‘Have you tried…?’ It’s the call of unsolicited advice-givers everywhere. Dr Jess Berentson-Shaw tackles the science (or the lack thereof) behind the latest fad treatments for babies – including those damn amber beads.
The Krakatoa eruption had nothing on this. I watched in horror as a voluminous fountain of precious breast milk blasted high into the air straight above our heads like a pyroclastic blast and then crashed back down over us in a tsunami of liquid gold. I looked down and a huge grin was visible on the chubby face that was otherwise masked in regurgitated milk.
This was my first daughter. A spewer of the most extraordinary talent. She would feed and feed and feed, then cry and cry and cry and cry and cry and cry, then vomit.
I remember my brother-in-law, watching amazed at one of these spectacles, rushing off to the kitchen where I caught the end of what he said to my sister: “….and it was like, like, like a lahar of vomit!”
It was overwhelming and she cried a lot. The midwife and GP did not have a lot to offer in the way of concrete advice except to say it was probably colic or maybe an immature valve in her tummy (this is code for your baby screams heaps and sometimes vomits and isn’t that a bit shit?). We spent a fortune at the pharmacy and health shops on various potions. Nothing really worked and she seemed to grow out of it.
Every parent has one or more of these stories – some childhood ailment that causes a lot of crying (that drives you to the point of insanity and maybe drink) and has no clear fix. So you spend a ton of money on a myriad of treatments, most of which don’t work. There is so much exploitation of the desperation of parents.
Often it would simply be better for everyone if the honest approach were taken for persistent but relatively minor concerns like teething pain. This, would go something like: “Yes this really sucks for you and them, and feels like it will never end, but babies do weird shit and (sometimes literally) have weird shit. Just be confident that you are doing everything you can and it will pass. There is, so far, no good science for anything else. I am sorry. Can I perhaps fold that huge pile of washing for you that looks like it may smother the baby if it falls?”
The ideal would be an empathetic pep talk telling you not to waste your cash. After all, you need it for when they are still at home at 27 because you are “such an awesome parent’ and they cannot bear to leave you.
Having said all that, science really needs to up its game on some of this stuff that affects parents, especially the most common and distressing aspects (like nausea in pregnancy).
So let’s talk about the quackery and where it lurks, and also what might actually work for some of those minor (but nonetheless insanity-inducing) ailments.
Amber beads for teething
So OK, I have to admit I had no idea what on earth it is that amber beads were supposed to do for a teething child, but since I know a bit about this researching lark, I went ahead and did a bit. Turns out they are supposed to relieve teething pain. Not by chewing on them, but apparently by releasing analgesic oil into the skin when worn as a necklace. The active agent is something called succinic acid and this is only found in true Baltic amber. However, a study of Baltic amber teething necklaces in Australia found that while there were trace amounts of the acid, the only way it was released was when the beads were smashed, and even then it did not have sufficient anti-inflammatory properties to make a difference to teething pain.
There is not a single published randomised control trial to test the claim that amber beads work (always a red flag for bullshit, as usually there will be at least one study on any intervention making such claims). Even if Baltic amber beads worked (and let’s be clear, they don’t) many of the beads commonly sold are not even Baltic amber. The worst part about amber beads is they pose a risk of either strangulation or choking on the beads if the necklace breaks. While this risk may be small, the impact is pretty severe. So really, amber beads: total bullshit.
Evidence it works: 0/10
Risks: Death (rare, but you know …)
Cost: around $32
Here is some reliable, evidence-based information on what might help with teething pain.
Oestopathy or chiropractic techniques for colic specifically
Argh the crying! It is so distressing! Anything, anything to stop it! Gentle manipulative techniques used by osteopaths and chiropractors have been tried by many parents to help with colic. This is one of those areas where current low quality studies suggest it is not really effective, but we need higher quality studies to be clear. In some studies it did reduce crying but that was only if the parents knew the child had had the treatment. Whereas if a parent did not know (we call it being blind to the treatment) there was no reduction in crying. While no risks were found, many studies did not actual measure the risks. Hmmm… not an overwhelming body of evidence to suggest it should be tried.
Evidence it works: 2/10
Risks: Unclear (but not likely to be severe or we would have heard). Note that this is only for gentle manipulation; run like the wind if someone wants to crack anything on your baby.
Cost: around $80-$125 per session
Herbs for colic (chamomile, fennel, lemon balm)
The idea here is that the baby screams because they are in pain due to tummy cramps (as opposed to just trying to break your spirit), and these herbs will relieve the pains/gas/etc. Some herbs are given directly to the baby (herb oils or water-based solution) and some are teas that breastfeeding women drink. There is a little bit of evidence that these may work to reduce the amount of crying, but the evidence is a little dodgy (what we call low quality trials with a risk of bias). It should be noted that herbs are not like homeopathy (which is basically water). They can have powerful biological effects, so adverse effects need to be considered. In the studies of these herbs only minor side effects like vomiting, sleepiness and constipation were reported. So overall it may be something that is worth trying.
Evidence it works: 3/10
Risks: Some side effects but not severe
Cost: Gripe tea $18
Laxatives for constipated babies
You know, I sometimes think if babies and kids are not pooing all over you and your home (“How the fuck did it get there?” you ask yourself, while staring in horror at some random part of the house), they are not pooing at all. Either way their poo stresses you out. It is a gift they bring at birth.
