Education and practice

Lack of knowledge about the pathophysiology of infantile colic limits the development of effective drugs and treatment modalities including acupuncture. Acupuncture research has targeted the baby without considering the mother. However, the pathophysiological clues indicate that infantile colic is a shared pathology between the mother and the baby, especially in the case of breastfeeding mothers. A new theory proposed in this paper involves levels of the cytokine tumour necrosis factor α in the mother’s milk and its infl uences on melatonin and serotonin metabolism in the baby as major components of the pathophysiology of infantile colic. These can be normalised by applying acupuncture to the breastfeeding mother alone or also to the baby. Yusuf Ozgur Cakmak of the ingestion of low-dose aspirin was overlooked—namely, a reduction in the cytokine tumour necrosis factor α (TNFα) releasing capacity of activated leucocytes. This is observed after ingestion of low-dose aspirin, independent of changes in prostanoid biosynthesis.6 The improvements in the infantile colic symptoms seen with acetylsalicyclic acid ingestion5 might therefore be attributed to the TNFα-based pathway. A new theory proposed in this paper is that TNFα in the mother’s milk might infl uence the metabolism of melatonin and serotonin in the infant, and that these are major components in the pathophysiology of infantile colic. EXPLORING THE MOTHER FACTOR: TNFα Melatonin is involved in the regulation of gastrointestinal motility and sensation while serotonin, which is found mostly in the gastrointestinal tract, has a muscular contraction action within the bowel.7 It is worth noting that melatonin can reduce abdominal and rectal pain.8 Levels of 5-hydroxy-3-indole acetic acid (5-OH IAA), a metabolite of serotonin, were studied in infants with infantile colic in order to investigate the aetiology of infantile colic: urinary 5-OH IAA levels in infants with colic were found to be higher than those in the control group.7 Peak serotonin levels cause Copyright 20 1 by British Medical Journal Publishing Group. group.bmj.com on June 20, 2017 Published by http://aim.bmj.com/ Downloaded from