7

If more, please specify:

25. On average, how long does/did your baby cry for at a time?

1-10 minutes 1

11-20 minutes 2

21-30 minutes 3

31-40 minutes 4

41-50 minutes 5

51-60 minutes 6

26. How many days in a week does/did your baby cry like this?

No days 1

1 day 2

2 days 3

3 days 4

4 days 5

5 days 6

6 days 7

7 days 8

105

27. From the list tick what you believe is/was causing your baby to cry so much? More than one

answer is allowed.

No Yes

27.1 Hunger 0 1

27.2 Dirty nappy 0 1

27.3 Your tension 0 1

27.4 Pain or discomfort 0 1

27.5 Fussy 0 1

27.6 Irritated 0 1

27.7 Nervous 0 1

27.8 Fed up 0 1

27.9 Tired 0 1

28. Do you feel your baby sleeps mostly because he/she felt:

Comfortable and tired 1

Exhausted from crying 2

Hard to say 3

Sucking for comfort

29. Does/did your baby use a dummy or suck his/her thumb to soothe?

No 0

Yes 1

106

Miscellaneous

30. Are/were any of the following effective in making your baby calm?

No Yes

30.1 Drinking warm water 0 1

30.2 Hot bath 0 1

30.3 Baby massage 0 1

30.4 Sugar and water 0 1

30.5 Swaddling 0 1

30.6 Front pack or sling 0 1

30.7 Pram 0 1

30.8 Pacing 0 1

30.9 Bouncing or jiggling 0 1

30.10 Lullabies 0 1

30.11 White noise 0 1

Treatment

31. Do you use complementary medicine?

No 0

Yes 1

32. What do/did you use to treat your child’s colic?

Complementary or natural

medicine 1

Conventional or main-stream

medicine 2

Both 3

107

33. Have you consulted with a complementary medicine practitioner for your child’s colic

before?

No 0

Yes 1

34. Where do/did you get your information regarding complementary medicine for colic from?

You may choose more than one answer:

If other, please specify:

35. Do/did you use any of the following complementary medicines for your child’s colic? You

may choose more than one answer:

No Yes

35.1 None 0 1

35.2 Individualised homeopathic

remedies 0 1

35.3 Herbal medicines 0 1

35.4 Herbal teas 0 1

35.5 Probiotics 0 1

35.6 Vitamins/minerals 0 1

35.7 Aromatherapy oils 0 1

35.8 Colic Calm 0 1

No Yes

34.1 Internet 0 1

34.2 Books/magazines 0 1

34.3 Health shops 0 1

34.4 Friends/family 0 1

34.5 TV/Radio 0 1

34.6 General Practitioner 0 1

34.7 Complementary Practitioner 0 1

34.8 Other 0 1

108

35.9 Gripe Water 0 1

35.10 Heel Nux Vomica Homaccord® 0 1

35.11 Heel Spascupreel® 0 1

35.12 Heel Viburcol® 0 1

35.13 Himalaya Bonnisan® 0 1

35.14 Iberogast® 0 1

35.15 Lennon Behoedmiddel vir

Kinders 0 1

35.16 Natura® Magen 0 1

35.17 Natura® Sedaped 0 1

35.18 Sister Lilian ColicCare 0 1

35.19 Tibb Bonnycare 0 1

35.20 Tummy Calm® 0 1

35.21 Other 0 1

If other, please specify:

36. Why do/did you choose complementary medicine as a treatment for your child’s colic?

37. Do/did you use any of the following medicines for your child’s colic? You may choose more

than one answer:

No Yes

37.1 None 0 1

37.2 Muthi Wenyoni 0 1

37.3 Buscopan® 0 1

37.4 Colief® Infant drops 0 1

37.5 Nexium® 0 1

37.6 Telament Paediatric Colic

Drops® 0 1

37.7 Other 0 1

109

If other, please specify:

38. In your experience is complementary medicine effective for colic:

Disagree 1

Unsure 2

Agree 3

39. In your experience does complementary medicine work well in conjunction with

conventional medicine (Western medicine) for colic:

Disagree 1

Unsure 2

Agree 3

40. In your experience does complementary medicine have no side effects:

Disagree 1

Unsure 2

Agree 3

Thank you for completing the questionnaire.

110

APPENDIX H

RESEARCH PROCEDURE

Research Procedure

Hand participant an envelope, clipboard (if needed) and a pen.

Inside the envelope is an information leaflet, consent form and

questionnaire.

Participant needs to read the information leaflet and then should they wish

to participate, they need to sign the consent form, allowing the researcher

permission to use their responses for data collection.

Participant then needs to complete the questionnaire by marking each

answer with an X or description where required.

Once completed, the consent form and questionnaire needs to be put into the

envelope.

Envelope must be sealed and a completed sticker to be stuck across the

envelope seal.

Participant may keep the information leaflet.

Place completed envelope in lockable box.

Participant can withdraw from participating in the research but only before

the envelope is sealed and placed in the lockable box.

The research is now complete, thank you.

Any questions, contact Natalie on 083 227 7110.

Thank you so much for your assistance.

111

APPENDIX I

LETTER OF PERMISSION FOR QUESTIONNAIRE

BabyCues

PO Box 35081

Shirley

Christchurch 8640

NEW ZEALAND

2nd

August 2015

To Whom It May Concern

I, Philippa Murphy, the author of the questionnaire, Infantile Colic and Reflux, utilised in New

Zealand in 2012, give permission for Natalie Di Gaspero my questionnaire for her study, which

aims to determine the perceived effectiveness of complementary medicine by mothers of

children with infantile colic in Gauteng.