When they stop going for 5, 10 – I heard 20 days once – the terror sets in. If you have a child in nappies you stop leaving the house at all: the fear is too great, and you hunker down waiting and hoping for the inevitable. While you do, you start to spoon in the various quack remedies that appear to be ‘natural’. They are all laxatives though.
Laxatives come in two types: osmotic and stimulant. Osmotic include lactulose, milk of magnesia and polyethylene glycol or PEG (it is sold as Movicol here in NZ) – these work by drawing water into the poo. Stimulants make the intestinal muscles contract, and include caster oil, aloe, senna, fibre and other such things.
A systematic review of all the good quality published studies concluded that Movicol (PEG) at a higher dose (0.7 g/kg) may work best and the side effects were minor compared to other treatments like castor oil and aloe. As a side note I have to say reading studies that use “rate of defecation” as a measure is not my favorite part of being a researcher.
Evidence it works: 6/10
Risks: Some side effects but none are severe
Cost: Can get it on prescription so $5, or free for children under six.
Ginger, mint oil, vitamin B6, acupressure, acupuncture and lizards’ tongues for pregnancy nausea
Actually that bit about the lizards’ tongues I made up, but frankly the health community has let down women badly in the area of researching treatments for nausea in pregnancy. So badly that we are willing to try anything some old hag in black hat sells us. For those lucky women who don’t experience nausea, well, I can’t think of anything polite to say so… moving on. For those who experience the hell of hyperemesis gravidarum and for those in between, there is still very little evidence regarding what works, despite the acknowledgement that is a serious and debilitating condition.
Just looking at the ‘natural’ treatments and whether they work, the first thing I notice is a pretty poor quality of trials – just people not doing good science and yet still claiming a remedy works. Frankly women deserve better than that. However, some treatments do show some reductions in scores on the delightfully named ‘Rhodes Index of Nausea, Vomiting and Retching’. Overall, according to a systematic review of all the evidence (the best science you can get), ginger and P6 acupressure (think of the seasickness bands) “may be helpful to women, with some evidence of benefit but the evidence overall was not consistent”. Everything else is unclear still and the lizards’ tongues I would not suggest.
Note that although ginger may be effective it is actually still a powerful pharmacological agent (for example it can act as a blood thinner), so if you are going to try it talk to your GP or midwife about taking it safely. Feel free to direct them to this study on its risks and benefits. Also pharmacological intervention is an option. The evidence for this is not extensive, so again talk to your GP about risks and benefits.
Evidence it works: 4/10
Risks: Some risks for ginger, none for acupressure
Cost: Ginger syrup $18, seasickness bands $30 or self-administered acupressure on the wrist (just search for P6 acupressure point): FREE.
A plea to funders, scientists, researchers and health practitioners here: we need more quality research on this! Nausea, vomiting and retching in pregnancy is common and hideous; it can impact seriously on women and their family’s mental wellbeing, as well as on productivity. People get pregnant; we need them to in fact – it is pretty hard to support ageing populations without new members of society. What we need is science to better assist in overcoming the shitty aspects of it.
Cabbage leaves for breastfeeding
Sometimes when a baby is having problems breastfeeding (or for other reasons) women get breasts that overfill – and if you did not already feel slightly like a dairy cow, this will pretty much do it for you. The result: swollen painful breasts. While this might raise a snigger, it is actually pretty distressing and can lead to women ending breastfeeding because of the knock-on effects like infection. There is very little out there to help women with the engorgement issue hence many remedies are ones that have been used for years, including that old midwife standard, cabbage leaves. Also used are acupuncture, acupressure, cold packs, massage, ultrasound and medication.
The bad news is, basically none of this stuff has been studied enough for there to be really good evidence regarding what works. On the other hand, cabbage leaves (they don’t need to be cold) and hot/cold packs, for some women in some small studies, do relieve distress and pain, and are cheap. So as an individual they are worth giving a go. Just keep your expectations low.
Evidence it works: 4/10
Cost: Not going to bother calculating the cost of a cabbage leaf or two due to seasonal and demand fluctuations.
Lanolin, peppermint oil, drugs, nipple shields versus nothing or breast milk for cracked nipples while breastfeeding
Researching this I have to say peppermint oil sounds pretty uncomfortable on cracked nipples – I am kind of grimacing as I write. The good news is that it is bullshit so don’t bother.
A systematic review into what works for cracked nipples concluded the following:
“Currently, there is not enough evidence to recommend any specific type of treatment for painful nipples among breastfeeding women. These results suggest that applying nothing or expressed breast milk may be equally or more beneficial in the short-term experience of nipple pain than the application of an ointment such as lanolin.”
Great! The free treatment is likely to be just as good as ones that cost. Also the authors point out that most women find the pain reduced to ‘mild’ by 7-10 days after birth. Still I think let’s all agree it sucks and it the source of a lot of new parent distress. Frankly, way more structural support for breastfeeding is needed generally if we want to provide the optimal environment for exclusive breastfeeding. Stop making it a woman’s responsibility to overcome the many obstacles in the way of breastfeeding (and hence making it her fault when she can’t) and put in place appropriate environments and support systems (like freely available lactation consultants to visit at home and unconditional paid leave for parents) that makes it more likely she can.
Evidence it works: 5/10 (breastmilk)
Next time I am going to take a dive into what works for infant sleep – because far and away the most quackery exists in that area. But equally, there are some effective behavioural techniques that can help, and that you do not need to spend thousands on.