Kind Regards

112

APPENDIX J

FIGURES FROM INFANTILE COLIC QUESTIONNAIRE

Figure J.1.Number of children suffering from colic

Figure J.2. Sufficiency of the ante-natal class.

82.2% (n=125)

15.1% (n=23)

2.6% (n=4)

0

20

40

60

80

100

120

140

1 Child 2 Children 3 Children

Nu

mb

er o

f P

arti

cip

ants

(n

)

How many of your children suffered from colic?

32.1% (n=26)

67.9% (n=55)

0

10

20

30

40

50

60

No Yes

Nu

mb

er o

f P

arti

cip

ants

(n

)

If so, do you feel you learnt enough in the class to care for your new-born in the post-natal stages?

113

Figure J.3. Is vomiting normal after a feed?

Figure J.4. Feeding method changes

67.1% (n=102)

32.9% (n=50)

0

20

40

60

80

100

120

No Yes

Nu

mb

er o

f P

arti

cip

ants

(n

) Do/did you feel that vomiting after feeding is a

normal thing for your baby to do?

35.5% (n=54)

64.5% (n=98)

0

20

40

60

80

100

120

No Yes

Nu

mb

er o

f P

arti

cip

ants

(n

)

Did you change your baby’s feeding method to try and ease the colic symptoms?

114

Figure J.5. Feeding on demand

Figure J.6. Increase in feeding hours between 5pm and 12am

28.9% (n=44)

71.1% (n=108)

0

20

40

60

80

100

120

No Yes

Nu

mb

er o

f P

arti

cip

ants

(n

) Have/did you feed on demand from birth?

45.4% (n=69)

54.6% (n=83)

0

10

20

30

40

50

60

70

80

90

No Yes

Nu

mb

er o

f P

arti

cip

ants

(n

)

Does/did your feeding increase in the evening hours (from around 5pm to 12am)?

115

Figure J.7. Consulted with a complementary medicine practitioner

31.6% (n=48)

68.4% (n=104)

0

20

40

60

80

100

120

No Yes

Nu

mb

er o

f P

arti

cip

ants

(n

) Have you consulted with a complementary medicine practitioner for your child’s colic

before?

116

APPENDIX K

PARTICIPANTS RESPONSES

Question 11:

These were the participants responses on what would have better prepared them for their child’s

colic:

Colic was not explained enough

Colic/Reflux; PND

Did not get the information that I needed

Engagement with other moms, the interaction would have helped me understand

How to handle a baby that continuously cries

I discovered some situations as I went along with taking care of the baby, so continuous

education is necessary with regular visits to the health practitioner.

I would have been better prepared if I was told how to deliver my first baby.

Information about it

Insufficient information on colic was an issue that could have been remedied as well as

information on how to wind children.

Knowing the symptoms and experience

Knowing what was wrong while baby cries

Knowledge about colic and what to do

Knowledge on natural medicine would have helped

More information on how to wind and soothe child.

More should be emphasised on complementary colic medication

No information on how to wind/burp child. More information on colic.

No information was given to us on how to deal with fevers, colic, sleeping and feeding

times and routines

Not much on colic

Not sure. Help from my mothers and sisters.

Nutrition, alternate learning

Only attended one class - baby was born before we could complete course. I'm sure we

would've been better prepared if able to complete course.

Reading up more during pregnancy

Sicknesses

Tips to calm baby

117

To be taught about it at the clinic before you get a baby, like while still pregnant

To be taught how to handle a child with colic symptoms/calm the body down when crying

What food to avoid to help avoid colic

What to do when the child is not consolable

What to expect when having your baby

Winding techniques! This was hardly covered. Chiropractor has helped in this.

118

APPENDIX L

PARTICIPANTS RESPONSES

Question 36:

These were the following responses from participants as to why they chose to use

complementary medicine as a form of treatment for their child’s colic:

Advice by friends(21) to stick to natural medicines, advice from my sisters/mother(2),

recommended by family (16), it was passed on from Grandparents, from word of mouth

(2)

Health shop recommendation.(3)

Recommendation by a doctor/homeopath (16),

Alternative

Because it was recommended as good for colic

Because it’s safe and it can be used for the whole family (2).

Believe in homeopathic remedies over conventional medicine in general

Conventional medicines didn’t seem to be working effectively (2)

Effective, safer and less side effects, don't like using too many chemicals with my baby

Felt it would be the best. I did not want general medicine that would sedate my baby.

I believe in Homeopathy. It works very well for me and my child.

I have grown up using it

I have used homeopathic medicine myself with great results.

I believe that complementary medicine is a much healthier option for the baby

I didn’t like the idea of giving baby anything besides breast milk so preferred to give

complementary medicine (because natural)

It had no side effects, safer, less harmful (11)

Less side effects & non-toxic , baby responded much better to complementary rather than

conventional

Safer for my child, puts mine and the babies mind at ease

I fully agree with it and don’t want harming, Western medicine for my child

I prefer the gentler approach and Telament made my daughter sick.

Western medicine is too harsh on a child

Did not like conventional (2)

A mother will try anything, I actually tried everything that could work (5)

119

Crying baby gives stress to the mother and worrying about your child is one thing that

makes a mother to try what’s best for the child

Did not know what else to use (2), would have used Chiropractor if had known

I only chose the medicine first because I thought it will help and it did not help much

I will try anything that will help(2)

It was cheaper (2) and worked well

It works well(3)

No specific reason(2)

The problem was not serious and generally a warm bath and lullaby was enough

To calm my baby down and to take out the winds

To find out if it will soothe my babies colic problem